1. BBV & STIs in Victorian Prisons
Kim Messieh
Sexual Health/BBV Nurse
Victorian Prisoner Initiative
Melbourne Sexual Health Centre

2. 13 Adult Prisons

3. Studies into BBV/STIs in Victorian Prisons

4. Studies in Victorian Prisons
Hepatitis C virus among inmates in Victorian Correctional facilities
Corrections Victoria & Burnet Institute, 2002
Victorian Prisoner Health Study
Corrections Victoria & Burnet Institute, 2003
Survey of Harms in Victorian Prisons
Women’s Hepatitis B Pilot Project
Devine, Karvelas & Sundararajan, 2007

5. Studies cont’d…
National Prison Entrants’ Bloodborne Virus & Risk Behaviour Survey Report
National Drug Research Institute 2004 & 2007
National Hepatitis B Needs Assessment
La Trobe University/ARCSHS 2007
Chlamydia Study
Lyn Pierce, 2006 (unpublished)
Hepatitis Summary Plan Study
Kim Messieh, 2008 (unpublished)

6. Overview of BBV/STI study results

7. HIV

8. HIV Victorian Prisoner Health Study, 2003 NPEBV&RBS Report, 2007
1% 3 (297) tested positive
NPEBV&RBS Report, 2007
Victoria 0% (117) No one tested positive
Nationally 0.4% 4 (586) tested positive

9. Chlamydia

10. Chlamydia Victorian Prisoner Health Study, 2003
Males & females tested
0.9% 4 (455) had Chlamydia
Chlamydia Study, 2006 (Lyn Pierce)
100 male new receptions tested
3% 3 (100) had Chlamydia

11. Hepatitis B

12. National Hepatitis B Needs Assessment
Jack Wallace, Stephen McNally
& Jacqui Richmond
2007

13. Communities most affected
…by chronic hepatitis B
People born in Asia & the Pacific Islands, Africa, Middle East & the Mediterranean
Indigenous Australians
People who inject drugs
Men who have sex with men (MSM)
People in custodial settings

14. Why Prisons? High proportion of people who inject No needle exchange
Over representation of Indigenous Australians
5.6% (220 of 3,936 men)
7% (18 of 257 women)
People from overseas
Men
17.7% overall in Vic
4.7% Vietnamese; 3.1% Europe – other
Women
12.5% overall in Vic
5.4% Vietnamese; 2.3% Europe – other

15. Prevalence of Hepatitis B
Number of people living with chronic hepatitis B in Australia is between %
Prevalence in Australian prisons described between 1.8 – 3.2%
Exposure rates to hepatitis B infection is – 40%
Wallace, McNally & Richmond (2007)

16. National Drug Research Institute 2004 & 2007
National Prison Entrants’ Bloodborne Virus & Risk Behaviour Survey Report
National Drug Research Institute
2004 & 2007

17. Hepatitis Bcab Prevalence
Nationally 21% (566)
Victoria 23% - 27 (115)
Men 25 (105) -45% tested positive
IDU 23 (56) -41%
Non-IDU 2 (49) -4%
Women 2 (10) -33% tested positive
IDU 2 (6) -33%
Non–IDU 0 (4) -0%
NPEBV&RBS Report, 2007

18. Hepatitis B immune status
Victorian statistics (national %)
No Immunity 59% (50)
Vaccine Immunity 16% (28)
Natural Immunity 22% (20)
Carrier 3% (2)
NPEBV&RBS Report, 2007

19. Women’s Hep B Pilot Project
391 women participated
No Immunity %
Vaccine Immunity 25%
Naturally Immune 19.4%
Carrier %
Devine, Karvelas & Sundararajan, 2007

20. Hepatitis C

21. Current prisoners
Hepatitis C Virus Among Inmates in Victorian Correctional Facilities, 2002
57.5% total
IDU 79.1%; Non-IDU 11.2%
Males 55.2%; Females 66.7%
Victorian Prisoner Health Study, 2003
Males 52%
Females 60%

22. Prison Entrants’ Nationally 35% - 208 (589) Victoria 41% - 49 (119)
Men 42 (108) tested positive
IDU 40 (59) -68%
Non-IDU 2 (49) -4%
Women 7 (11) tested positive
IDU 6 (7) -86%
Non–IDU 1 (4) -25%
NPEBV&RBS Report, 2007

23. Response to these issues

24. Victorian Prisoner Initiative
Joint collaborative project between
Department Human Services
Justice Health (DoJ)
St Vincent’s Correctional Health Service
Pacific Shores Healthcare
The GEO Group
Melbourne Sexual Health Centre

25. Public Health Project Commenced December 2005 as a 2½ year project
Has now been refunded for 3 (-4)years July 2008 – June 2011
Started with
Lyn at MAP; Kim at DPFC
Expanded to include PPP and MRC
Leading to covering all 13 prisons in Victoria
Nyree Chung
Developed Clinical Practice Guidelines
Took on Nurse Immuniser role at PPP

26. Aim
To improve the screening & management of BBV/STIs & increase vaccinations, especially for Hepatitis B, in the Victorian prison system

27. Leading & Managing Change
Work alongside 3 health service providers
Looking at systems & processes
Recognising need for on the job training as well as for external accredited courses for staff
Pre & Post Test HIV & Hep C Counselling Course
Nurse Immuniser Program
Facilitate BBV/STI & Immunisation clinics for prisoners
Feedback to Advisory Committee

28. Hepatitis B Vaccination
Vaccination programs in prisons extremely important
From commencement of project DHS has given vaccines free to all prisoners
This will continue until June 2010
Schedule has been revised to 0,1 & 3 months (that is, 3rd dose 2 – 5 months after 2nd)
This is to increase number of prisoners completing course whilst in prison

29. Improved documentation
3 different health providers
High movement of prisoners between prisons
High rate of recidivism
…Therefore we decided to pilot revising the Hepatitis Summary Plan
This form captures hepatitis A, B & C information as well as LFTs
and kept in the most current file

30. Hepatitis C Treatment Currently available only for men
Running several years through PPP
About 10 per year
Commenced a pilot at regional prison 2008
Currently about 10 on treatment
If ‘successful’ will be replicated at other prisons
Plans to include women too

31. Thank you.. Kim Messieh T: 9341 6229 kmessieh@mshc.org.au Lyn Pierce