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Scottish Prisons and the Hepatitis C Challenge

Scottish Prisons and the Hepatitis C Challenge. Scottish Drugs Forum February 2007 Andrew Fraser. Scottish Prisons’ HepC Challenge. Scale of HepC infection Risk behaviour Transmission Scope of the Challenge Whole prison Prevention Harm Reduction Detection, assessment, treatment support

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Scottish Prisons and the Hepatitis C Challenge

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  1. Scottish Prisons and the Hepatitis C Challenge Scottish Drugs Forum February 2007 Andrew Fraser

  2. Scottish Prisons’ HepC Challenge • Scale of HepC infection • Risk behaviour • Transmission • Scope of the Challenge • Whole prison • Prevention • Harm Reduction • Detection, assessment, treatment support • Care of a long-term condition in another community setting • Alcohol

  3. Hepatitis C Infection • Estimated prevalence c.20% overall* • Higher in women 34% • Lower in young men • Current figures • Glenochil 19% Shotts 13% - prevalence • About 1 in 3 of adults tested • 1 in 5 of young men tested • 1 or 2 with end-stage liver disease * WASH studies 1990s

  4. 20% prevalence - SPS 1% - Scotland So… 7,100 prisoners each day 21,148 prisoners each year 1,420 with hepC 50,000 est. 2-3% of infected Scots 6-9% Hepatitis C in Prison and Scotland

  5. The courts decide how long our patients stay • A la Carte – long-term prisoners • Stable and motivated • few • Table d’hote – short-term prisoners • Ambition to be stable • most • Carry out

  6. Risk Behaviour and Transmission • 70% have a drug problem • 3% continue to inject in prison • 69% share • Shotts Study • Tattooing ? Steroids? • Sex ? c.1% • Alcohol – 40% report they have a problem • Sources: Annual Prisoner Surveys Roy, SCIEH 2003 • WASH studies, 1990s Hutchison, SCIEH 2003

  7. The Challenge • COCO – Custody, Order, Care, Opportunity • 9 OOs – Offender Outcomes • 1. Sustained or improved physical & mental wellbeing • 3. Reduced or stabilised substance misuse • Corporate objectives • Reduce the risk of BBV transmission • Addictions policy • Investment & through-care

  8. Going Inside • Assessment – drug withdrawal risk • Attitude switch to duty of care • Store clean works • Stabilisation – • & detox • Induction – and tobacco and alcohol • Injecting risks • Support – self-esteem, basic life skills, HepB vaccine • Still to go – • Confidence in a range of Rx • Time to assess • Peer support

  9. What’s available ? • Equivalent service • Interventions – e.g. 17% on methadone • Buprenorphine detox. • Support • Clean & cleaning materials • Ambition for abstinence • Condoms and dental dams • Still to go – • All services at the level of the best • paraphernalia

  10. On return to the Outside • Preparation for release • Includes o/d awareness, resusc. skills • In touch with services • Return clean equipment • Still to go – • Mutual respect / better communications • Integrated care, especially alcohol

  11. HepC specifically…. • Education • Testing, Dona Milne report • Assessment -> referral • Long-term care • Forum and networks • Structured Care • Results • Still to go ….

  12. HepC specifically…. (2) • Still to go – • Forum Action Plan • More testing – >> 3% of national effort • More In-reach • Late stage disease management • Governance – information / consistency • Good practice everywhere • Pilot. peer-ed programme with C level • Cut down on prison transfers A la carte for all ?

  13. … and Alcohol • Not in the shadow of drugs • Poly–drug misuse means everything together • Another reason to get to grips with alcohol misuse • Don’t duck the issue

  14. Hepatitis C • C is for Challenge

  15. Hepatitis C • C is for Challenge Cautious Optimism Peter Bramley 2006

  16. Scottish Prisons and the Hepatitis C Challenge Andrew Fraser Director of Health and Care andrew.fraser@sps.gov.uk

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