Evaluation of a prison outreach clinic for the diagnosis and
hepatitis C: implications for the national strategy
Skipper C., Guy J. M., Parkes J., Roderick P., Rosenberg W. M.
Gut. 2003; 52(10): 1500-4
Hepatitis C virus (Hepatitis C Virus) infection is a major public health
recognised by the UK National Strategy that proposes that a
for assessment, diagnosis, and treatment be established in all
integrated within managed clinical networks. A prison sentence
opportunity to focus on traditionally hard to reach patients.
To evaluate the prevalence of Hepatitis C Virus infection in a UK prison
cluster and to
assess the effectiveness of a prison outreach service for
A nurse specialist led clinic within a cluster of adult
established, offering health education on hepatitis C, advice
minimisation, and Hepatitis C Virus testing. Infected prisoners were offered
access to a
care pathway leading to treatment. Outcome measures were
uptake of the
service, and diagnosis and treatment of hepatitis C.
A total of 8.5% of 1618 prisoners accepted testing: 30% had
infection with Hepatitis C Virus. Most were ineligible for treatment due to
illness or did not receive treatment for logistic reasons.
use was the major risk factor in all cases. Only 7% of Hepatitis C Virus
amplification positive inmates received treatment in prison.
There is a large pool of Hepatitis C Virus infected prisoners at risk of
constituting a source of infection during their sentence and
discharge. A prison outreach clinic and care pathway was
effective in delivering health education, reducing the burden
on prison and
hospital services. It provided an opportunity for intervention
but had a
limited effect in eradicating Hepatitis C Virus in prisoners and it remains
this might be achieved.
"Enlightenment does not come 'by imagining figures of
light but by making
the darkness conscious.'" (Jung)