Testing for hepatitis C virus infection in UK prisons: what actually happens?

Jack, Kathryn; Thomson, Brian James; Irving, William Lucien

Abstract

Prisons are a key demographic in the drive to eradicate hepatitis C virus (HCV) as a major public health threat. We have assessed the impact of the recently introduced national opt-out policy on the current status of HCV testing in 14 prisons in the East Midlands (UK). We analysed testing rates pre- and post-introduction of opt-out testing, together with face-to-face interviews with prison healthcare and management staff in each prison.
In the year pre-opt-out, 1,972 people in prison (PIP) were tested, compared to 3440 in the year following opt-out. From July 2016 – June 2017, 2706 people were tested, representing 13.5% of all prison entrants (median 16.6%, range 7.6% to 40.7%). Factors correlating with testing rates were: pre-admission location of the PIP (another prison or the community, OR 2.2, 95% CI 1.9-2.3, p less than 0.001); whether the PIP could access healthcare independently of prison officers (OR 1.7, 95% CI 1.5-1.8, p less than 0.001); an absence of out-reach services for HCV treatment (OR 1.3, 95% CI 1.2-1.5, p less than 0.001), whether >50% of PIP reported ease of access to a nurse (OR 2.0, 95% CI 1.8-2.2, p less than 0.001), and whether prison healthcare was supplied by private or NHS providers (OR 1.3, 95% CI 1.2-1.5, p less than 0.001).
Testing rates remained far below the minimum national opt-out target of 50%. Inadequacy of healthcare facilities and constraints imposed by adherence to prison regimens were cited by healthcare and management staff at all prisons. Without radical change, the prison estate may be intrinsically incapable of supporting NHSE to deliver the HCV elimination strategy.

Citation

Jack, K., Thomson, B. J., & Irving, W. L. (2019). Testing for hepatitis C virus infection in UK prisons: what actually happens?. Journal of Viral Hepatitis, 26(6), 644-654. https://doi.org/10.1111/jvh.13071

• Journal Article Type: Article
• Acceptance Date: Jan 5, 2019
• Online Publication Date: Jan 31, 2019
• Publication Date: Jun 1, 2019
• Deposit Date: Jan 30, 2019
• Publicly Available Date: Feb 1, 2020
• Journal: Journal of Viral Hepatitis
• Print ISSN: 1352-0504
• Electronic ISSN: 1365-2893
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 26
• Issue: 6
• Pages: 644-654
• DOI: https://doi.org/10.1111/jvh.13071
• Keywords: Chronic viral hepatitis, diagnostic virology, hepatitis C, prisons
• Public URL: https://nottingham-repository.worktribe.com/output/1506111
• Publisher URL: https://onlinelibrary.wiley.com/doi/abs/10.1111/jvh.13071
• Additional Information: This is the peer reviewed version of the following article: Jack, K, Thomson, BJ, Irving, WL. Testing for hepatitis C virus infection in UK prisons: What actually happens? J Viral Hepat. 2019; 26: 644‐ 654, which has been published in final form at https://doi.org/10.1111/jvh.13071 This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.
• Contract Date: Jan 30, 2019