Prevention and treatment of viral hepatitis B and C in prisoners

The challenge: 

There is a very large burden of disease due to viral hepatitis C and B amongst prisoners in Australia and worldwide. These infections cause progressive liver disease culminating in cirrhosis, liver failure and cancer. Very few correctional systems provide adequate health care for inmates, as prisons are unique physical and organisational structures, and prisoners form a distinct micro-society with their own rules and regulations. The challenge being faced in this project is to understand the prison environment in terms of viral hepatitis transmissions, as well as to develop efficient and effective prevention and treatment strategies.

The project: 

The Viral Immunology Systems Program leads clinical research studies in the prison environment, including prospective cohort studies (HITS-p and SHARP), as well as clinical trials such as SToP-C, and health service evaluation studies such as PACT. These studies are conducted in partnership with the Justice Health & Forensic Mental Health Network and Corrective Services, and are based in field sites across more than 30 individual prisons in NSW. The studies aim to understand risk factors and transmission rates for hepatitis B and C, as well as evaluating the effectiveness of existing prevention strategies as well as the potential for antiviral treatment to reduce hepatitis C incidence.

The method: 

The studies include prospective cohorts in which incarcerated subjects are enrolled in longitudinal follow-up to record risk behaviours and uptake of prevention strategies as well as regular testing for acquisition of hepatitis B or C infections. In the treatment-as-prevention study SToP-C, regular surveillance for hepatitis C infection is being followed by rapid scale up of high effective antiviral therapies to measure the impact of treating all infected individuals on the rate of ongoing transmissions. In the PACT study, the successful nurse-led model of assessment and treatment for hepatitis C is being expanded to correctional centres nationally.

The results: 

These prison-based research projects have already had major impacts both on policy and clinical practice in health service delivery in the NSW prisons, and has been internationally recognized as trend-setting research. The outcomes of the ongoing studies will continue to inform correctional health systems in relation to hepatitis B and C prevention and treatment.

The impact: 

The primary intent of a period of imprisonment is punishment by deprivation of liberty. Additional punishments such as physical or psychological harms should be considered acceptable. The outcomes of these projects first seek to understand and prevent these secondary harms, and also take the opportunity of improving the health of prisoners whilst incarcerated by treatment of hepatitis B and C infections.

Project contact: 
Professor and Program Head