BBV

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
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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
• Corrections Victoria Burnet Institute, 2003
• Womens Hepatitis B Pilot Project
• Devine, Karvelas Sundararajan, 2007

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Studies contd

• 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• Lyn Pierce, 2006 (unpublished)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• Kim Messieh, 2008 (unpublished)

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Overview of BBV/STIstudy results
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HIV
8
HIV

• Victorian Prisoner Health Study, 2003
• 1 3 (297) tested positive
• NPEBVRBS Report, 2007
• Victoria 0 0 (117) No one tested positive
• Nationally 0.4 4 (586) tested positive

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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

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Hepatitis B
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National Hepatitis B Needs Assessment

• Jack Wallace, Stephen McNally
• Jacqui Richmond
• 2007

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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

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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

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Prevalence of Hepatitis B

• Number of people living with chronic hepatitis
  B in Australia is between 0.5 - 0.8
• Prevalence in Australian prisons described
  between 1.8 3.2
• Exposure rates to hepatitis B infection is
  30 40
• Wallace, McNally Richmond (2007)

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National Prison Entrants Bloodborne Virus
Risk Behaviour Survey Report

• National Drug Research Institute
• 2004 2007

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Hepatitis Bcab Prevalence

• Nationally 21 - 120 (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
• NonIDU 0 (4) -0
• NPEBVRBS Report, 2007

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Hepatitis B immune status

• Victorian statistics (national )
• No Immunity 59 (50)
• Vaccine Immunity 16 (28)
• Natural Immunity 22 (20)
• Carrier 3 (2)
• NPEBVRBS Report, 2007

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Womens Hep B Pilot Project

• 391 women participated
• No Immunity 54.8
• Vaccine Immunity 25
• Naturally Immune 19.4
• Carrier 0.8
• Devine, Karvelas Sundararajan, 2007

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Hepatitis C
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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

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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
• NonIDU 1 (4) -25
• NPEBVRBS Report, 2007
• NPEBVRBS Report, 2007

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Response to these issues
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Victorian Prisoner Initiative

• Joint collaborative project between
• Department Human Services
• Justice Health (DoJ)
• St Vincents Correctional Health Service
• Pacific Shores Healthcare
• The GEO Group
• Melbourne Sexual Health Centre

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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

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Aim

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

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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

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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

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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

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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

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Thank you..

• Kim Messieh
• T 9341 6229
• kmessieh_at_mshc.org.au
• Lyn Pierce
• T 9341 6258
• lpierce_at_mshc.org.au