Hepatitis C virus (HCV) infection is a major public health challenge for Australia. Acute HCV infection progresses to chronic disease in up to 75% of cases. These people are at risk of progressive liver fibrosis leading to cirrhosis, liver failure and hepatocellular carcinoma (HCC). Approximately one-third of people with chronic HCV infection will develop cirrhosis, generally after 20–30 years of infection.
Prisoners are one of the most high-risk and complex populations living with chronic viral hepatitis. With more than 6,200 prisoners in the Victorian prison system and an estimated sero-prevalence for HCV of over 40%, they are especially vulnerable to the serious health consequences of untreated liver disease.
In response to this vulnerability and alongside the development of new highly effective HCV medicines, a statewide prison based program for the assessment, treatment and management of prisoners with chronic viral hepatitis commenced in July 2015. The Statewide Hepatitis Program (SHP) has implemented an innovative model of care and is now delivering best practice clinical assessment, treatment and management of prisoners with chronic viral hepatitis.
The SHP is an initiative that represents a successful working partnership between St Vincent’s Hospital Melbourne (SVHM) Gastroenterology Department and Department of Justice, State Government of Victoria. The SHP strives to deliver best practice clinical care in a challenging environment. The SHP has implemented a model of care that is committed to reducing the transmission of HCV and advocating for prisoners living with chronic viral infection. Overall the SHP is striving to deliver excellent care beyond where hepatitis care is today.
All prisoners are offered screening for viral hepatitis upon entry to prison. This screening is also offered every time a prisoner moves from one prison location to another. Any prisoners who are sero-positive are offered referral to the Statewide Hepatitis Program.
The program delivers statewide, decentralised care for patients through protocol-driven, structured assessment and management of antiviral therapy by skilled Clinical Nurse Consultants (CNCs) who visit each prison in person every 2-4 weeks. All prisoners referred to the service have a clinical assessment, including measurement of liver stiffness by transient elastography (portable FibroScan device). The service is supervised by two part-time hepatologists. There is limited involvement by supervising hepatologists, using both face-to-face and telemedicine consultations. The Statewide Hepatitis Program is integrated into the local prison primary healthcare team, with close collaboration with prison primary care nurses, primary care physicians, addiction medicine clinicians, psychiatrist services and SVHM pharmacy to deliver an integrated approach to care.
The hepatologists hold a weekly clinic for face-to-face consultations for prisoners with more complex liver health care needs. This clinic takes place at St Vincent’s Correctional Health Outpatient Department at Port Phillip Prison. The telemedicine sessions are triaged and coordinated by the CNC Nurses and occur from the SHP Office at SVHM. They are successfully engaging prisoners with specialised care from the SHP specialists, eliminating the need for multiple prisoner transfers to SVHM Outpatients Department.