For a long time now, Scotland has laid claim to being a world leader in its response to hepatitis C.
In taking up the gauntlet thrown down by the World Health Organization to eliminate viral hepatitis as a public health concern by 2030, we have the opportunity to live up to that reputation.
The emergence in recent years of more effective treatments will surely prove to be a significant turning point on the journey to elimination. The challenge ahead is to make sure that those who will benefit from these treatments are able to access them.
ADDRESSING HEALTH INEQUALITIES IN OUR PRISONS
Across Scotland, there are an estimated 36,700 people living with hepatitis C – 40% of whom have never been diagnosed.[i] Identifying those who don’t know their status, and re-engaging those who have been lost to follow up, is therefore crucial.
In this context, prisons are a key arena for action. With almost one in five prisoners estimated to be living with hepatitis C,[ii] prisons present a unique opportunity to address health inequalities where the audience is literally captive, and the Scottish Government’s Sexual Health & Blood Borne Virus Framework (2015-2020) has already made testing in prisons a priority.
Through our work, we have seen first-hand the dedication of blood borne virus (BBV) teams in prison to support people living with hepatitis C. However, while testing and treatment within prison is now well established alongside community services, the transition between the two remains a frequent stumbling block.
Back in 2011, responsibility for prison healthcare transferred from the Scottish Prison Service to local NHS boards – with continuity of care as people enter and leave prison a key driver for change. While the transfer has led to some improvement, recent reports from the Royal College of Nursing and the Scottish Public Health Network have both identified continuing gaps.
Our hepatitis C community project in Glasgow works with many former prisoners who have provided valuable insight into the pitfalls. Faced with a lack of practical support around critical issues like accommodation, financial support and addressing drug use, people told us that hepatitis C fell off their radar, and many stopped attending local healthcare services.
This is an important reminder that tackling hepatitis C is about more than just managing the virus, but also about getting people to a place where they are physically and mentally prepared for treatment.
This is the challenge we are seeking to address through our AbbVie-funded Prison Link pilot at HMP Barlinnie. Through the project, we support prisoners to develop liberation plans, making sure the right support is in place to address the practical issues that prevent people from following through with their treatment after release. With this support in place, individuals can focus on clearing hepatitis C and moving forward with their lives, benefiting both the individual and the wider community.
The initial results from the first six months of the project are promising. A large majority of prisoners referred to us have continued to engage with support services after liberation as they prepare for and progress through treatment. We have supported prisoners from beyond Greater Glasgow to access local support when they return to other parts of the country and, where individuals have relapsed, in many cases we have been able to keep in contact to support them to re-engage.
In a short space of time we have seen enough evidence to encourage us that the project is worth pursuing in prisons across the country, and discussions are underway with key stakeholders to explore what to do next. Expansion across the country would present interesting challenges, such as how to assess the different range of needs associated with distinct prison populations, not least the specific needs of female prisoners.
However, these strike me as exactly the types of challenges that we should be taking on if we are serious about leading the world on the elimination of hepatitis C.