1. Scottish Prisons and the Hepatitis C Challenge Scottish Drugs Forum February 2007 Andrew Fraser

2. Scottish Prisons’ HepC Challenge Scale of HepC infection –Risk behaviour –Transmission Scope of the Challenge –Whole prison –Prevention –Harm Reduction –Detection, assessment, treatment support Care of a long-term condition in another community setting Alcohol

3. Hepatitis C Infection Estimated prevalence c.20% overall* –Higher in women 34% –Lower in young men Current figures –Glenochil19%Shotts 13% - prevalence –About 1 in 3 of adults tested –1 in 5 of young men tested 1 or 2 with end-stage liver disease * WASH studies 1990s

4. Hepatitis C in Prison and Scotland 20% prevalence - SPS 1% - Scotland So… 7,100 prisoners each day 21,148 prisoners each year 1,420 with hepC 50,000 est. 2-3% of infected Scots 6-9%

5. The courts decide how long our patients stay A la Carte – long-term prisoners Stable and motivated few Table d’hote – short-term prisoners Ambition to be stable most Carry out

6. Risk Behaviour and Transmission 70% have a drug problem –3% continue to inject in prison –69% share Shotts Study Tattooing ? Steroids? Sex ? c.1% Alcohol – 40% report they have a problem Sources: Annual Prisoner Surveys Roy, SCIEH 2003 – WASH studies, 1990s Hutchison, SCIEH 2003

7. The Challenge COCO – Custody, Order, Care, Opportunity 9 OOs – Offender Outcomes –1. Sustained or improved physical & mental wellbeing –3. Reduced or stabilised substance misuse Corporate objectives –Reduce the risk of BBV transmission –Addictions policy –Investment & through-care

8. Going Inside Assessment – drug withdrawal risk –Attitude switch to duty of care –Store clean works Stabilisation – –& detox Induction – and tobacco and alcohol –Injecting risks Support – self-esteem, basic life skills, HepB vaccine Still to go – –Confidence in a range of Rx –Time to assess –Peer support

9. What’s available ? Equivalent service –Interventions – e.g. 17% on methadone –Buprenorphine detox. Support Clean & cleaning materials Ambition for abstinence Condoms and dental dams Still to go – –All services at the level of the best –paraphernalia

10. On return to the Outside Preparation for release –Includes o/d awareness, resusc. skills In touch with services Return clean equipment Still to go – –Mutual respect / better communications –Integrated care, especially alcohol

11. HepC specifically…. Education Testing, Dona Milne report Assessment -> referral Long-term care Forum and networks Structured Care Results Still to go ….

12. HepC specifically…. (2) Still to go – –Forum Action Plan –More testing – >> 3% of national effort –More In-reach Late stage disease management Governance – information / consistency –Good practice everywhere Pilot. peer-ed programme with C level Cut down on prison transfers A la carte for all ?

13. … and Alcohol Not in the shadow of drugs Poly–drug misuse means everything together Another reason to get to grips with alcohol misuse Don’t duck the issue

14. Hepatitis C C is for Challenge

15. Hepatitis C C is for Challenge Cautious Optimism Peter Bramley 2006

16. Scottish Prisons and the Hepatitis C Challenge Andrew Fraser Director of Health and Care andrew.fraser@sps.gov.uk