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About this toolkit

This toolkit has been developed to support the implementation and scale up of hepatitis B and C prevention and care in prisons across Europe. It includes a practical, interactive framework to assess your individual service and create a plan to drive forward elimination in your setting.

This toolkit aims to support the user in developing tailored strategies for scaling up or implementing viral hepatitis prevention, testing and treatment services in prison, and offers a framework for monitoring and evaluating these services. It can be part of national and regional elimination efforts, aligning with the World Health Organization’s (WHO’s) 2030 targets to eliminate hepatitis and ultimately save ​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​lives.

The toolkit has been developed to reinforce the key principle of equivalence of care in the context of healthcare provision and to strengthen initiatives for continuity of care between the community and prison services (UN, 2016).

The tools and templates in the toolkit are developed to be adapted for different types of prisons to account for variability and the heterogeneity of service delivery. The toolkit also includes models of care from European prisons developed by the European Union Drug Agency (EUDA) describing interventions for hepatitis B and C.

On account of this high burden of disease and the high risk of transmission, the interventions in prisons discussed in this toolkit are specifically directed towards hepatitis B and C, and not other types of viral hepatitis or other infections. Therefore, in the context of this toolkit, viral hepatitis prevention and care shall refer to hepatitis vaccination (hepatitis B) and hepatitis prevention, management and treatment (hepatitis B and C).

It is important to note however, that the scale up of services for viral hepatitis​​​​ ​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​should and are likely to benefit other infectious diseases such as HIV and STIs, from public health, economic and individual health standpoints.

Eliminating viral hepatitis in prisons
  • Outlines the importance of prisons in the context of viral hepatitis elimination
Strategy development
  • Overview of policy framework
  • Step-by-step guide to developing a strategy including how to conduct a health needs assessment
Strategy implementation
  • Focuses on the practicalities of implementation along the care cascade
  • Considers population groups - women, youth and foreign nationals
Monitoring
  • Proposal for a monitoring and evaluation framework
  • Outlines why data important
  • Includes guide on key considerations for effective monitoring
Tools and resources

This toolkit is primarily designed for anyone working in health services in the prison setting, however the information will likely be relevant to other audiences including policy-makers, security staff, peer workers, advocates, and voluntary ​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​workers.

The information contained in this toolkit is broadly applicable to those working with prisons across a variety of geographical levels (local/regional/national). The toolkit has been developed specifically for countries in the European Union/European Economic Area (EU/EEA) region, but contains information of relevance and utility beyond European prison settings.

ECDC/EUDA established an Advisory Group to guide the development of the toolkit. The group was convened on the basis of their expertise in the in the field of prison health and infectious diseases.

The Advisory Group provided input on the scope of the toolkit and the different elements that should be included. It was agreed that the toolkit would be a collation of relevant information from a range of sources, including existing public health guidance, the published literature and related projects undertaken across the region.

The Advisory Group also provided input around the level of detail that should be included and the language. Drafts of the toolkit were shared with the Advisory Group for their review. The Advisory Group provided feedback throughout the project during meetings and in writing.

An initial survey and focus groups were conducted among ECDC/EUDA expert networks to identify barriers and facilitators for the implementation of evidence-based interventions to control hepatitis B and C in prison settings. The results of this work provided information on key areas to be addressed in the toolkit.

The project team identified key information sources, including existing public health guidance and scientific reviews by different organisations related to prison and infectious diseases, models of care in EU prisons, as well as other toolkits and the scientific literature.

Toolkits, especially the STOP-C toolkit, and other resources developed by teams in Australia to support hepatitis elimination work in prisons were acknowledged by the Advisory group to be user-friendly and action-oriented resources for the target audience and these were a major source of inspiration and starting point for this project.

Through the coordination of European Centre for Disease Prevention and Control (ECDC) and the European Union Drugs Agency (EUDA), this toolkit has been developed by a project team at the International Network on Health and Hepatitis in Substance Users (INHSU) in collaboration with an Advisory Group of leading European experts in the field and the University of Pisa.

ECDC and EUDA would like to acknowledge the support and guidance provided by members of the Advisory Group for the development on the toolkit. Members of the Advisory group include: José Miguel Antolín, Guglielmo Arzilli, Catalin Bercaru, Christian Brixko, Maria Buti, Joaquin Cabezas, Luca Ceccarelli, Nicola Cocco, Emmett Conroy, Filipa Alves da Costa, Emma Day, Charlotte Deogan, Carole Devaux, Justina Dzienko, Gabriele Fischer, Signe Gilbro, Christiane Haas, Patrick Hoffman, Derval Igoe, Lina Jurgelaitiene, Betina Kiefer, Arkadiusz Komorowski, Marc Lehmann, Andrew Lloyd, Sara Mazzilli, Fadi Meroueh, Antons Mozalevskis, Marcelo Naveira, Eamonn O’Moore, Rui Morgado, Els Plettinckx, Roberto Ranieri, Rafaela Rigoni, Ehab Salah, Alessio Saponaro, Graham Shaw, Heino Stöver, Gustav Tallving, Lara Tavoschi, Cristina Valente, Ioanna Yiasemi.

This report of the European Centre for Disease Prevention and Control (ECDC) and the European Union Drug Agency (EUDA) was coordinated by Erika Duffell (ECDC), Thomas Seyler and Linda Montanari (EUDA).

The draft toolkit was produced under contract ECDC/14789 with the University of Pisa in collaboration with International Network on Health and Hepatitis in Substance Users and the Kirby Institute. It was drafted by Olivia Dawson (International Network on Health and Hepatitis in Substance Users (INHSU)).