In March 2016 rapid treatment scale-up for chronic hepatitis C was initiated across the Cairns region including at the Lotus Glen Correctional Centre (LGCC) located near Mareeba in Far North Queensland. LGCC has over 800 beds for male prisoners and had an estimated HCV prevalence of 10-15 per cent prior to March 2016. With a collaborative approach between the Cairns Sexual Health Service, the health service at LGCC and the Cairns Hospital Liver clinic all clients identified with chronic hepatitis C at the prison were treated within 12 months. This was assisted by a nurse at LGCC holding the “hepatitis C portfolio”.
The Lotus Glen hepatitis elimination project has been run within existing service provision and with no additional funding, allowing the multi-disciplinary collaboration to use modern, almost side-effect-free treatments, in line with Australian Guidelines and best practice.
A continuous improvement culture has meant that services have been re-orientated to provide the new treatments to expand the number of prison inmates who can be on treatment simultaneously with pharmacy and nursing support.
All entrants to LGCC are offered routine voluntary blood-borne virus and sexually transmitted infection screening at prison reception, with those testing positive for HCV antibody (Ab) referred to prison nursing staff for confirmatory HCV RNA and HCV genotype testing. During visits to LGCC by an external team consisting of a hepatology nurse (fortnightly visits) and sexual health physician (monthly visits), those with detectable HCV
RNA underwent liver disease evaluation (either via Fibroscan® or AST to platelet ratio index [APRI]) and were prescribed an interferon-free DAA regimen for 8, 12 or 24 weeks.
Medications dispensed from a nearby tertiary hospital pharmacy were sent to LGCC each month, and patients received directly observed therapy. Patients undergoing treatment received counselling and education on prevention of HCV reinfection.
An empowered workforce: The Cairns Hep C Free by 2020 campaign and the Lotus Glen hepatitis elimination project have both empowered the local workforce of nurses, GP’s, specialist doctors, pharmacists, health promotion, public health and Aboriginal and Torres Strait Islander Health Workers to be involved in the testing and treatment responses. Cairns had some of the first GP prescribers for the new treatments and are currently supporting nurse practitioners to prescribe in line with changes to national guidelines.
Consumer Voice: The Cairns Hep C Free by 2020 campaign has worked closely with the Cairns Hepatitis Action Team which is a group of local Cairns residents who have been impacted by chronic hepatitis. Members of the Cairns Hepatitis Action Team have now all accessed the new treatment for chronic hepatitis C and have achieved a cure. They speak about their experiences regularly in local and national media to encourage others to be tested and treated. Within the prison setting, men who had completed the DAA treatment were great advocates for other prisoners to access the program.
