HMP Kirkham Hep C Pathway
Pathway for Clients at risk of Hep C and testing positive for Hep C
Aim
The aim of the pathway is to ensure access to Hep C screening, treatment and ongoing community and medical support.
Who is this pathway for?
Prisoners at HMP Kirkham
Patients at risk of Hep c - Hep c testing should be offered to anyone who:
- Has unexplained abnormal liver function tests or unexplained jaundice.
- Has ever injected drugs (including performance enhancing substances/steroids) using shared equipment regardless of how frequent or long ago this was.
- Has had a blood transfusion in the UK before September 1991 or received any blood products before 1986
- Has received medical or dental treatment in countries where infection control may be poor
- Is the child of a mother with Hep C
- Is a regular sexual partner of someone with hepatitis C
- Has been accidentally exposed to blood where there is a risk of transmission of hepatitis C
- Has had tattoos, piercing, acupuncture or electrolysis where infection control procedures are poor
- Serving a prison sentence
- Shared Hair clippers within a prison environment
Pre- and post-testdiscussion –
Pre- and post-testdiscussion should be provided by those testing clients for hepatitis C. This discussion should include how the results of the test will be given
Testing
In line with NICE guidance to increase the number of people at increased risk of hepatitis C infection being tested. Active case finding will be offered at HMP Kirkham.
Opt out Screening for Hep C will be offered at 2nd reception for all new receptions. Additionally opportunistic screening will be re offered regularly when prisoners attend healthcare for appointments. Prisoners will be assured that this screening will be offered without prejudice.
Staff offering testing will be given training on how to offer tests appropriately and how to deliver results both positive and negative. Training is available online from RCGP Hep B&C detection, diagnosis and management, part 1.
PCR –
A sample of blood will be obtained in a brown tubed (serum gel) bottle. The bottle should contain enough blood to test further for PCR if the test is positive. A positive test indicates that the patient has been exposed to the virus, by further testing of PCR indicates whether the virus is active and hence the patient has Hep C. This will also enable differentiation between those with current infection and those with previous, resolved hepatitis C infection. Therefore, a positive result should only be conveyed to the patient if they have a positive result with a PCR.
The blood test request form attached to the specimen should state:
Hep C test if positive please test PCR, genotype and viral load.
Individuals with a positive hepatitis C antibody test should undergo hepatitis C PCR testing to enable Responsibility for this lies with those carrying out the hepatitis C antibody testing.
Blood results should be sent to the patient within 48 hours of receipt of the results via BBV results slip if negative. All men testing negative should be provided with information . Men should be provided with information on how to remain negative.
Hep C information provided in the Healthcare waiting area.
Positive results will be given to the patient by the GP, and only on receipt of a positive PCR result. Referral to the hep C visiting specialist nurse will be completed via a task sent to the Hep C nurse. The BBV lead nurse at HMP Kirkham, will co ordinate the Hep C visiting specialist clinic. Public Health England(PHE) to be informed by fax via the form below within 3 days of notification of positive result.
Booklet Hep C – You need to Know, will be provided to all men who test positive.
Repeat testing - Individuals who continue to inject or continue with risk taking behaviour and have previously had a negative hepatitis C antibody test should undergo repeat testing on a six monthly basis. If in contact with drugs services or GP, clients should be reminded of the need for such repeat testing, which can then be performed at the testing points identified in the pathway.
Sharing of information – Information should be shared only with the patient’s consent to support their treatment.
Referral for treatment - If in agreement, clients with active hepatitis C, that is those with a positive hepatitis C PCR, should be referred to the Hepatitis C Nurse Practitioner at Blackpool Victoria Hospital. Referrals should be made by those responsible for the continued care of the client.
Hepatitis C Trust
The hepatitis C trust is a registered charity which provides advice, help and support on Hepatitis C. A telephone Help line provides a confidential helpline for prisoners.
0800 999 2052