Transcript European Federation for Prison Health Health Without Barriers

European Federation for Prison Health
Health Without Barriers (HWBs)
ANNUAL GENERAL MEETING
SHARING GOOD PRACTICES IN
PRISON HEALTH
3rd June 2015 – Cagliari (Italy)
Roberto Monarca – HWBs President
Founding of HWB “Health Without Barriers”London, 15th October 2013
British Medical Association - London
HWB
THE EUROPEAN FEDERATION FOR
PRISON HEALTH
Is
a Federation of independent National
Societies, together operating to promote
Healthcare and Human Rights in European
Prisons, for the public benefit.
MISSION
HWB intends to enhance Prison Health
Services in order to improve prisoners’
health and custody conditions within
the European prisons, hereby
protecting the collective welfare of the
population at large.
• An international network of those national
organizations working in prison health could be a
resource for:
•National Organizations
•European Institutions (Commission, Parliament, etc.)
•International Organizations (WHO, ECDC, UNODC,
etc.)
ORGANOGRAM
12.11.2014, ROME
II° Public Hearing at the
Italian Senate
18.03.2014, ROME
I° Public Hearing at the Italian
Senate
1.02.2014, VITERBO
Establishment HWBs
Secretariat
2/3-10.2014, PORTLOISE
WHO/HIPP Steering Group
Meeting
28.05.2014, STRANSBURG
WHO/HIPP Steering Group
Meeting
2013
19.11.2014, MADRID IV
Encuentro Salus Publica
2014
15.10.2013, LONDON
Constitution
20.05.2014, TURIN:First
HWBs Meeting
2015
24.10.2014, BARCELONA
First Board of Directors
Meeting
6.11.2014, VITERBO
Official Signature HWBs
Statute
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HIV TREATMENT AND CARE AMONG
ITALIAN INMATES
Roberto Monarca
European Federation for Prison Health
Health Without Barriers (HWBs)
ANNUAL GENERAL MEETING
SHARING GOOD PRACTICES IN PRISON HEALTH
3rd June 2015 Cagliari (Italy)
Italian Prison System January 2015
Number of establishments: 220
Ministry of Justice
Prison population total
In charge of Prison
Health: Ministry of
Health
Source:
www.prisonstudies.org
53,889
Prison population rate
87
(per 100,000 of national
population)
Pre-trial detainees (% of 34.9
prison population)
Foreign prisoners (% of
prison population)
32.3
Official capacity of
prison system
49,943
Occupancy level %
107.9
Overcrowding
10
Prisons as disease
“concentrator”
Mental Health
Problems
HIV
TB
HCV
Diabetes
HBV
Sexually
Transmitted
Diseases
OBESITY
ADDICTION
PRISON
Smoking
Tumors
Public Health
Cardiovascular
Diseases
Prisons - a breeding ground for BBVs
•
Criminal Justice /Legal framework: overuse of imprisonment, over-representation of most
vulnerable population groups for BBV
•
Poor prison conditions: overcrowding, malnutrition, poor ventilation, hygiene
•
Poor prison management: violence, gangs, corruption
•
Low access to health care (preventive, curative, reproductive and palliative) and weak or
nonexistent linkages with public health sector and NGOs
•
Low access to screening test for transmittable diseases
•
Stigma and discrimination for PLWHA, for detainees; for drug users , MSM
•
Denial & lack of interest
•
Persistance of high risk behaviours inside prisons
Unprotected sexual relations
Injection of drugs in the absence of sterile needles & syringes
Tattooing, piercing, scarifications, brother blood sharing rituals
Safety of medical equipment (dental, medical, gynecological)
Sharing other injection equipment (water, spoons, etc.) and razors, toothbrushes
Modified from S. Enggist WHO-EUROPE
Data from International Literature
• controlled incidence studies not availables
country
Year
Journal
Note
HIV-Ab+% HBsAg+%
HCVAb+%
Italy
2012
Eur Rev Med
Pharm Sci.
All prisoners
5,6
5,3
32,8
Hungary
2011
J Urb Health
All prisoners
0,4
1,5
4,9
France
2009
Eur J Microb
Infect Dis
Incoming
prisoners
1,9
2,1
4,9
Germany
2007
Epid Infect
Young inmates
5,2
#
8,6
Russia
2006
Addiction
Only IDU
14,0
#
67,0
Spain
2005
Enf Inf Micr
Cl
All prisoners
19,1
#
32,8
Italy
2005
J Med Virol
All prisoners
7,5
6,7
38,0
Russian
Fed
2005
Lancet
All prisoners
4,0
#
35,7
Most Recent Data
country
Year
Italy
Source Note
HIVAb+%
HBsAg
+%
HCVAb+%
TB
cases
PPD+ %
2012 SIMSPe All
3.8
5.3
32.8
#
21.8
France
2010 APSEP
All
prisoners
2.0
#
4.8
#
#
Spain
2013 SESP
All
prisoners
6.0
#
21.3
100
(2010)
40.0
UK
2014 PHE
All
prisoners
0.6
(2011)
1.7
(2012)
10.6
(2013)
78
(2013)
#
prisoners
(England
and Wales)
•
•
controlled incidence studies not available.
Opt-in Screening policy in most Countries. In UK Opt-Out policy introduced in April 2014
and applied in a minority of facilities
Many individuals who do not interface consistently
with health care institutions (e.g. illicit drug users,
the mentally ill, and the socially and medically
marginalized), yet when incarcerated, have an
important opportunity not only to be identified as
being HIV-infected but also to initiate HAART when
medically indicated.
Sandra A. Springer and Frederick L.Altice
“Improving the Care for HIV-infected Prisoners. An Integrated Prison Release Health Model”.
In: Public Health behind Bars. Springer 2007
HIVAb+ prevalence in Italian Prisons
Official Data
Ministry of Justice
(Execution Rate: unknown)
•
•
•
•
•
•
2004 = 2,6%
2005 = 2,5%
2006 = 1,8%
2007 = 1,9%
2008 = 2,0%
2009 = 2,1%
(1.458)
(1.488)
( 702)
( 923)
(1.162)
(1.360)
Data from Italian Society for
Medicine and Health in
Prison (S.I.M.S.Pe.)
(Execution Rate: >70%)
•
•
•
•
•
2003
2005
2009
2012
2013
 HIV-Ab+
= 8,4%
 HIV-Ab+
= 7,5%
 HIV-Ab+
= 7,2%
 HIV-Ab+
= 3,8%
Survey SIMIT-SIMSPe
Survey SIMIT- SIMSPe
[ July 2013]
• 35/205 Prisons
•
•
•
•
Inmates : 15.675/64.873 (24,2%)
Foreigners: 5.761 (36,7%)
IVDU : 4.232 (27,0%)
Newcoming prisoners: 1.764
• HIV screening tests:
•
•
•
•
•
•
Execution rate : 42,3% [6.630]
HIV-Ab+ prevalence: 5,1% [338]
Test proposal: 75,8% [1.338]
 Tests accepted: 68,8% [921]
Execution rate at entry : 45,1% [604]
HIV-Ab+ prevalence at entry: 3,3% [20]
• Patients treated with HAART: 81.4% [275/338]
Survey SIMIT- SIMSPe [ July 2013]
Immuno-virological Data
Patients in HAART [275]
HIV-RNA:
Execution rate 100%
<50 cp/mL  73,5%
CD4 count:
Execution rate  96%
Untreated Patients [63]
HIV-RNA:
Execution rate  92,2%
CD4 count :
Execution rate  91,2%
Survey SIMIT- SIMSPe [ July 2013]
Lack of treatment causes in pts. CD4+<350/mmc[13]:
• Refusal
 69,2% [9]
• Waiting for blood tests
 23,1% [3]
• Side effects
 7,7% [1]
Methods of drug administration:
• In cell
 70,0%• o.d.
• In Infirmary  30,0%• b.i.d.
• DOT
 42,8%• t.i.d.
• SAT
 31,5%• o.d./DOT
• Mix modality  25,7%
 17,2%
 31,4%
 51,4%
 65,7%
Survey SIMIT- SIMSPe [ July 2013]
Antiretroviral Regimen
in 275 inmates in HAART
p<0,005
70
62,6
60
50
40
26,2
30
20
8,7
10
2,5
0
%
PI
NNRTI
INI
Others
Survey SIMIT- SIMSPe [ July 2013]
ANTIRETROVIRAL DRUGS
Antiretroviral Regimen
in 275 inmates in HAART
Protease inhibitors (PI)
Atazanavir
Lopinavir
Darunavir
Fosamprenavir
Saquinavir
Total
Non nucleoside reverse trascriptase inhibitors
(NNRTI)
Efavirenz
Nevirapine
Rilpivirine
Etravirine
Total
3 Nucleoside Reverse Transriptase Inhibitors
(NRTI)
Abacavir-Lamivudine-Zidovudine
Integrase inhibitors (INI)
Raltegravir
CCR5 inhibitors
Maraviroc
NRTI backbone
Tenofovir disoproxilfumarate-emtricitabine
Abacavir-lamivudine
Zidovudine-lamivudine
Other
n (%)
88 (32.0%)
51 (18.5%)
23 (8.4%)
9 (3.3%)
1 (0.4)
172 (62.6%)
50 (18.2%)
9 (3.3%)
8 (2.9%)
5 (1.8%)
72 (26.2%)
6 (2.2%)
24 (8.7%)
1 (0.4%)
194 (70.5%)
41 (14.9%)
12 (4.4%)
28 (10.2%)
Conclusions
• HIV prevalence in prison above 5% (12 times higher
than general Italian population)
• Diagnostics, treatment and care are offered to the
vast majority of HIV infected inmates
• HIV-RNA and CD4 count monitoring highly available
in Italian prisons
• More than 80% of HIV+ inmates are treated with
HAART , 73,5% of whom show an undetectable HIVRNA
• PI based regimens in the majority of cases (62,5%)
• Low use of STR, QD and DOT
“La Sanità Penitenziaria è Sanità
Pubblica“ *
* DUBLIN DECLARATION ON HIV/AIDS IN PRISONS IN
EUROPE AND CENTRAL ASIA, 2004