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BBV STIs in Victorian Prisons

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BBV STIs in Victorian Prisons

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    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

    4. 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 Women’s Hepatitis B Pilot Project Devine, Karvelas & Sundararajan, 2007

    5. Studies cont’d… 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2004 & 2007 National Hepatitis B Needs Assessment La Trobe University/ARCSHS 2007 Chlamydia Study Lyn Pierce, 2006 (unpublished) Hepatitis Summary Plan Study Kim Messieh, 2008 (unpublished)

    6. Overview of BBV/STI study results

    7. HIV

    8. HIV Victorian Prisoner Health Study, 2003 1% 3 (297) tested positive NPEBV&RBS Report, 2007 Victoria 0% 0 (117) No one tested positive Nationally 0.4% 4 (586) tested positive

    9. 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

    11. Hepatitis B

    12. National Hepatitis B Needs Assessment Jack Wallace, Stephen McNally & Jacqui Richmond 2007

    13. 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

    14. 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

    15. 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)

    16. National Prison Entrants’ Bloodborne Virus & Risk Behaviour Survey Report National Drug Research Institute 2004 & 2007

    17. 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% Non–IDU 0 (4) -0% NPEBV&RBS Report, 2007

    18. Hepatitis B immune status Victorian statistics (national %) No Immunity 59% (50) Vaccine Immunity 16% (28) Natural Immunity 22% (20) Carrier 3% (2) NPEBV&RBS Report, 2007

    19. Women’s 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

    20. Hepatitis C

    21. 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%

    22. 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% Non–IDU 1 (4) -25% NPEBV&RBS Report, 2007 NPEBV&RBS Report, 2007

    23. Response to these issues

    24. Victorian Prisoner Initiative Joint collaborative project between Department Human Services Justice Health (DoJ) St Vincent’s Correctional Health Service Pacific Shores Healthcare The GEO Group Melbourne Sexual Health Centre

    25. Public Health Project Commenced December 2005 as a 2˝ 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

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

    27. 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

    28. 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

    29. 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

    30. 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

    31. Thank you.. Kim Messieh T: 9341 6229 kmessieh@mshc.org.au Lyn Pierce T: 9341 6258 lpierce@mshc.org.au

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