People in police custody are known to present with increased prevalence of injecting

drug use. In one study that looked at patterns of illicit drug use of people in police

custody in London, of those prisoners who reported illicit drug use, 56% used the

intravenous route and 25% had shared needles at some point¹.

Around 90% of those infected with Hepatitis C in Scotland acquired the virus through

injecting drug use behaviour (sharing needles/syringes and other injecting

paraphernalia) and the majority of these were former injectors who remain

undiagnosed².

Given the prevalence of injecting drug use amongst people in police custody, and that

injecting drug use in the primary route of transmission of Hepatitis C in Scotland, a

team of police custody nurses supported by the NHS Forth Valley BBV MCN

developed a proposal to introduce a screening programme for Hepatitis C in police

custody as a test of change.

People in police custody referred to a healthcare professional were screened to

ascertain their risk of Hepatitis C. Consent was obtained to screen at risk individuals

for Hepatitis C as well as other blood borne viruses (Hepatitis B and HIV). Those who

were currently, or had ever, injected drugs were targeted for screening.

166 IV drug users were indentified by nursing staff during the test of change – 59

(35%) consented to screening in police custody.

Screening was undertaken using the Dried Blood Spot (DBS) testing process. This

simple test involves taking a few spots of blood from a finger prick which is placed on

an absorbent card and sent to the lab for testing.

Information from completed consent forms was collated over an 18 month period (July

2016 to April 2018) to evaluate the screening of people in police care who were

identified as being at risk of Hepatitis C infection.

The results reported in this test of change report are not generalisable and are

intended to evaluate a screening programme within the local setting, and influence

the future clinical practice of the local police custody healthcare team.

The test of change demonstrated that Hepatitis C screening is an intervention that

can be successfully facilitated by healthcare professionals in police custody.

Significantly the test of change demonstrated that the police custody suite is an

important opportunity to offer screening to those at risk;

• 3 in 4 people who consented to screening in police custody had not been

screened previously in their communities, and

• 1 in 3 people were not actively engaged in community support

suggesting that for a significant minority, the police custody suite was

their only access to a screening programme.

A Test for Change Screening People in Police Custody for Hepatitis C.

Barry Muirhead – Clinical Nurse Manager

Susan Millar – Clinical Forensic Nurse

Introduction

Method Conclusion

Results

South East Scotland Forensic Medical & Healthcare Services for People in Police Care

& NHS Forth Valley Blood Borne Virus Managed Clinical Network

1. Payne-James JJ, Wall I, Bailey C. Patterns of illicit drug use of prisoners in police custody in London, UK. J Clin

Forensic Med 2005;12(4):196–8.

2. Roy KM, Hutchinson SJ, Wadd S, Taylor A, Cameron SO, Burns S, et al. Hepatitis C virus infection among injecting

drug users in Scotland: a review of prevalence and incidence data and the methods used to generate them.

Epidemiol Infect 2007;135(3):433-42.

It was noted that amongst the group that consented

to screening in police custody, only

1 in 4 of this group reported having been tested

previously.

For a third who were not engaged with addictions support in

the community, police custody was an additional opportunity

to offer screening

References

Acknowledgements

The police custody healthcare team would like to acknowledge NHS Forth Valley BBV

MCN for the guidance, expertise and support in developing this test of change.