Welcome from Executive

Background

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.

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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.

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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.

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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.

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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.

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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.