We received 15 excellent entries for the first BSG Service Prize in 2019. See the Highly Commended submission from Dr Stuart McPherson, Consultant Hepatologist at Newcastle upon Tyne hospitals NHS Foundation Trust & Newcastle University on behalf of the North East and North Cumbria Hepatitis C Network and NE Prisons Service on the Development of a Universal Blood-borne Virus Testing Programme for Implementation in all NEE Prisons and the Development of an HCV Treatment Pathway within prisons.

The paper (Morey et al. J Viral Hep 2018) provides full details of the pilot project in HMP Durham and all the outcomes. A manuscript is in preparation describing the outcomes of the roll-out to all prisons.


 

Development of a Universal Blood-borne Virus Testing Programme for Implementation in all NE England Prisons & Development of an HCV Treatment Pathway within prisons

Dr Stuart McPherson on behalf of the North East and North Cumbria Hepatitis C Network and NE Prisons Service

 

Authors and Institution (listed with their role)
  • Dr Stuart McPherson, Consultant Hepatologist, Newcastle upon Tyne hospitals NHS Foundation Trust & Newcastle University
  • Sarah Morey, Senior Lecturer
  • Rajan Bhandari, Medical Student
  • Craig Thompson, Administrator
  • Dee Jones, Prison Nurse
  • Margaret Hewett, Hep C Nurse
  • Abi Hamoodi, PHE NE
  • Ewan Hunter, Consultant
  • Manoj Valappil, Clinical Virologist
  • Yusri Taha, Clinical Virologist
  • Julie Dhuny, NE Prisons Commissioner

 

Summary of the service story
  • A “task and finish” group developed a universal blood borne virus testing (BBVT) programme for implementation in all NE England prisons, which was formally commissioned.
  • In addition, a robust HCV treatment pathway was developed to effectively deliver antiviral treatment within the prisons. This pathway included consultant‐led telemedicine clinics supported by specialist nurse in‐reach.
  • The key to overcoming the challenge of setting up the testing and treatment pathway was excellent collaboration between clinicians, nurses, prison staff, staff from Public Health England and the prison commissioners. All those involved clearly saw the benefits of the programme so worked collaboratively to make it work.

 

Challenges
  • Hepatitis C (HCV) is common in incarcerated individuals (~7% of the UK prison population).
  • Now more than 95% of those treated with an 8 to 12‐week oral combination of antivirals are cured of HCV giving us an unprecedented opportunity to eliminate HCV from the UK.
  • In England, HCV testing rates in prisons have historically been low (c. 4%; PHE 2013).
  • In 2013‐2014, only 8% of prisoners (<300) were tested for HCV in North East England (NEE) Prisons, and 43% were HCV antibody positive.
  • HCV‐positive inmates had to travel to the HCV clinic at the Freeman Hospital, Newcastle, with a maximum of one inmate per week. Attendance rates were poor, costs for prisoner transport were high. In 2013/4 only 4 patients started treatment due to these limitations.
  • Given the low rates of HCV testing there was a clear need to increase rates of testing to identify HCV positive individuals who could then receive antiviral treatment to cure the infection.
  • There was also an urgent need to develop a more efficient, cost effective HCV treatment pathway to treat all the patients diagnosed with HCV within the prison.

 

Evaluation and Outcomes
  • The pilot of BBVT began at HMP Durham in March 2016.
  • In the pilot, from March 2016 to February 2017, 2831 of the 4280 (66%) new receptions offered BBV testing. 1495 (53% of offered, 35% of total) of new receptions accepted BBV testing, of whom 95 (6.4%) were anti‐HCV antibody positive. In the year before only 164 individuals were tested in HMP Durham. 47 (49.5%) were HCV RNA positive, confirming a prevalence of active infection in 3.1% of all tested. Seven (0.5%) individuals were HBsAg positive and 2 (0.1%) were HIV positive.
  • From April 2017 the testing and treatment pathways have now been fully implemented across all 7 NEE prisons. At end of 2018, from a total of 19519 new receptions to prison, 14861 were offered testing (76%).
  • A total of 9241 individuals have now been tested. 470 (5%) were HCV antibody positive and 374 (4%) were HCV RNA positive.
  • Telemedicine clinics (TC) were fully implemented from August 2015. Attendance rates at the TC were good at 83%. Overall, satisfaction with the TC among the prisoners was very high (80% good or excellent).
  • Of the 374 HCV RNA positive individuals identified, 356 were referred for treatment and to date 269 (72% of RNA pos) have been commenced on antiviral treatment. Early release was the main reason for non-treatment. Of those with a known outcome, 87% have achieved a cure of HCV.

 

Learning Points
  • Collaboration with all stakeholders is key from the beginning so problems can be identified and addressed. Involving all parties early in discussion gives them “ownership” of the project, which helps ensure effective delivery.
  • Involve the commissioners from the beginning as ultimately, they pay for it. If they see the value in the project and help guide it, then they are more likely to fund it.

 

Supporting information:

The attached paper (Morey et al. J Viral Hep 2018) provides full details of the pilot project in HMP Durham and all the outcomes. A manuscript is in preparation describing the outcomes of the roll-out to all prisons.

 

Contact details for members interested in getting more information

Liver Unit, Freeman Hospital, Freeman Road, Newcastle upon Tyne, NE7 7DN

stuart.mcpherson@nuth.nhs.uk