It is World Hepatitis Day on 28 July and Nottinghamshire Healthcare’s offender health teams have been successfully tackling Hepatitis C in prison populations across the East Midlands. The teams have achieved micro-elimination of the virus at HMP North Sea Camp and are close to eradication at Morton Hall Immigration Removal Centre in Lincolnshire.
Micro-elimination involves eliminating a virus in defined segments of the population as a way to incrementally achieve national elimination. The approach sets out realistic elimination goals, is less complex and less costly than a full scale country-level initiative and can build on and share best practice and models of care.
The Trust’s Offender Health Directorate began a project earlier in the year to increase the uptake of testing for Hep B, C and HIV, with the knowledge that there is a high proportion of the prison population who are undiagnosed.
The team at North Sea Camp changed the way they asked patients about undergoing Blood Borne Virus (BBV) testing; transitioning from an opt in to opt out question. This resulted in an increase in screening from an average of 40-45% of the resident population to an uptake of 60 -70%. However, the team wanted to achieve 100% and therefore began to not only ask for patients to consent to testing but also explained how they were trying to create a safer environment and improve safety for each resident and their families and community.
The change in language and information provided to the patients had a positive impact on testing and uptake. The team achieved 100% uptake of screening for all new receptions (arrivals) to the prison. Following this they started testing and re-testing the remaining population, using the same method, achieving a combined figure of more than 98% of the population tested. This is a huge achievement for a screening test which is not mandatory. A small percentage of residents have refused to be tested, but the team continues to work with these patients offering alternative options.
The Hepatitis C Trust recently confirmed that the prison has achieved micro-elimination. Gary Henry said: “I think with the level of testing achieved at the prison. We can now say they have micro eliminated. The emphasis now needs to be about recognising the great work the team has done and for them to continue testing and ensuring new receptions are tested.”
It is believed that HMP North Sea Camp is the first prison to achieve micro elimination; this will be confirmed in the coming weeks.
The team at Morton Hall has also seen uptake of BBV screening increase to nearly 92% since introducing new initiatives including promoting testing and providing leaflets to detainees around medications and lifestyle. They also ensure all detainees are discharged with any medication needed and supporting documentation.
Due to the amount of detainees identified as being infected, the team now runs several clinics a month with a specialist nurse to provide further tests and support, and when needed, liaising with consultants at the hospital on behalf of the detainee.
The Trust’s other prison healthcare teams at HMPs Lincoln, Nottingham, Ranby, Lowdham Grange and Leicester are also making great headway in achieving the micro elimination target, working passionately to screen patients. HMP Lincoln screened over 100 patients yesterday as part of a large screening day to recognise World Hepatitis Day.
Charlotte Goode-Bond, Area Manager Lincolnshire Offender Health said: “We could not be prouder of the achievements of the entire directorate to work towards achieving micro elimination. North Sea Camp has achieved the extraordinary by being the first prison to achieve this status. Their passion and dedication towards providing a high level of care to the patients is amazing. And then to have an Immigration Removal centre achieving the same outcome with work pressures including high turnover of patient population and populations where English is not their first language. We are so proud to work with our colleagues who deliver this care to our patients. This demonstrates their commitment to working towards the World Health Organisation’s goal of eliminating Hepatitis by 2025. Well done to all the staff that have supported this achievement.”
Hepatitis C is a virus that can infect the liver. If left untreated it can cause serious and potentially life-threatening damage over many years. The virus is usually spread through blood-to-blood contact.
It is estimated that 113,000 people in England are living with chronic hepatitis C.
Many people with hepatitis C will be living without a diagnosis, due to the infection often having no specific symptoms. The only way to know for certain is to get tested. Early diagnosis and treatment can help prevent or limit damage as well as ensuring the infection isn’t passed to others.