Health Protection Team, Public Health Wales, Cardiff CF10 4BZ, UK.
Communicable Disease Surveillance Centre, Public Health Wales, Cardiff CF10 4BZ, UK.
J Public Health (Oxf). 2020 May 26;42(2):423-428. doi: 10.1093/pubmed/fdaa022.
Viral hepatitis is a leading cause of death worldwide. The World Health Organisation introduced a target to reduce hepatitis C virus (HCV) as a public health threat by 2030. Testing and treatment of those at elevated risk of infection in prison is key to achieving disease elimination. An opt-out testing policy for those in prison was introduced in Wales, UK, in 2016.
We analysed all Wales laboratory data where the testing site was a prison. We analysed numbers tested and positivity for a 14-month period before and after the introduction of opt-out testing policy.
Between September 2015 and December 2017, 6949 HCV tests were from prison settings in Wales, equating to 29% of admissions to prison (P < 0.001). All but one prison increased testing following the introduction of opt-out policy. Percentage positivity for HCV remained at 11% before and after opt-out policy (P = 0.572). Short-stay prisons saw higher rates of HCV positivity than long stay.
Data suggest implementation of opt-out policy improved uptake and diagnosis of HCV amongst those in prison; however, further effort is required to fully embed screening for all. Positivity remains high amongst those in prison, particularly in short-stay prisons. Laboratory data can support audit of opt-out policy.
病毒性肝炎是全球主要的死亡原因之一。世界卫生组织提出了一个目标，即在 2030 年之前降低丙型肝炎病毒（HCV）对公共健康的威胁。对监狱中具有较高感染风险的人群进行检测和治疗是实现消除疾病目标的关键。2016 年，英国威尔士在监狱中推出了一种针对所有人的检测政策。
我们分析了威尔士所有实验室数据，检测地点是监狱。我们分析了在采用“选择退出”检测政策之前和之后的 14 个月内，检测人数和阳性率。
2015 年 9 月至 2017 年 12 月，威尔士有 6949 例丙型肝炎病毒检测来自监狱环境，占监狱入院人数的 29%（P<0.001）。在采用“选择退出”政策后，除了一家监狱外，所有监狱都增加了检测。在采用“选择退出”政策前后，丙型肝炎病毒的阳性率均为 11%（P=0.572）。短期拘留监狱的丙型肝炎病毒阳性率高于长期拘留监狱。
数据表明，“选择退出”政策的实施提高了监狱中人群对丙型肝炎的检测和诊断率；然而，还需要进一步努力，全面筛查所有人群。监狱中丙型肝炎病毒的阳性率仍然很高，特别是在短期拘留监狱中。实验室数据可以支持对“选择退出”政策的审核。
