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Hepatitis Service Provision at HMP Birmingham: Progressing a Previous Service Improvement Plan
  1. Tooba Arif1,2
  1. 1West Midlands East Health Protection Unit, Public Health England, Birmingham, West Midlands, UK
  2. 2Division of Surgery and Interventional Science, University College London, London, UK
  1. Correspondence to Dr Tooba Arif; tooba.arif{at}


Introduction Hepatitis B is a vaccine-preventable disease, and hepatitis C is amenable to treatment. Both are highly prevalent in the prison population. This project provides a comprehensive evaluation of current hepatitis services at Her Majesty’s Prison Birmingham, assessing progress since previous work and proposing further suggestions for improvement.

Methods A review of hepatitis services was undertaken in 2013, in the context of underperformance against national targets. This revealed that the hepatitis B vaccination and hepatitis C testing coverage was 22% and 0%, respectively. A resulting service improvement plan included interventions such as the development of a bloodborne virus (BBV) policy, implementing opt-out testing and introducing dried blood spot testing for ease of administration. In 2015, national guidelines were used to evaluate current practice, with comparison to previous practice. The indicators assessed included BBV policy, vaccination and testing protocols, prisoner education and reporting of results. Discussions were held with prison stakeholders to address areas that required development, producing a revised action plan.

Results Hepatitis services were available to all prisoners starting their sentence in 2015, n=4998. Testing was offered on an opt-out basis to all entrants, increasing the testing coverage by 7.6% from 2013. Vaccination was offered to 57% of entrants, with coverage slightly lower than 2013, largely due to prisoner refusal. In light of this, many strategies were devised to educate prisoners, increase opportunities to receive testing and vaccination, and decrease the risk of patients being lost to follow-up. An update in 2016 saw progress in many of these areas.

Discussion Being in prison provides offenders with stability in their lifestyle and easier access to healthcare services. By optimising these services in line with national guidance, and implementing specific strategies to encourage uptake of hepatitis testing and vaccination, we may be better able to serve this vulnerable sector of the population.

  • audit and feedback
  • clinical practice guidelines
  • healthcare quality improvement
  • quality measurement

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  • Contributors TA led this project, performed the necessary background research, collected data, collated and analysed results, devised and implemented a new action plan, wrote up and submitted this manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval This study is not classed as research by the NHS Health Research Authority, hence formal ethical approval was not required, as the focus is on service improvement in general rather than individual patients.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Presented at PatientSafety Prize Session, Royal Society of Medicine, London, UK, November 2017National Foundation Doctors Presentation Day,Bristol, UK, January 2016

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