High levels of hepatitis C uncovered among prisoners and homeless

Innovative new screening programmes have uncovered high levels of hepatitis C among the prison and homeless populations.

Doctors say the results show the need to shift resources for treating the disease out of hospitals and into the community.

More than 200 inmates in Mountjoy Prison recently presented during a two-day mass screening, two-thirds of whom had not been screened previously.

Altogether, 700 prisoners have been offered screening, and 500 have accepted, under a “buddy system” set up by the Irish Red Cross and the Irish Prison Service.

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The programme, which relies on inmate volunteers to inform their peers about the benefits of testing, has led to a significant increase in screening uptake, according to an analysis. “High levels of support among staff and prisoners further underpin the benefits,” it says.

Although the results are still being processed, a significant number of those tested were found to have hepatitis C, according to Dr Des Crowley, GP and addiction specialist at the prison.

“We have to think laterally about how we provide services here,” he says. “There are groups of vulnerable people who are not being tested, and even when they do know their status, are not attending for treatment. They need to be treated in the community for this disease, which is now treatable, curable and preventable.”

Dr Jack Lambert, a specialist in liver disease at the Mater hospital, says the Mountjoy programme is a "success story" that could be replicated elsewhere in Ireland and as a model for prison systems in other countries.

Highly treatable

In a separate study, 38 per cent of 547 homeless people in Dublin tested positive for hepatitis C, which is now highly treatable and curable thanks to newly developed treatments.

Of the 206 people who tested positive during the screening by Safetynet homeless services, 112 were new cases that had not been previously diagnosed and 94 cases were “known”.

Most of those who participated in a follow-up interview were living in a hostel, while others were sofa-surfing or sleeping rough. The average period of homelessness was 6.2 years, with a range of two months to 20 years.

Those interviewed identified unstable accommodation as a barrier to attending specialist appointments and treatment for hepatitis C.

Other common reasons for nonattendance were active addiction, incarceration, fear of side-effects of treatment and forgetfulness.

The study, to be presented by Irish researchers at a conference on hepatitis C and drug addiction next month, says homelessness is a major barrier to accessing treatment.

“For this population, myriad health and social risk factors need to be addressed in conjunction with further care if we are to make any difference in hepatitis C prevalence.”