Theme: Models of Care Year: 2024
Background: Berwyn in Wrexham, North Wales is United Kingdom’s (UK) largest prison (capacity 2100 men). There are examples from several UK prisons of HCV micro-elimination after high-intensity test and treat events. The aim was to develop a model delivered by nurses, pharmacists and peers, to deliver micro-elimination as part of day-to-day prison life.
Description of model of care/intervention/program: An accelerated pathway successful in community clinics was adapted. A blood-borne virus (BBV) nurse was appointed. Reception staff were trained to deliver opt-out rapid HCV testing of all new prisoners. Two posts were created for Hepatitis C Trust (HCT) peers. One had lived experience of prison, drug use and HCV. HCT peers provided education, encouraged testing, and trained peers within prison population to do likewise. Anyone declining testing was followed up within 7 days by HCT/ prisoner-peers to encourage a test. BBV nurse reviewed prisoners testing positive and arranged blood tests/Fibroscan. Assessment and electronic prescribing of treatment was done remotely by specialist pharmacists. Micro-elimination was judged against Welsh government definitions specifying 100% prisoners offered test, 90% being tested and 90% of those testing positive starting treatment.
Effectiveness: The team was fully operational from April 2023 including 17 trained prisoner-peers. 100% of prison population were offered HCV test by September 2023 with acceptance rate of 95% sustained since then. HCT/ prisoner-peers persuaded 75% of initial decliners to be tested. The latest result for December 2023 was 1909 tested from 1986 population (96%). During 2023, 41 men required HCV treatment. Two were released before treatment could start meaning 95.1% (39) received treatment.
Conclusion and next steps: A small dedicated team including peers has enabled a large prison to achieve HCV micro-elimination. Testing rates have been sustained above 95% for 4 months. This model demonstrates delivering micro-elimination as part of day-to-day prison running is achievable.