Monday was World Hepatitis Day, the annual awareness raising day coordinated by the World Hepatitis Alliance. Over 170 organisations who work in the field of viral hepatitis, representing every region of the world are involved, and our own Dr. Helen Harris and Dr Éamonn O’Moore have teamed up to discuss the current state of hepatitis C in the UK and an innovative approach to tackling blood borne viruses in prisons:
Dr Helen Harris: World Hepatitis Day this year featured the theme of ‘Think Again’. At Public Health England (PHE), we’ve been thinking about the current state of hepatitis C in England, and what it will take to prevent hepatitis C infection, save lives and reduce future health care burdens.
Our latest hepatitis C in the UK report highlights where national progress in tackling the infection has been made, but it also shows the scale of the challenge ahead. An estimated 214,000 individuals in the UK have long-term (chronic) infection with hepatitis C, yet only around 3% of those with long-term infection are treated each year.
Hospital admissions from hepatitis C-related end stage liver disease have risen from 608 in 1998 to 2,390 in 2012, while deaths have risen from 98 in 1996 to 428 in 2012. Liver transplant first registrations where post-hepatitis C cirrhosis was an indication for transplant have quadrupled from 45 in 1996 to 188 in 2013.
In the UK hepatitis C predominantly affects marginalised groups of society, including those who inject drugs and minority ethnic populations. Hepatitis C also affects a large proportion of people in prison and other detention centres, principally as a result of the relatively higher levels of injecting drug use that is observed in this population. If we are to tackle hepatitis C, there is an urgent need for more testing and expansion of treatment into non-traditional settings; better monitoring and reporting of treatment outcomes is also required.
PHE cannot do this alone, and it’s only through a partnership approach that we can hope to tackle the future burden of hepatitis C related disease, and ultimately save lives. As my colleague Éamonn O’Moore will discuss, our new screening initiative in prisons is an excellent example of this kind of partnership in action.
Dr Éamonn O’Moore:We know that use of needles and other contaminated drug paraphernalia is a significant risk factor for transmission of hepatitis C, HIV and hepatitis B. About half of those who inject psychoactive drugs in England are infected with hepatitis C, around one in every 100 has HIV; and about 17% have been infected with hepatitis B.
Two-thirds (69%) of prisoners have used at least one drug during the year prior to incarceration and drug users are frequently imprisoned due to the association of acquisitive crime with illicit drug use.
Sentinel surveillance data (covering about a third of prisons in England) from PHE shows that between 2009 - 2013, almost 13% of prisoners tested for hepatitis C were found to be positive, compared with only 3% of people tested via GP surgeries over the same period.
However, the most recent Prison Health Performance and Quality Indicator data (October-December 2013) shows only 9% of prisoners were tested for hepatitis C in English prisons in 2013-14, meaning a prisoner infected with a blood borne virus such as hepatitis C, either before or during a period of incarceration, may not receive treatment and return to the community still living with the virus.
This evidence was in the forefront of our minds when PHE, the National Offender Management Service (NOMS) and NHS England came together last year to discuss tackling blood borne virus infections in prisons. In the resulting publication, the National Partnership Agreement, all three organisations agreed that introducing an opt-out policy was a priority. There are strong expectations that this will result in an increase of both the offer and the up-take of blood borne virus testing in prisons.
Sixteen prisons in England, located in the North West, Yorkshire and Humber, East Midlands and the South West are working as ‘pathfinder prisons’, allowing us to learn how to scale up the programme from their experiences.
There is overwhelming support for the introduction of this policy in English prisons, as it will address a major public health issue and tackle health inequalities. The benefits of better control and prevention of blood borne virus infections in prison will also have a ‘community dividend’, resulting in less transmission of new infections and ultimately reducing the costs on the NHS of end-stage liver disease associated with undiagnosed and untreated hepatitis C infection.
Featured image copyright Public Health England. Used under Crown Copyright