P122 Conquering Hepatitis vIa MicroElimination (CHIME): testing new entrants to prison for HCV infection

Background

Comprehensive opt-out testing of new entrants to prison for evidence of HCV infection, followed by rapid initiation of appropriate antiviral therapy, is an integral part of the NHS England viral hepatitis elimination strategy. This study examined rates of testing in three local (category B) prisons (Nottingham, Leicester, Lincoln) to assess compliance with the national target of 75% testing and to identify factors associated with success/failure of this strategy.

Methods

Data on the weekly numbers of new entrants to each prison, their origin (community or inter-prison transfer), length of prison stay and whether or not each individual had been tested for HCV infection were acquired from electronic health records. An anti-HCV test was recorded if this occurred within the four weeks following the week of arrival. Data were collected from March 2022 from Nottingham (3 weeks), Leicester (28 weeks) and Lincoln (28 weeks) – a total of 59 prison weeks. Questionnaires were administered to 166 people in prison (PIP) who had not been tested after 4 weeks’ stay in order to interrogate possible reasons for refusal.

Results

The overall testing rates were 36.16% (n=664/1836). 63.62% (n=1168/1836) had arrived from a community location and 39.13% (457/1168) of this group were tested. The remaining 36.38% (n=668/1836) arrived via an inter-prison transfer and 30.99% (n=207/668) were tested. Testing rates stratified by length of prison stay are shown in the table 1. The majority of PIP 68.52% (n=1258/1836) were in the prison for more than one month. The two most common reasons for PIP not being tested were “not interested”/”I’m not a drug user”/”why should I” (75/166, 66%) and having had a recent test (40/166, 24%).

Conclusions

Testing rates within these three East Midlands prisons were well below expected national targets. PIP admitted from the courts or police custody are more likely to be tested than those transferred from another prison. Their reasons for not being tested suggest that the importance of testing for HCV is not being communicated properly, either due to a lack of time or of understanding. This failure is likely to be due to under-resourcing of health-care staff in reception clinics. Until testing is seen as “routine”, and/or prison healthcare staff are provided with adequate training and time to counsel PIP appropriately, national targets will not be reached.