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 healthcare for inmates, as prisons are challenging physical and organisational structures, and prisoners form a distinct micro-society with their own rules and regulations. This project aims 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 (VISP) leads clinical research studies in the prison environment, including prospective cohort studies (HITS-p and SHARP-p), as well as clinical trials such as SToP-C, and health service evaluation studies such as PIVOT. 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, and 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 SToP-C treatment-as-prevention study, regular surveillance for hepatitis C infection is being followed by rapid scale up of highly effective antiviral therapies to measure the impact of treating all infected individuals on the rate of ongoing transmissions. In the PIVOT study, an evaluation of the improved efficiencies associated with use of fingerstick point of care testing for hepatitis C to make rapid diagnoses and to facilitate antiviral treatment is being evaluated.

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 recognised 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: 

Acquisition of hepatitis C or B infections whilst in prison is a significant and ever-present threat, particularly to those who engage in high-risk behaviours in which blood borne viruses such as these can be transmitted. The outcomes of these projects first seek to understand and prevent these transmission factors and look to improve the health of all prisoners by treating those infected with hepatitis B and C and encouraging the prevention of further transmission.

Project contact: 
Professor and Program Head