An Onsite Primary Care Based Approach Allows Rapid Reduction Of Hepatitis C Prevalence In Prison. A Case Study From Canberra, Australia

Author: Levy M, Harkness B, Evans R, Luppi J

Theme: Models of Care Year: 2018

On March 1, 2016 the Australian Minister for Health authorised the prescription of DirectActing Antiviral medications (DAA) to all Australian citizens living with chronic hepatitis C
infection. This included all Australian prisoners.
To capitalise on the globally unique opportunity of universal access, our service developed a
model of care aimed to maximise and expedite prisoner access to hepatitis C treatment.
Description of model of care/intervention:
The nurse-led program identified patients through voluntary admission bloods, self- or peerreferral. Nurses and primary care physicians together, determine appropriate treatment. Once
commenced on treatment the patients consulted with nurses for ongoing support and
pathology testing. The service liaised with the Canberra Hospital Liver Clinic on more complex
cases including patients with cirrhosis and hepatitis B/C co-infection.
Each dose of the DAAs has been supervised by nursing staff. This was initially done due to
the concern a prison market may develop for these new and expensive medications. Dosing
has continued to be supervised, but now with the purpose of providing ongoing support and
monitoring while on treatment.
Since listing of the new DAAs, the HCV PCR positive rate among the 485 detainees in the
ACT prison system has reduced from 33% to less than 3%, or a reduction of over 90%. Of
those still to treat, five are acute infections, awaiting 6-month pathology to assess for
Conclusion and next steps:
We feel an approach that has moved treatment out of tertiary hospitals and into routine prison
based primary health clinics has resulted in such a rapid eradication of hepatitis C from the
prison system.
The service will continue to offer blood-borne virus screening to all current detainees and
new admissions in the prison system and expediting access to treatment for anyone found to
be hepatitis C positive.
Disclosure of Interest Statement:
Nil disclosures of interest

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