30 March 2021
INHSU Prisons – a dedicated special interest group within INHSU – recently held a ‘speed geeking’ event, welcoming experts from across Europe and beyond to share their knowledge and expertise about diagnosing and treating hepatitis C in the prison environment.
Andrew Scheibe, TB HIV Care
Dr. Andrew Scheibe is a medical doctor by training who works in harm reduction research, programs, and policy in South Africa and the region. His work focuses on the intersections between infectious diseases, determinants of health and rights. Andrew is a technical advisor for TB HIV Care and a researcher at the University of Pretoria.
Andrew presented a summary of the planned viral hepatitis project that TB HIV Care (a civil society organisation) is planning at a prison in Cape Town, South Africa. This work builds on existing relationships through their support for HIV prevention and treatment service delivery in the prison setting. The project will include rapid point-of-care HBV and HCV screening, laboratory confirmation of infection, non-invasive assessment of liver function and prescription by the prison doctor, with digital support from the Liver Clinic at Groote Schuur Hospital/University of Cape Town. Planning has been delayed due to COVID-19 (first and second waves), but activity to date, and the inclusion of HBV screening as part of HIV Pre-Exposure Prophylaxis services, has highlighted the need for additional training around viral hepatitis and the value of the work.
Discussion points from Andrew’s session included:
- Surprise among participants about lack of access to DAAs in the community settings and currently no access in prisons, and need for affordable and accessible treatment options
- Need to support the continuation of treatment among people post-release
- Highlighting the need for peer-to-peer discussions among people who use drugs around hepatitis services, however, the challenges around this in settings where there is limited acknowledgment of drug use
- Options of how to advocate and shift perspectives around providing for the health needs of people in prison who use drugs ± are living with HIV infection
- The challenges of reliance on high tech and expensive POCT PCR testing platforms, and threats to sustainability if not supported in a sustainable way
- The need to explore multi-panel/multi-disease rapid test kits
Marianne Byrne, Kirby Institute and National Drug and Alcohol Research Centre
Marianne Byrne is a Clinical Trials Manager at the Kirby Institute and National Drug and Alcohol Research Centre, UNSW Sydney. She coordinates the ASCEND (Advancing the health of people who use drugs: hepatitis C and drug dependence) program grant, which aims to enhance integration of hepatitis C and drug dependence research.
Marianne’s session discussed the SToP-C study which provides evidence that HCV treatment scale-up can prevent transmission. As part of this study, a new online toolkit will be introduced soon, describing recommendations for scaling up testing and treatment. Other discussion points from Marianne’s session included:
- Key recommendations presented include strong partnerships with correctional authorities with champions; dedicated nurses and officers, a nurse-led model of care with simplified monitoring, and targeted education for staff and inmates
- Importance of harm reduction, particularly in preventing reinfection during scale-up and once treatment scale is reached
- Importance of strong partnership between the correctional authority and health service, and policies supporting testing and treatment in prisons
- The SToP-C Toolkit will be useful, including strategies for overcoming logistical barriers ‘on the ground’
Neus Solé Zapata, Brians 1 Prison
Neus Solé Zapata is a nurse at Brians 1 prison, Barcelona. She works in the liaison nurse program.
In this presentation, Neus spoke about the work that the liaison nurses do in Catalan Prisons, and the interventions carried out with prisoners with Hepatitis C to guarantee their continuity of care once released. Neus’ session discussed:
- Inclusion criteria in the liaison nurse program
- Number of patients linked weekly and how to do it
- Access to public health and treatments in Catalonia
Kunal Naik, PILS
Kunal Naik is the Advocacy and Communication Manager at PILS, a Mauritian-based NGO leading the AIDS response in Mauritius, where he is involved in advocacy at a national, regional, and international level, especially through the work being done with Coalition Plus. Kunal’s advocacy work has focused on HIV, Harm Reduction, Drug Policies, and Key Populations. He is also the chair of the Mauritian Country Coordinating Mechanism (MCCM), which oversees the Global Fund Grant to fight AIDS in Mauritius. Kunal forms part of the secretariat of the High-Level Drugs and HIV Council of Mauritius and was recently voted to be the Sub-Saharan Africa representative on the Members Advisory Council (MAC) of the International Drug Policy Consortium (IDPC).
Kunal’s session focused on the harm reduction strategies (NSP, MST) in place to address infection and stressed the challenges encountered for HCV treatment.
- Advocacy elements to support HR within prisons
- Data – the need to generate more data within prison settings.
- Range of Harm Reduction programs
- Cost-benefit of HR vs HCV infection
Jorge Valencia, Harm Reduction Unit of the Addiction Institute
Dr Jorge Valencia is a medical practitioner and researcher in infectious diseases. He works in the Harm Reduction Unit of the Addiction Institute (Madrid) and is involved in research regarding viral infections(treatment, care, and prevention) in people who injected drugs.
Jorge shared details of his organisation’s mobile unit which visits sites (hotspots) and carries out HCV screenings with a rapid test. Positive tests are confirmed with on-site PCR resulting in a referral to the hospital on the same day. Jorge’s session focused on:
- Coordination between prisons and harm reduction services
- DAA dispensation outside of the hospital
- Role of navigators and POC
- Surveillance of HCV reinfections
- Challenges in PWID and immigrants
Des Crowley, HSE Addiction Services & Irish Prison Service
Dr Des Crowley, Addiction GP Specialist HSE Addiction Services & Irish Prison Service shared his insights on the topic ‘using peers to improve HCV screening rates in correctional settings’.
Become a member of INHSU Prisons
If you’re interested in hepatitis C and the health of people who use drugs in prison, we encourage you to become a member of INHSU Prisons and connecting with a global network of people within the sector. Membership is possible via the main INHSU membership which costs just €90 for full membership and €30 for nurses/allied health or low-middle income countries. Find out more here.