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The purpose of this paper is to provide education on blood-borne viruses (BBVs) to prison staff to help reduce stigma within the prisons, improve the care prisoners receive and reduce the risk of occupational transmission.

An e-module was used to improve staff understanding of hepatitis B (HBV), hepatitis C (HCV) and HIV at a prison in Wales, UK. An assessment was used to gather data on prison staff understanding of BBVs prior to undertaking the e-module.

In total, 530/697 (76 per cent) prison staff completed the BBV e-module. Average pre- and post-course assessment scores were 8.6/11 and 10.85/11, respectively. Most staff understood the modes of hepatitis transmission, however, gaps in understanding were highlighted. In total, 22 per cent of staff believed HBV and HCV were airborne, 9 per cent believed transmission occurred through sharing cutlery. In total, 31 per cent of staff believed prisoners with hepatitis should declare their status to the prison.

The e-module significantly improved staff understanding of BBVs and should be incorporated into future prison training packages. Future education should include how BBVs are not transmitted with an emphasis on casual contact. Medical confidentiality in prisons should also be addressed. Improving understanding will help reduce the stigma of BBVs within prison and improve the multidisciplinary care the prisoner receives.

To the authors knowledge this is the first published evaluation of a BBV learning package for custodial staff. Evaluation of this educational package demonstrates a unique and valuable insight into the general understanding of BBVs by prison staff in Wales, UK.

When Mandie Wilkinson's patients ran a mile after tests for hepatitis and HIV, she had no idea her efforts would lead to a highly successful blood borne virus clinic. There were many hurdles. Not only are patients reluctant to test for potentially fatal diseases such as hepatitis C, but the options for treatment are limited. Working with drug users is not everyone's cup of tea either and finding staff proved equally difficult. Now six years down the line, Mandie's nursing team has treated over 40 high‐risk patients, tests for liver cancer, provides community treatment programmes and is developing new screening methods for deep vein thrombosis and cervical cancer.

This paper aims to describe the strategies being put in place to develop blood borne virus (BBV) services across prisons in Wales, UK, in response to the recommendations for prisons within the Welsh Government's Blood Borne Viral Hepatitis Action Plan for Wales.

A task and finish group was established to ensure multidisciplinary engagement between healthcare and custody staff. A service improvement package was developed focusing on awareness raising and/or development of clinical services for prisoners, prison officers and prison healthcare staff.

Prison healthcare staff have undergone training in BBVs and are being supported to deliver clinical services to prisoners. Training has been delivered in pre/post test discussion and dried blood spot testing; care pathways have been established between prison and community specialists for treatment referrals. An e‐learning module is being rolled out to raise awareness amongst custody staff and encourage occupational hepatitis B vaccination. Literature on “liver health” has been produced to be given to every prisoner across Wales.

It is envisaged that BBV services will become a routine part of prison care in Wales. Data on activity are being collected for evaluation and it is hoped that tackling BBVs in prisons will help reduce rates of infection both within prisons and in the wider community.

This paper describes new initiatives that have been established to tackle BBVs across Welsh prisons and will be relevant to any prison healthcare staff looking to develop similar services.

The aim of this study is to explore the characteristics of a group of patients over 50 years old who are entering a substitution treatment programme for opioid dependence and to compare the characteristics of this group with those aged under 50 who are enrolled in the same substitution treatment programme.

This is a cross sectional survey involving 92 cases in the 50 and above age group and 194 cases in the under 50 age group from community drug and alcohol services. Data were collected on demographic details, substance misuse and treatment history and progress with treatment. All the data were analysed using the Statistical Package for the Social Sciences (SPSS), version 1.1. Statistical significance between fewer than 50 and 50+ groups were assessed using Fisher's exact test.

Amongst the 92 in the group 50 years and above, 67 (average dose=63.25 mg) were on methadone maintenance (average dose=63.25 mg) and 19 (average dose=10.37 mg) on buprenorphine. In total, 11 per cent started using opiates after the age of 50. Sixty per cent used other substances out of which 31 per cent used multiple substances. Benzodiazepines, cocaine and amphetamines were the common substances of misuse. Thirty seven were infected with HCV. Comorbid rates for physical and mental illnesses were 64 per cent and 62 per cent, respectively. Nearly 86 per cent achieved good compliance with the treatment programme. Statistically higher rates of being single, lacking stable accommodation, prescription of buprenorphine, high dose prescriptions and lower rates of blood‐borne viruses, physical health and mental health, past forensic history were found in the under 50 age group compared with the 50+ age group.

There are a considerable number of patients above the age of 50 in maintenance treatment and they differ from the less than 50 age group. Old age and substance misuse psychiatrists should be aware of the prevalence of comorbid substance misuse, physical (including blood borne viruses) and psychiatric disorders in this population. Further research is required in this neglected area and a service provision should be based on such robust research.

This is the first study to the authors' knowledge that compares the demographic and treatment profiles of under 50 and over 50 years by age of patients in a methadone maintenance treatment programme. It clearly points to significant differences in the profiles based on age which will have implications for service provision which will have to take into account these age‐related differences in particular related to physical health and social needs.

Prison officers face multiple occupational hazards including needlestick injuries, which may result in the transmission of blood‐borne viral infections. This study aimed to assess the prevalence of needlestick injuries, the circumstances under which needlestick injuries occur and the responses of injured prison officers. Cross‐sectional data were collected from prison officers in two Australian jurisdictions between January and May 2006, using a self‐report questionnaire. Descriptive analyses were conducted. Of 246 prison officers who completed the survey, two‐thirds had found needles and syringes in the workplace. Seventeen officers (7%) reported having experienced a needlestick injury. Most injuries occurred during searches. Serological testing for blood‐borne viral infections following injury was common, but less than half the injured officers accessed support services. Needlestick injuries appear to be a relatively rare occurrence, but may be further reduced by improving search techniques and equipment and regulating needles and syringes in prisons.

The purpose of this paper is to evaluate the prevalence of HBV and/or HCV co-infection among HIV-infected inmates entering the correctional facility.

Prospective collection of data of HIV-infected inmates entered the institution over a ten-year period.

During study period 365 consecutive different inmates were evaluated. HCV co-infection was observed in more than 80 per cent of the tested HIV-infected inmates, past HBV infection in 71.6 per cent and active HBV co-infection was detected in 7.1 per cent; triple coinfection (HIV, HCV and HBs-Ag positivity) was present in 6 per cent of the total.

This study confirms high prevalence of co-infections among HIV-infected inmates. Testing for HBV and HCV in all HIV-infected inmates at entry in any correctional system is recommended to identify those in need of specific care and/or preventing interventions.

This paper aims to explore the cessation of injecting amongst male drug users when in prison in England and uncovers what influenced this behaviour and why.

Qualitative interviews were conducted with 30 male drug users on release from prison to explore what happened to their injecting drug use in prison. The research was conducted from a pragmatic harm reduction approach using grounded theory.

Not injecting in prison was identified as a pertinent finding and nine overarching themes accounted for this decline. The themes often overlapped with one another, highlighting how the decision not to inject when last in prison was multi‐factorial. Running throughout the themes were participants' concerns regarding the health and social risks attributed to injecting in prison, alongside an appreciation of some of the rehabilitative measures and opportunities offered to injecting drug users when in prison.

This qualitative research offers an updated perspective on illicit drug injecting in prison in England from the view of drug users since health and prison policy changes in prescribing and practice. It contributes to evidence suggesting that prisons can be used as a time of reprieve and recovery from injecting drug use.

Prison populations in Western countries are characterised by a high hepatitis C prevalence. This reflects a high rate of imprisonment for drug related offences. Prison entrants who are HCV‐negative face a significant risk of acquiring hepatitis C. Effective prevention strategies and successful treatment of a significant percentage of hepatitis C‐positive inmates could reduce the risk of transmission in the prison context significantly. Several reports of treating hepatitis C in prisoners in major facilities have been published. We report our experience of establishing a liver clinic service in two regional prisons in New South Wales, Australia. Liver biopsy requirements to access treatment in Australia meant that only 46 of 196 reviewed patients were able to commence treatment in our 5‐year experience. Treatment completion rate was 61% and end of treatment viral response was 57%. The removal of liver biopsy requirements in Australia in April 2006 has freed up access to treatment and our results encourage further effort to optimise the process of assessment and treatment in this high‐risk population.

Brazil’s street-based drug use is mostly characterized by non-injection psychostimulant (e.g. crack-cocaine) drug use in Brazil, with limited interventions and service availability. Recently, an influx of multi-ethnic migrants within an urban drug scene in Sao Paulo was associated with heroin use, a drug normatively absent from Brazil. The purpose of this paper is to characterize and compare heroin use-related characteristics and outcomes for an attending sub-sample of clients from a large community-based treatment centre (“CRATOD”) serving Sao Paulo’s local urban drug scene.

All non-Brazilian patients (n = 109) receiving services at CRATOD for 2013–2016 were identified from patient files, divided into heroin users (n = 40) and non-heroin users (n = 69). Based on chart reviews, select socio-demographic, drug use and health status (including blood-borne-virus and other infections per rapid test methods) were examined and bi-variately compared. Multi-variate analyses examined factors independently associated with heroin use.

Most participants were male and middle-aged, poly-drug users and socio-economically marginalized. While heroin users primarily originated from Africa, they reported significantly more criminal histories, drug (e.g. injection) and sex-risk behaviors and elevated rates of BBV (e.g. Hepatitis C Virus and HIV). A minority of heroin users attending the clinic was provided methadone treatment, mostly for detoxification.

This study documented information on a distinct sample of mostly migration-based heroin users in Sao Paulo, Brazil. Based on the local experience, global migration dynamics can bring changes to established drug use cultures and services, including new challenges for drug use-related related behaviors and therapeutic interventions that require effective understanding and addressing.