Welcome from Executive
Almost a quarter of a million Australians are affected by chronic hepatitis C (HCV) infection, with the overwhelming majority infected via injecting drug use. As there is a close relationship between imprisonment, injecting drug use, and HCV, in any given year, at least 15,000 of those infected spend time in prison. This group are likely to constitute one of the most marginalised patient groups affected by HCV who are unlikely to access health services in any other setting. In addition, this group features high rates of ongoing HCV transmission both in prison and in the community. In combination, these attributes argue for high priority to be placed on antiviral treatment of prisoners.
Australia is one of 194 countries which were signatory to the World Health Organization Global Health Sector Strategy 2016–2021 which aims to eliminate HCV as a public health threat by 2030. The strategy includes key targets: for HCV of a 80% decline in incident infections, a 65% reduction in HCV-related mortality, and HCV antiviral treatment provision for 80% of those infected.
The pharmaceutical development and Australian Pharmaceutical Benefits Scheme (PBS) listing of direct-acting antiviral agents (DAAs) now offers well-tolerated, short course, highly curative treatments for HCV, including S100 prescribing for prisoners. Australia is in a unique position globally with universal, heavily subsidised access both to testing (for HCV antibodies and the virus), as well as to DAA treatments. These elements underpin Australia’s strategy towards the World Health Organisation 2030 HCV elimination goals. The major residual challenge for Australia is development and implementation of the health service infrastructure and models of care to ensure comprehensive access and uptake of DAA treatments to all those affected.
Delivery of health services in the prison context is challenging, as prisons feature complex bureaucratic structures, overcrowding, frequent movements, high rates of mental illness, and uncontrolled exposure to violence and illicit drugs. Despite these challenges, in collaboration with the Justice Health & Forensic Mental Health Network (JH&FMHN) in NSW, Professor Andrew Lloyd (NPHN Executive Chair) has established a safe, effective, and efficient hepatitis service in the NSW prisons with task transfer to hepatitis-skilled nurses, telemedicine links to specialist support, portable fibro-elastography to assess liver scarring, as well as structured protocols and proformas. A similar nurse-led model of care has also recently been successfully implemented in the prisons system in Victoria by Professor Alex Thompson (NPHN Executive Member). By contrast, available data suggests that more limited services exist in correctional facilities in other states and territories.
Against this backdrop, the National Prisons Hepatitis Network (NPHN) was established with a first goal to connect key stakeholders from each Australian jurisdiction to facilitate information exchange and support, to enhance development of health infrastructure for testing and treatment of HCV in the custodial sector nationally.
As laboratory notifications for HCV do not specifically identify prisons as a testing source, only regular surveys such as the previous triennial National Prison Entrants’ Blood Borne Virus and Risk Behaviour Survey (NPEBBVS) offer insights into HCV prevalence. In addition, the PBS does not specifically identify antiviral treatments originating in prison, although estimates via S100 prescriptions offer some insights. Hence, the second goal is to support the NPHN in developing data capture systems to measure testing and treatment rates in the prison sector.
The third goal of the NPHN will be to facilitate health services research to drive policy making for scale-up of HCV treatment in the prisons. See ‘Research Initiatives’ for NPHN-initiated research projects.
About Hepatitis C
NPHN Key Priorities
The NPHN has identified key priorities to which align efforts:
Enhance hepatitis C testing and treatment infrastructure in each state and territory to increase prisoners’ access to care
Facilitate continuing exchange of information regarding hepatitis C testing and treatment of prisoners across Australia
Establish a prisons education initiative with a goal to develop prison-focused HCV education programs for three target audiences: prisoners, correctional officers, and healthcare providers working in the custodial setting.
Establish a model for surveillance of HCV, HBV, and HIV risk and infection rates, incarceration, and treatment uptake in prisons sector across each State/Territory
Advocate for continued scale-up of hepatitis C services and treatment in the prisons sector nationally
The NPHN Executive Committee is comprised of elected key members from each state and territory with representation from a variety of disciplines, including specialist physicians, health administrators, and consumer representation. The Executive Committee meet quarterly via teleconference to discuss the progress of NPHN initiatives, assess alignment with NPHN priorities, and plan the annual workshop.
Current Committee Members (as at November 2019)
Professor Andrew Lloyd, The Kirby Institute UNSW Sydney
Professor Alex Thompson, St Vincent’s Hospital Melbourne
Professor Mark Stoove, Burnet Institute Melbourne
Mr Anton Colman, Royal Adelaide Hospital
Robert Kemp, QLD Department of Health
Ms Michelle Kudell, Hepatitis Queensland
Dr Katerina Lagios, Justice Health Services ACT
Dr Graeme MacDonald, Princess Alexandria Hospital
Dr Catherine Marshall, Royal Darwin Hospital
Ms Colette McGrath, Justice Health & Forensic Mental Health Network
Dr Daniel Pronk, South Australia Prison Health Service
Dr Joy Rowland, WA Department of Justice
Ms Annabelle Stevens, NSW Department of Health
Dr Chris Wake, Tasmanian Health Services
NPHN membership consists of key stakeholders involved with hepatitis service delivery in Australian prisons. Members are encouraged to connect with other NPHN members via the Network to enhance information and knowledge exchange and encourage collaborations. Membership is through invitation and expression of interest. Members receive regular email updates and an invitation to the Annual Workshop.