Hepatitis C micro-elimination in HMP Berwyn, the UK's largest prison
Elizabeth Hurry, Specialist Pharmacist (Hepatology and Gastroenterology), Betsi Cadwaladr University Health Board
Introduction
HMP Berwyn based in Wrexham is the UK’s largest prison. Prison populations are known to have a high prevalence of hepatitis C (HCV). Hepatitis C (HCV) testing rates were low due to stigma, lack of knowledge, and time constraints 29% of arrivals in 2017 rising to 62% by 2019).
Initially, opt-out testing saw limited success, and monthly treatment clinics struggled to serve all prisoners effectively, especially during COVID-19. Given HCV's treatability and the World Health Organisation’s goal to eliminate it by 2030, an improvement was needed to provide equitable, timely care.
The aim is to achieve and sustain HCV micro-elimination (100% offered a test, 90% take up, 90% treatment) at HMP Berwyn by March 2024, aligning with Welsh Health Circular targets.
Methods
Improving testing: Blood-Brone Virus Nurse employed; point-of-care testing with mouth swabs and rapid viral load testing started in July 2021 for all new arrivals.
Improving treatment rates: Specialist pharmacist funded from January 2022; adapted accelerated treatment pathway; weekly multidisciplinary meetings for rapid treatment initiation.
Peer support: Two Hepatitis C Trust peers employed in October 2022, trained 19 prisoner volunteers to assist with education, support, and stigma reduction.
Education roll-out: Continuous education for staff and prisoners; reception staff trained for reliable testing; monthly meetings with senior healthcare staff
Testing long-term prisoners: Systematic targeting of untested long-term prisoners by peers and nurse.
Data: SystmOne used for real-time data on testing levels.
Outcomes
- Micro-elimination of hepatitis C achieved and sustained.
- Benefits include reassurance for prisoners or prompt treatment to prevent complications like cirrhosis.
- Prisoners gain equal access to timely, safe, and effective care
- Testing and treatment rates are easily monitored.
- Increased staff knowledge and support
- Testing is now routine, with reduced stigma and open discussion among prisoners.
- Volunteer prisoners gained valuable skills and teamwork experience.
- Multi-disciplinary teamwork proved effective in achieving goals.
Learnings
- Regular meetings built trust, identified strengths, and aligned efforts.
- Tailored feedback to prison healthcare leads
- Barriers to patient/staff engagement were addressed as they arose; future projects should identify these early.
- Treatment pathway adapted for prison-specific needs (e.g., medication management).
- Improved data documentation with a consistent template to monitor progress.
What next?
- Maintain and embed testing and treatment
- Permanent roles established
- Expanded HCV testing responsibilities to more prison healthcare staff
- Internal peer mentors being recruited
- Regular training for prison staff to sustain engagement.
- Work shared at international conferences and workshops.
