Rich Feffer, MS, CCHP, is Correctional Health Programs Manager for the Hepatitis Education Project in Seattle, WA. This post is based on his session “Providing Hepatitis Education to Inmates” taking place at the 2016 Spring Conference on Correctional Health Care in Nashville, TN, April 9-12, 2016. Learn more about the conference and register HERE.

Hepatitis A, B, and C are viral infections that cause inflammation of the liver and they are disproportionately common condition among the inmate patient population. Hepatitis C (HCV), for example, is found in 10-40% in the corrections population compared to only 1-2% in the general population. There is still a great deal of misinformation and stigma about viral hepatitis. Our patients, whether currently battling the disease or not, need to understand disease transmission and prevention. Those currently living with viral hepatitis also need to understand treatment options, self-care, how to navigate the correctional health care system and linkage-to-care options upon release. One model of a successful hepatitis education program is found in the state prison system of Washington.

Hepatitis Education at the Washington State Prison System

Since 2001 the Hepatitis Education Project (HEP) has provided inmate health education regarding hepatitis and other blood-borne pathogens at all 12 Washington State prison facilities. HEP is a community based non-profit organization that provides advocacy, education, and direct services for viral hepatitis.

The main education program is a two-hour hepatitis and blood-borne pathogen class delivered by HEP to inmates in all 12 WA prisons and one work release facility. The class is taught monthly at the men’s intake facility, every-other-month at the women’s intake facility, and at least twice annually at all other facilities. A total of 64 classes are held across all 13 facilities, reaching about 900 inmates annually.  Class participation varies, but is typically voluntary unless the local facility or program requires it. There is a signup process and classes are advertised in living units and other high traffic areas. Recently, remote classes were added using a Webinar process.

A second program was added in 2015 and consists of six 2-hour sessions in which inmates are trained as peer educators for HIV and viral hepatitis risk reduction. The program, called Project SHIELD, is an evidence-based intervention adapted from CDC materials for use in corrections. SHIELD “Peer Educators” are taught risk reduction skills and communication strategies for talking to people in their social networks about risk reduction. The program started with a pilot at two facilities. So far, 79 inmate peer educators have been trained after a thorough screening.

Outcomes of a Hepatitis Education Program

Qualitative feedback shows that class participants both enjoy and appreciate the opportunity to learn about these topics. Inmates have shown hepatitis and HIV knowledge increases on pre- and post-tests. Medical staff also report an increase in requests for vaccination and testing after classes take place and have reported learning new information themselves from classes they observe, especially pertaining to community-based resources.

As a side benefit, the presence of HEP educators in the facility increases awareness of available resources. For example, HEP staff routinely supply health care staff with educational handouts and literature about community-based programs to help patients on release.

The effect of the SHIELD program is still being evaluated, but inmates report increased knowledge and understanding of disease transmission along with increased confidence in their own communication skills and an intention to reduce their own risk in the future.

Tips for Starting a Hepatitis Education Program 

Starting and maintaining a Hepatitis Education Program takes time, collaboration, patience and persistence. Here are a few tips to help make it work.

• Evidence-based Models: Use evidence-based models and be ready to explain why they are important and why they are beneficial for the system to implement both in the short and long term.
• Keep Records: Once implemented, keep records and data to show the impact of your program. This will sustain the support and resources needed to continue the program.
• Communicate with Stakeholders: During the entire process it is important to communicate effectively with all relevant stakeholders. Coordinating programs in corrections involves many departments within a correctional system such as administrative staff, custody, program staff, and medical. Make sure all parties are at the table during the planning process to minimize problems down the road. When challenges do occur, be professional, respectful, and responsive.
• Find a Champion: Identifying a champion in your system or jurisdiction can help in systems where implementing change or new systems may be difficult. The HEP program benefitted greatly from the presence of a knowledgeable champion inside the WA Department of Corrections.

An effective inmate hepatitis education program can help control the spread of hepatitis while assisting patients to manage their condition successfully.

How do you provide hepatitis education in your setting? Share your tips in the comments section of this post.

This post is part of a series discussing topics addressed during sessions of the 2016 Spring Conference on Correctional Health Care. All posts in this series can be found HERE.