Hepatitis Service Provision at HMP Birmingham: Progressing a Previous Service Improvement Plan.

Introduction: Hepatitis B is a vaccine-preventable disease, and hepatitis C is amenable to treatment. Both are highly prevalent in the prison population. This project provides a comprehensive evaluation of current hepatitis services at Her Majesty's Prison Birmingham, assessing progress since previous work and proposing further suggestions for improvement.

Methods: A review of hepatitis services was undertaken in 2013, in the context of underperformance against national targets. This revealed that the hepatitis B vaccination and hepatitis C testing coverage was 22% and 0%, respectively. A resulting service improvement plan included interventions such as the development of a bloodborne virus (BBV) policy, implementing opt-out testing and introducing dried blood spot testing for ease of administration. In 2015, national guidelines were used to evaluate current practice, with comparison to previous practice. The indicators assessed included BBV policy, vaccination and testing protocols, prisoner education and reporting of results. Discussions were held with prison stakeholders to address areas that required development, producing a revised action plan.

Results: Hepatitis services were available to all prisoners starting their sentence in 2015, n=4998. Testing was offered on an opt-out basis to all entrants, increasing the testing coverage by 7.6% from 2013. Vaccination was offered to 57% of entrants, with coverage slightly lower than 2013, largely due to prisoner refusal. In light of this, many strategies were devised to educate prisoners, increase opportunities to receive testing and vaccination, and decrease the risk of patients being lost to follow-up. An update in 2016 saw progress in many of these areas.

Discussion: Being in prison provides offenders with stability in their lifestyle and easier access to healthcare services. By optimising these services in line with national guidance, and implementing specific strategies to encourage uptake of hepatitis testing and vaccination, we may be better able to serve this vulnerable sector of the population.