A Recap: Hep B in Corrections - The Top End of the NT

My name is David Young, I am a GP in rural NSW and having completed an Hep B s100 prescribers course last year I was invited to attend the 2018 Australasian Viral Hepatitis Conference in Adelaide. 

This blog is about the presentation by Dr Jane Davies on the topic of Hep B in Corrections: the Top End of the NT.

The NT has the highest imprisonment rate in Australia at 958.1 prisoners per 100,000 adult population, which is 4.7 times the national rate. ATSI people are represented at a rate of 14 times the rate of the non indigenous population. 82% of the prison population were ATSI.  

The Prison Health Services are managed through a government run primary health division utilising an electronic health record which is shared with other government health agencies. On day five of admission the Hep serology and sero-code are documented by an RN. Positive results are reviewed by an RN or the Prison GP when education and baseline investigations are initiated, with referral as required. 

Subsequent specialist clinic assessment and treatment initiation was hampered by a 50 % non attendance rate and difficulty accessing Fibroscans. Ongoing monitoring and review are provided by the Prison CNC and Specialist/Prison Doctor. Follow up of released prisoners has been an issue. 

To address some of these issues Health care staff have been encouraged to undertake the s100 prescribers course and receive education from specialists via telehealth consultations. Guidelines for the sero-coding project have also been adopted. 

Prisoners have received education from NT AIDS and Hepatitis council education programs. Medications have been dispensed from the Public Hospital to Corrections pharmacy and patients receive daily supervised dosing. Their care can be transferred to hospital service / clinic on release. 

Telehealth specialist consultations have also been implemented on a weekly basis which has been easier for the prison and results in fewer DNA appointments. Care on release can also be continued by the specialist involved. 

The issue of Fibroscaning has been improved by nurse led fibroscan outreach trips to the prison. Fibrosis is also being screened with hepascore/APRI along with specialist assessments. 

As there is minimal inter prison transfer in the NT continuity is not as difficult as in other jurisdictions. However if unplanned discharge occurs the Specialist CNC attempts to follow up and ensure that an adequate medication supply is provided and that care is transferred to the hospital specialist service. 

In a 2018 Snapshot of Darwin Corrections there were: 

  • 1100 people incarcerated. 

  • 70 had Hep B but not on treatment and 13 had Hep B and were on treatment. ie total of 83. 

  • 89% of ATSI prisoners vs 19% of non ATSI had had their viral load recorded in the last 12/12 . 

Under the Hep B- PAST project the goal is to eliminate CHB from indigenous Australians in the NT. 

The first aim is to improve health literacy about HBV amongst indigenous communities, peoples living with HBV and primary healthcare providers, and secondly to improve the Cascadr of Care for individuals living with CHB in the NT. This is to ensure that “NO ONE IS LEFT BEHIND” 

 

 

Author bio: 

I am a Rural GP from Armidale NSW. I have been practicing in rural/ remote locations for the last 37 years (minus a five-year stint in a Brisbane Super Clinic). During this time I have worked with rural, Indigenous and refugee populations. I have also worked in Drug and Alcohol Services as well as at Rehabilitation facilities. In the last 12 months, I have done a Hepatitis B prescriber course and became accredited to prescribe Hepatitis B.