Brockville Mental Health Centre (BMHC) is home to a unique program designed to counter one of the most serious public health problems known around the world: hepatitis C.
Approximately 20 percent of incoming residents of the St. Lawrence Valley Correctional Treatment Centre (part of the BMHC), have hepatitis C. With the support of local partners, treatment is provided to anyone who wants it.
Hepatitis C is a viral infection, caused by the hepatitis C virus (HCV), which is bloodborne and can cause serious liver damage. A significant number of those who are chronically infected will develop cirrhosis or liver cancer. Transmission can occur through injection drug use and unsafe injection practices, transfusion of unscreened blood and blood products, and sexual practices that lead to exposure to blood. Some people with hepatitis C don't know they're infected because symptoms may take decades to appear.
The World Health Organization estimates that 71 million people around the world have a chronic hepatitis C infection. The largest group at risk includes people born between 1945 and 1965, an age group which is five times more likely to be infected than those born in other years.
There is currently no effective vaccine against hepatitis C. Until recently, treatment typically required weeks of injections and oral medications that had serious side effects and a low success rate. The good news is that the latest treatment (oral medication taken every day for eight to 12 weeks instead of over several months) has fewer side effects and a cure rate as high as 98 percent.
Jane Benson, a nurse at BMHC who works in the hepatitis C program, says the team saw an ideal opportunity to help a high-risk group of men get treatment and prevent them from potentially passing it on.
“It wasn't something that we were actively looking to do because we're about mental health, but we've had a few guys go into actual liver failure while they're here,” says Benson. “A lot of them are sick. It's something that our clients tell us they're very appreciative of. They're very excited to get the treatment here.”
In this care model, a correctional nurse and a community-based nurse specialist work together to provide screening, diagnosis, and treatment for hepatitis C for all consenting residents of the facility. This partnership has led to a high treatment success rate, with a cure rate of 47 percent, well above the national average of seven percent. This partnership could be implemented other correctional facilities, which would support the World Health Organization target of reducing global hepatitis C virus infections by 90 percent by 2030.
According to Lynn Vignola, an RN with West Ottawa Specialty Care who is part of the initiative, systemic screening programs do not exist in provincial or territorial prisons, except for British Columbia.
One of the biggest challenges is funding. While treatment is covered for people who are working and have health benefits, it’s out of reach for those who count themselves among the working poor or are without secure housing.
“Many of my guys have known they've had hepatitis C for years, but because of their addiction issues, or whatever else is going on, they don't follow up with treatment,” says Benson. “Here, we know they're going to get all their medications. You have to take it every day and we don’t want people to miss doses. This is the best place for them to make sure that they get the full treatment.”
The support of local partners is integral to the success of the program. If the client leaves the facility before the end of their treatment, Benson makes arrangements with health partners in the person’s home community for support, which could be anywhere in Ontario.
“More people need to know that it’s a very treatable illness,” says Benson, who encourages anyone who is in a high-risk category to get tested.
The Royal receives funding for its hepatitis C program through the Trillium Foundation.
For information about World Hepatitis Day 2021, go to worldhepatitisday.org.