Viral hepatitis, which includes hepatitis B and hepatitis C, is a major health concern for people in prison globally. Globally, there are more than 11.5 million people who are incarcerated at any one time, and rates of viral hepatitis for people in prison are substantially higher than among the general population.
Hepatitis B vaccination, and curative hepatitis C treatments, have proven to be highly effective. But access to vaccination and other prevention measures, testing and treatment, and the broader health services to deliver these interventions, is limited in prisons.
The World Health Organization (WHO) has set targets to eliminate viral hepatitis as a public health threat by 2030. The targets include: diagnosing at least 90 per cent of people living with hepatitis B or C; treating at least 80 per cent of people infected with hepatitis B or C; providing hepatitis B vaccination to 90 per cent of individuals, as well as targets to reduce the overall number of cases and deaths from hepatitis B and C. It has identified prisons and people in prison as key priorities for global elimination efforts.
To achieve these targets, a team of global experts in viral hepatitis in people in prisons, including the Kirby Institute’s Dr Yumi Sheehan and Professor Andrew Lloyd, have developed the first international guidelines specifically focused on the prevention, testing, and treatment for viral hepatitis in the prison sector. Published in Lancet Infectious Diseases, the guidelines make 30 best-practice recommendations aiming to standardise a global approach to prison-based viral hepatitis elimination efforts with consistent policy, practice, and reporting.
“Effective delivery of hepatitis B and C care in prison settings is feasible. We have demonstrated, for example, that a point-of-care test-and-treat model of care and treatment-as-prevention approach are highly effective in Australian prisons at driving down infections. But there are often multiple logistical, organisational, and structural issues that can make it very challenging to implement services like this in prisons,” explains Dr Sheehan, who is co-first author on the paper. “These guidelines stress that collaboration between justice health and correctional systems, public health agencies, and community organisations will be essential to achieving the 2030 targets.”
Some of the key recommendations include universal screening and diagnosis, timely access to simplified treatment protocols, implementation of hepatitis B vaccination programs, high coverage opioid agonist therapy and prison needle syringe programs, integrated education and peer support, and continuity of care post-release to prevent treatment interruption.
The recommendations were developed by systematic review of the available research to underpin the evidence-base, and each recommendation was graded for quality of evidence and strength using the GRADE method. The guidelines cover policy, testing, treatment, continuity of care, prevention and harm reduction, education, minority populations and special considerations, and monitoring and evaluation.
“This holistic, whole-of-system approach to health delivery in prisons will help ensure these measures are effective and sustainable when implemented,” says Dr Sheehan.
The guidelines advocate for equity in healthcare, aligning prison health services with community standards. They were developed by an international team including academics, clinicians, public health officers, and advocates, and are intended to inform policymaking by national and regional government departments with responsibility for the provision or oversight of prison health services.
“People who are incarcerated have a right to access to health services. Not only is this important for individual wellbeing of one of society's most marginalised populations, but it has a direct impact on broader public health when these individuals return to their communities. Given viral hepatitis constitutes the major health burden of infectious diseases among people in prison globally, leveraging prisons as touchpoints is an essential elimination strategy,” says Dr Sheehan.
Full guidelines can be accessed here.