Evaluation of a prison outreach clinic for the diagnosis and prevention of
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

Background

Hepatitis C virus (Hepatitis C Virus) infection is a major public health problem
recognised by the UK National Strategy that proposes that a care pathway
for assessment, diagnosis, and treatment be established in all prisons,
integrated within managed clinical networks. A prison sentence provides the
opportunity to focus on traditionally hard to reach patients.

Aims

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 hepatitis C.

 

Subjects

Male prisoners.

Methods

A nurse specialist led clinic within a cluster of adult prisons was
established, offering health education on hepatitis C, advice on harm
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.

Results

A total of 8.5% of 1618 prisoners accepted testing: 30% had active
infection with Hepatitis C Virus. Most were ineligible for treatment due to psychiatric
illness or did not receive treatment for logistic reasons. Injecting drug
use was the major risk factor in all cases. Only 7% of Hepatitis C Virus polymerase chain
amplification positive inmates received treatment in prison.

Conclusion

There is a large pool of Hepatitis C Virus infected prisoners at risk of complications,
constituting a source of infection during their sentence and after
discharge. A prison outreach clinic and care pathway was perceived as
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 unclear how
this might be achieved.

"Enlightenment does not come 'by imagining figures of light but by making
the darkness conscious.'" (Jung)