For a long time now, Scotland has laid claim to being a world leader
in its response to hepatitis C.
In taking up the gauntlet thrown down by the World Health
Organization to eliminate viral hepatitis as a public health concern
by 2030, we have the opportunity to live up to that reputation.
The emergence in recent years of more effective treatments will
surely prove to be a significant turning point on the journey to
elimination. The challenge ahead is to make sure that those who will
benefit from these treatments are able to access them.
ADDRESSING HEALTH INEQUALITIES IN OUR PRISONS
Across Scotland, there are an estimated 36,700 people living with
hepatitis C – 40% of whom have never been
diagnosed.[i] Identifying those who don’t know their
status, and re-engaging those who have been lost to follow up, is
In this context, prisons are a key arena for action. With
almost one in five prisoners estimated to be living with
hepatitis C,[ii] prisons present a unique
opportunity to address health inequalities where the audience is
literally captive, and the Scottish Government’s Sexual Health &
Blood Borne Virus Framework (2015-2020) has already made testing in
prisons a priority.
Through our work, we have seen first-hand the dedication of blood
borne virus (BBV) teams in prison to support people living with
hepatitis C. However, while testing and treatment within prison is now
well established alongside community services, the transition between
the two remains a frequent stumbling block.
Back in 2011, responsibility for prison healthcare transferred from
the Scottish Prison Service to local NHS boards – with continuity of
care as people enter and leave prison a key driver for change. While
the transfer has led to some improvement, recent reports from the
Royal College of Nursing and the Scottish Public Health Network have
both identified continuing gaps.
Our hepatitis C community project in Glasgow works with many former
prisoners who have provided valuable insight into the pitfalls. Faced
with a lack of practical support around critical issues like
accommodation, financial support and addressing drug use, people told
us that hepatitis C fell off their radar, and many stopped attending
local healthcare services.
This is an important reminder that tackling hepatitis C is about
more than just managing the virus, but also about getting people
to a place where they are physically and mentally prepared for treatment.
This is the challenge we are seeking to address through our
AbbVie-funded Prison Link pilot at HMP Barlinnie. Through the project,
we support prisoners to develop liberation plans, making sure the
right support is in place to address the practical issues that prevent
people from following through with their treatment after release. With
this support in place, individuals can focus on clearing hepatitis C
and moving forward with their lives, benefiting both the individual
and the wider community.
The initial results from the first six months of the project are
promising. A large majority of prisoners referred to us have continued
to engage with support services after liberation as they prepare for
and progress through treatment. We have supported prisoners from
beyond Greater Glasgow to access local support when they return to
other parts of the country and, where individuals have relapsed, in
many cases we have been able to keep in contact to support them to re-engage.
In a short space of time we have seen enough evidence to encourage
us that the project is worth pursuing in prisons across the country,
and discussions are underway with key stakeholders to explore what to
do next. Expansion across the country would present interesting
challenges, such as how to assess the different range of needs
associated with distinct prison populations, not least the specific
needs of female prisoners.
However, these strike me as exactly the types of challenges that we
should be taking on if we are serious about leading the world on the
elimination of hepatitis C.
If you would like further information on the pilot or services
provided by Waverley Care, please email firstname.lastname@example.org
or call 0141 332 2520
 Campaigning in Scotland, Hepatitis C Trust. Available at: http://www.hepctrust.org.uk/campaigning/policy-and-parliamentary/campaigning-scotland (Date Accessed: June 2017)
 Taylor et al., University of Scotland, University of Bristol and
NHS Health England. 2012. Hepatitis C Prevalence and Incidence among
Scottish Prisoners and Staff Views of its Management: Final Report.
Available at: http://www.hcvaction.org.uk/resource/hepatitis-c-prevalence-and-incidence-among-scottish-prisoners-and-staff-views-its (Date Accessed: June 2017)