Hepatitis Qld initiated this nurse-led model in April 2018 and Mim attended on a fortnightly basis to provide blood testing, fibroscan and treatment initiation in collaboration with the Princess Alexandria Hospital (PAH) telehealth hepatology team. Mim screened and started treatment for 45 prisoners. By February 2019 the service expanded and a pilot project was launched for a visiting medical officer (VMO) to prescribe HCV treatments, with Mim providing the workup and a further 55 started treatment with the VMO from February 2019, making a total of 100 prisoners starting treatment. In total, Mim performed 81 fibroscans and screened 400 high risk men in only 16 months in a part time role.
It would be easy to naively assume that a prison is an ideal setting for an in-reach program offering testing and treatment, having as it were, a captive, high-risk population. There were plenty of challenges to overcome however, not the least of which was poor communication between the prison officers and prisoners about the service. This is indicative of a culture with the prison system that requires patience, persistence and I would suggest, a good deal of humor to survive – if not overcome.
This was the aspect of her presentation that spoke the loudest to me and a common theme running through many of the presentations at the Nurse-Led Forum that day. It’s become blindingly obvious that there are significant systemic obstacles that stand in the way of high-risk populations accessing HCV testing and treatment.
Yes, it’s also true that sudden withdrawal from alcohol, drugs or both in prison populations, high anxiety and frequent movement between facilities compound the difficulties associated with testing and treatment. Mim has achieved outstanding results.
I was given pause to reflect on those systemic issues – the ones that can seem so very daunting and insurmountable. Prisons are behemoths that run on strict codes and rules that do not bend. Three of the six challenges that Mim described related to systems within the prison, with lack of cooperation and communication about the service by prison officers creating a significant barrier to her service. It’s my opinion that what Mim is dealing with; what many of us are dealing with, is a form of prejudice. Regardless of location or foundation, at the very heart of it that’s the name of the major obstacle that we are all faced with. It takes passion and patience to chip away at cultures and values that negatively impact access to health service delivery to vulnerable populations. Thanks for your work Mim.
Author bio: Kate is a research nurse working at the Burnet Institute in Melbourne on nurse-led, outreach models of HCV testing and treatment with People Who Inject Drugs