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

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Presentation on theme: "Scottish Prisons and the Hepatitis C Challenge Scottish Drugs Forum February 2007 Andrew Fraser."— Presentation transcript:

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


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