A Drop in the Ocean - Hepatitis C amongst Chronic Disease in the Prison Population; Is Self Management Possible?


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Alexandra Taylor, Prisons Program Educator, Hepatitis Victoria delivered this presentation at the 2012 Correctional Services Healthcare Summit. The annual event addresses the gaps, promotes multidisciplinary care and the continuum of care into the community. For more information, visit the conference website: www.healthcareconferences.com.au/correctionalhc

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A Drop in the Ocean - Hepatitis C amongst Chronic Disease in the Prison Population; Is Self Management Possible?

  1. 1. A drop in the ocean • Hepatitis C amongst chronic disease in the prison population, is self management possible?
  2. 2. Copyright © Hepatitis Victoria Hepatitis Victoria • Hepatitis Victoria is the peak not-for-profit community organisation working across the state for people affected by or at risk of viral hepatitis. We work to • prevent the transmission of viral hepatitis, • increase access and referral to quality viral hepatitis information, care, treatment and support, • Provide leadership and coordination for the community response to viral hepatitis.
  3. 3. Copyright © Hepatitis Victoria Hepatitis Victoria • Hepatitis Infoline 1800 703 003 • Community participation • State-wide Indigenous, Prisons and Young People Programs • Training and education • Campaign and Advocacy • Good Liver Magazine • www.hepvic.org.au - (03) 9380 464 – hepvic • facebook.co loveyour.livervictoria
  4. 4. Copyright © Hepatitis Victoria Acknowledgments • Louisa Walsh, Hep C Take Control Program Coordinator Hepatitis Victoria. • Sexual Health & Viral Hepatitis Team , Prevention and Population Health Branch Department of Health Victoria
  5. 5. Copyright © Hepatitis Victoria Viral Hepatitis in Prisons • Hepatitis C • 35% of BBV prison entrants • 43% Indigenous • 33% non-Indigenous • Hepatitis B core antibody positive (past exposure) • 21% of BBV prison entrants • 42% Indigenous • 17% non-Indigenous
  6. 6. Copyright © Hepatitis Victoria History of the Prisons Program • 2001 – originally funded as the ‘Prisons Project’ through Commonwealth HCEPI • Original work focused on new prison entrants and staff • Developed a focus on training with prison peers • Four major prisoner led projects- for prisoners, by prisoners • Ongoing involvement in pre-release education programs • Ongoing involvement in staff training.
  7. 7. Copyright © Hepatitis Victoria Chronic disease in prison inmates • 25% of prison entrants self-report that they have a current chronic medical condition (Australian Institute of Health and Welfare, The Health of Australia’s Prisoners 2009 • Cardio Vascular disease within the 35 to 44 age bracket for prisoners is at twice the rate of the general population at 4% compared to 2%. • Diabetes • 2% of prisoners in the 25- 34 age bracket compared with the general population 0.5%. • 5% of prisoners in the 35- 45 year age group living with diabetes compared to 2% of the rest of the population.
  8. 8. Copyright © Hepatitis Victoria Health behaviours amongst prisoners • Smoking – female (78%) , male (74%) entrants were daily smokers • Alcohol & Other Drugs Overall, 55% – 3 in 5 (58%) prison entrants reported consuming alcohol at hazardous levels during the 12 months prior to prison entry – two-thirds (66%) reported illicit drug use in the previous 12 months • 740 prison entrants of the NPEBBV&RBS had ever injected drugs – one in five (20%) had re-used someone else’s used needle or syringe, and 15% had shared injecting equipment with one or more persons.
  9. 9. Copyright © Hepatitis Victoria Heart disease and Hepatitis C • Proposed link between poor health behaviours and physiological causes of people living with hepatitis C and liver damage or the increased risk of developing cardio- vascular disease. Hepatitis C Virus Infection and the Risk of Coronary Disease • Physiological causes via the role of cytokines, which are markers of inflammation. • Cytokines are regulators of host responses to infection, immune responses, inflammation, and trauma. • Pro-inflammatory cytokines can affect other areas of the body, increasing a person’s likelihood of developing rheumatoid arthritis, fibromyalgia and cardio vascular diseases.
  10. 10. Copyright © Hepatitis Victoria Diabetes and Hepatitis C • Diabetes 2% of prisoners in the 25- 34 age bracket have diabetes, compared with the general population of the same age group having just 0.5%. • Older prisoners- 5% of prisoners in the 35- 45 year age group living with diabetes compared to 2% of the rest of the population. • a family history of type 2 diabetes increases susceptibility of developing diabetes, or onset at earlier age. • 1. An insulin-resistant liver, commonly due to fatty deposits in the liver produces unwanted glucose. • 2. Insulin-resistant muscle does not absorb insulin from the bloodstream, leading to high levels of sugar in the blood.
  11. 11. Copyright © Hepatitis Victoria Hep C: Take Control Project • Hepatitis C-specific chronic disease self management program: – 6 week group program – Incorporating hepatitis C-specific health education and goal setting/behaviour change intervention. – Pilot project in 2009/10 – Now core business of Hepatitis Victoria – Currently working with community-based integrated hepatitis C nurses to target harder-to-reach, more marginalised, clients.
  12. 12. Copyright © Hepatitis Victoria Hep C: Take Control Results • More than 60 people have been through the course. • Show improvements in all health areas required for self management as measured by the hei-Q, but especially, problem solving, negotiating the health system and social integration and support. • Areas of self-identified health priorities – stress and worry, managing to work, diet, exercise, quitting smoking, fatigue.
  13. 13. Copyright © Hepatitis Victoria What is chronic disease self management? • Self management involves the individual with the chronic condition working in partnership with their carers and health professionals so that they can: 1. Know their condition and various treatment options; 2. Negotiate a plan of care and review/monitor the plan; 3. Engage in activities that protect and promote health; 4. Monitor and manage the symptoms and signs of the condition; and 5. Manage the impact of the condition on physical functioning, emotions and interpersonal relationships. Flinders University 2006
  14. 14. Copyright © Hepatitis Victoria CDSM does not… • Mean self treatment. • Discourage visits to the doctor or other health professionals. • Increase the risk of becoming unwell. • Threaten health professionals’ role or expertise. • Reduce the cost of care through reduction in services.
  15. 15. Copyright © Hepatitis Victoria CDSM benefits • Better clinical outcomes. • Improved health and QOL. • Reduced ‘crisis’ medical intervention (unplanned GP visits, emergency presentations, hospital admissions). • Increased self efficacy. • Increased client satisfaction with service. • Increased job satisfaction for workers.
  16. 16. Copyright © Hepatitis Victoria Hep C: Take Control Course Outline • 6 week course, 2 hours per week – Week 1: Introduction – Week 2: Diet and Exercise – Week 3: Sleep, Fatigue, Alcohol and other Drugs – Week 4: Thoughts and Emotions – Week 5: Disclosure, Stigma and Support – Week 6: Treatment and The Future
  17. 17. Copyright © Hepatitis Victoria Week 1: Introduction & the Virus & it’s Effects • Myth busting • Gives an opportunity for participants to express their knowledge • Opportunity for facilitators to clear up misinformation or confusion of messages, explain how to find information • What is self management? • Gives participants a clear understanding of course content. • Facilitator can gauge responses
  18. 18. Copyright © Hepatitis Victoria Week 2: Diet and Exercise • SMART Goals- adapt to group discussion (resistance?) • Diet options differ and have limitations for prison to prison. • Participants to discuss limitations, challenges (what will make success difficult?) » Inappropriate equipment/exercise for gender, age. • Opportunity for participants to explore what changes they could make, be it very small. (what will help you succeed?) » Regular meals, canteen choices » access to gym and sporting equipment
  19. 19. Copyright © Hepatitis Victoria Week 3: Sleep, Fatigue, Alcohol and Other Drugs • Sleep & fatigue • May be affected by medications & high stress rates amongst prisoners (medications, pharmacotherapy's, depression, anxiety) • Participants to explore how to manage this. • Alcohol and other drugs • Smoking, reduction, cessation – (83% being current smokers, and almost three- quarters (74%) daily smokers • Returning to alcohol & other drugs on release. – goal setting, looking at past successes, failures
  20. 20. Copyright © Hepatitis Victoria Week 4: Thoughts and Emotions • Cycle of depression and anxiety (In 2010, 31% of prison entrants reported having ever been told that they had a mental health illness) – Chronic illness, Stigma relating to hepatitis C, Managing depression • Change your thinking style! Helpful & unhelpful thinking – basic cognitive therapy exercise (may encounter some resistance) • Rewards! (??) How do you give yourself a reward in a place of punishment?! • Lapse & relapse – re-evaluating strategies, recognising what works
  21. 21. Copyright © Hepatitis Victoria Week 5: Disclosure, Stigma and Support • Disclosure- What and when to disclose, who and how? – Prisoners often are used to disclosing information to those in authority, often not realising their rights – Often believe they should know others status. • Have you ever experienced stigma or discrimination because of HCV? What action can you take? • Circles of support – Who? – When? – How?
  22. 22. Copyright © Hepatitis Victoria Week 6: Treatment and The Future • Self esteem activity (positive attributes, everyone has them!) • Treatment options • Where to from here? Options for ongoing support after course – Prison peer educators, medical, friends, each other! • On release • Hepatitis Victoria (Info line, Support Group) counselling, family, friends, partners • Review current goals – Encourage setting a goal for the next 2 months.
  23. 23. Copyright © Hepatitis Victoria Foreseeable challenges • Choices limited when it comes to diet and preferred exercise regimes • Women in particular find themselves less active and prone to weight gain while inside- more gender and age appropriate activities needed • Limited access to prevention and harm reduction if engaging in injecting drug use while incarcerated.
  24. 24. Copyright © Hepatitis Victoria Foreseeable benefits • Access to health services, exercise facilities and regular meals in prison • A break from behaviours on the outside that are harmful to health • May complement other, current prison programs around behaviour change and life skills • Goals and direction of course are participant led, so gives a certain amount of control
  25. 25. Copyright © Hepatitis Victoria Conclusion • Could be adapted for other health conditions • Has ‘in principle’ approval from Justice Health Victoria • Would require comprehensive evaluation • Past courses have been externally evaluated, therefore comparable to other environments and target groups. • Should and could cover chronic hepatitis B