The development of a toolkit to support the elimination of viral hepatitis B and C in prisons
Background: Prisons are over-represented by people with blood borne virus infections due to a number of factors including the high levels of injecting drug use among people in prison. As a result of the high prevalence of hepatitis C (HCV) and hepatitis B (HBV) infections in prisons, this setting has become a focus for hepatitis elimination efforts. Whilst great progress has been made in a few European Union (EU) and European Economic Area (EEA) countries, the coverage of essential prevention and control services and adequate data monitoring schemes for viral hepatitis across countries is sub-optimal in most prison settings. Our project aims to develop a toolkit to support EU/EEA countries in their efforts to improve HBV and HCV prevention, testing and treatment services for people living in prison.
Methods: The project is a joint collaboration between the European Centre for Disease Prevention and Control (ECDC) and the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). The project builds on a partnership between the University of Pisa, the International Network on Health and Hepatitis in Substance Users (INHSU) and the Kirby Institute, University of New South Wales, to support ECDC and EMCDDA in developing the toolkit. We established an Advisory Group of local individuals and partner organisations working in the field of hepatitis and prison health to support the project and build on the local expertise and existing work in this area. The toolkit aims to include a range of different resources compiled into an user-friendly online repository. The toolkit collates available practical tools, such as checklists and fact sheets, identified by the Advisory Group as tools that can enhance local hepatitis elimination efforts for health care providers and public health authorities in the prison sector.
Results: Key elements of the toolkit include a summary of the evidence around the effectiveness of eliminating hepatitis in the prison setting, information on barriers to the scale up and implementation of viral hepatitis services and on different models of care across the care continuum, including harm reduction services, vaccination programmes, testing initiatives and services tailored to women living in prison.
Conclusions: There is a growing body of evidence indicating that targeted interventions tackling hepatitis in prisons are feasible and effective in reducing viral hepatitis burden and decreasing virus circulation among people living in prison, and the community at large. Our toolkit provides prisons with a range of tools to support the effective scale up of services to prevent and control hepatitis B and C that will underpin the success of national and regional hepatitis elimination efforts.
