Transcript Scottish Prisons and the Hepatitis C Challenge

Scottish Prisons and the
Hepatitis C Challenge
Scottish Drugs Forum
February 2007
Andrew Fraser
Scottish Prisons’ HepC Challenge
• Scale of HepC infection
– Risk behaviour
– Transmission
• Scope of the Challenge
–
–
–
–
Whole prison
Prevention
Harm Reduction
Detection, assessment, treatment support
• Care of a long-term condition in another community
setting
• Alcohol
Hepatitis C Infection
• Estimated prevalence
c.20% overall*
– Higher in women 34%
– Lower in young men
• Current figures
– Glenochil
19% Shotts
prevalence
– About 1 in 3 of adults tested
– 1 in 5 of young men tested
13% -
• 1 or 2 with end-stage liver disease
* WASH studies 1990s
Hepatitis C in Prison and Scotland
• 20% prevalence SPS
• 1% - Scotland
So…
7,100 prisoners each
day
21,148 prisoners each
year
• 1,420 with hepC
• 50,000 est.
• 2-3% of infected
Scots
• 6-9%
The courts decide how long our
patients stay
• A la Carte – long-term prisoners
• Stable and motivated
• few
• Table d’hote – short-term prisoners
• Ambition to be stable
• most
• Carry out
Risk Behaviour and Transmission
• 70% have a drug problem
– 3% continue to inject in prison
– 69% share
•
•
•
•
Shotts Study
Tattooing ?
Steroids?
Sex ?
c.1%
Alcohol – 40% report they have a problem
•
Sources: Annual Prisoner Surveys
–
WASH studies, 1990s
Roy, SCIEH 2003
Hutchison, SCIEH 2003
The Challenge
• COCO – Custody, Order, Care, Opportunity
• 9 OOs – Offender Outcomes
– 1. Sustained or improved physical & mental
wellbeing
– 3. Reduced or stabilised substance misuse
• Corporate objectives
– Reduce the risk of BBV transmission
– Addictions policy
– Investment & through-care
Going Inside
• Assessment – drug withdrawal risk
– Attitude switch to duty of care
– Store clean works
• Stabilisation –
– & detox
• Induction – and tobacco and alcohol
– Injecting risks
• Support – self-esteem, basic life skills, HepB vaccine
• Still to go –
– Confidence in a range of Rx
– Time to assess
– Peer support
What’s available ?
• Equivalent service
•
•
•
•
– Interventions – e.g. 17% on methadone
– Buprenorphine detox.
Support
Clean & cleaning materials
Ambition for abstinence
Condoms and dental dams
• Still to go –
– All services at the level of the best
– paraphernalia
On return to the Outside
• Preparation for release
– Includes o/d awareness, resusc. skills
• In touch with services
• Return clean equipment
• Still to go –
– Mutual respect / better communications
– Integrated care, especially alcohol
HepC specifically….
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•
•
•
Education
Testing, Dona Milne report
Assessment -> referral
Long-term care
• Forum and networks
• Structured Care
• Results
• Still to go ….
HepC specifically….
• Still to go –
– Forum Action Plan
– More testing – >> 3% of national effort
– More In-reach
• Late stage disease management
• Governance – information / consistency
– Good practice everywhere
• Pilot. peer-ed programme with C level
• Cut down on prison transfers
A la carte for all ?
(2)
… and Alcohol
• Not in the shadow of drugs
• Poly–drug misuse means everything
together
• Another reason to get to grips with
alcohol misuse
• Don’t duck the issue
Hepatitis C
• C is for
Challenge
Hepatitis C
• C is for
Challenge
Cautious Optimism
Peter Bramley 2006
Scottish Prisons and the
Hepatitis C Challenge
Andrew Fraser
Director of Health and Care
[email protected]