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Hepatitis C Care Beyond Prisons

Staff from The Hepatitis C Trust joined Paul Goggins (MP for Wythenshaw and Sale East) on a visit to HMP Manchester, to see first-hand an excellent example hepatitis C testing and treatment.

Vicky O'Brien from The Trust joined Jayne Dodd (hepatitis specialist nurse for Greater Manchester) and Jo Noble (Hepatitis C Liaison Nurse at HMP Manchester) showcased the work of their multidisciplinary team’s hepatitis C care within their prison’s walls, earlier this month (October).

In our latest blog, Vicky O'Brien guides you through her prison visit.

As Jo unlocked the twenty or so doors to the medical wing – joking that she was going to install automatic sliding doors in her home upon her retirement - I couldn’t help thinking about how people often talk with despair about the ‘revolving doors’ of prison. It is true that the 84,000 prisoners in England and Wales are a hugely dynamic population, with unfortunately high re-offending rates. However, the medical team at HMP Manchester are seizing the opportunity to make prisoners with hepatitis C’s incarceration a point of transformation.

A large proportion of English and Welsh prisoners are either living with, or at risk of transmitting hepatitis C. The last comprehensive survey of hepatitis C prevalence in prisoners in England was undertaken in 1997. This indicated that 9% of adult men, 11% of women were living with hepatitis C. The experience of the team at HMP Manchester suggests prevalence is now likely to be significantly higher, as 50% of prisoners estimated to be drug users, a high proportion of prisoners are already living with hepatitis C before they reach first reception. And unfortunately, the risk of transmission can continue within prison walls, with the sharing of drugs and tattooing needles, toothbrushes and razors common.

Pictured: Jayne Dodd, Jo Noble and MP Paul Goggins

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Former Prisons Minister Paul Goggins MP has been a great advocate and ally in The Hepatitis C Trust’s drive to ensure universal offer of an opt-out test for hepatitis C in prisons – a policy that will hopefully come into effect in the next year thanks to the support of Public Health England’s Health and Justice Team. As we spent the day talking to various staff working in the wing, we were told how replicating HMP Manchester’s testing and in-reach treatment in other prisons was quite simple, and would bring huge cost-savings and benefits to the wider community.

Jayne and Jo have been pioneering continuous ‘opt-out’ testing for hepatitis C, reporting that testing allowed them to spread key prevention messages, normalize the disease (which continues to be stigmatised) and refer prisoners on to potentially life-saving treatment. Jayne Dodd has also been working across four prisons in Greater Manchester, making sure prisoners elsewhere have access to treatment and running staff training sessions. The in-reach treatment pathway she promotes ensures that prisoners who test positive are then referred for an initial appointment with a specialist nurse within the prison, where a full health screen takes place. Prisoners can then be referred for a further appointment with a visiting consultant within the prison medical wing, and either start treatment, or continue to be monitored.

For a critical percentage of inmates, prison provides the only opportunity to safely treat the patient because of the close supervision and other optimal factors such as nutrition and reduced exposed to alcohol or other non-prescribed drugs. The added benefit is the reduction in risk of transmitting the virus to others upon their release.

One inmate told the MP about his journey with hepatitis C. During this sentence, the prisoner had successfully completed a course of anti-viral treatment and so no longer has the virus, and is also in recovery for drug addiction. He had been knowingly living with his hepatitis C and drug additions for nearly two decades, but with the support of the nurses at HMP Manchester he had finally felt ready to tackle both during this sentence. He said addressing his hepatitis C empowered him to address his addiction problems. He now works as a Peer Mentor for other prisoners undergoing treatment, and hopes to continue this work upon his release.

Caring for prisoners with hepatitis C has benefits that extend beyond prison walls into our communities. There are also benefits for the prison staff and management too. The team told us how the costs of escorting prisoners outside for treatment or dealing with the consequences of end-stage liver disease amongst prisoners far outnumber the cost of bringing passionate and highly committed nurses like Jayne inside, or even purchasing the prison’s very own Fibroscan machine, so it can monitor liver function on-site.

As ever with hepatitis C services, pockets of best practice and passionate individuals are leading the way, but there is still room for development. The team has further ambitions to increase staff training and ensuring that hepatitis C treatment continues in primary care settings. Paul Goggins MP now hopes to share these front-line staff’s expertise and insights with other parliamentarians.

Vicky O'Brien works as a Policy & Parliamentary Advisor for HCV Action.

HCV Action is a professional community that brings together hepatitis C healthcare professionals from across the patient pathway. For more information and to join for free, go to Hepatitis C Trust, provides secretariat support to HCV Action.