Lack of hep C treatment for N.S. inmates missed opportunity in disease control: advocates
When people with the disease are living in close quarters, it can create opportunity for infection to spread
Health-care practitioners say the lack of treatment options for provincial inmates with hepatitis C is creating inequities in health care and missing an opportunity to control the spread of the disease.
Treatment for non-incarcerated Nova Scotians is publicly available.
Dr. Lisa Barrett is an infectious disease doctor who sees inmates with HIV and hepatitis C at the Central Nova Scotia Correctional Facility in Dartmouth, N.S.
She said when she sees an inmate with hepatitis C, she advises them about how to maintain a healthy liver and avoid toxins — and then tells them that she can't offer treatment.
"Even if you are ready, engaged and asking to be treated within the correctional setting right now, unless we have a compassionate access program from a drug company, we don't have access to care, in terms of treatment," said Barrett.
"And that's a difficult conversation to have … because I know that the patient, the person I'm trying to look after, in front of me, is not getting the same care that someone about five kilometres away potentially is getting."
There are a number of treatments for hepatitis C on Nova Scotia's drug formulary, including a breakthrough treatment that can cure most people with the disease through a 12-week daily pill regimen. The province covers the cost of several of these treatments for Nova Scotians — unless they're incarcerated provincially.
'Just live with it'
Hepatitis C is a progressive infection spread through blood-to-blood contact such as intravenous drug use or dirty tattoo needles. In its later stages, it can cause liver failure and cancer, although it may take decades to get to that point.
But even in its earlier stages, hepatitis C can cause nausea, a lack of motivation and fatigue.
Justin Curran, 28, said his fatigue makes him feel as though he could fall asleep at any time.
Curran was released from jail in February 2018 after serving a two-year sentence for robbery. Prior to being incarcerated, he contracted hepatitis C from intravenous drug use.
While in jail, he said he asked for treatment twice — once at the Northeast Nova Scotia Correctional Facility in Pictou County and once at the Cape Breton Correctional Facility in Sydney — and was denied both times.
"It made me pretty depressed, actually, that it was basically telling me, 'Here, just live with it.' It's letting someone know that it's hurting your insides, and you can get treatment, but they won't [provide it]. It doesn't make sense to me at all."
Curran said while he was incarcerated in Pictou, several other inmates in his unit were also seeking treatment for hepatitis C and were also turned down.
"I could count names off for probably 10 minutes of people I met with [hepatitis C] inside the institutions. I know a couple people in there, they were pretty sick. You could see the yellowing starting, and they don't do anything. It's crazy."
Disproportionate rates of infection
A disproportionately high number of inmates have hepatitis C. Research suggests that between 15 and 30 per cent of inmates in Canada are infected, and some estimates place that figure even higher. The prevalence of hepatitis C in the general population is roughly 0.6 per cent.
When so many people with hepatitis C are living in close quarters, that creates an opportunity for the infection to spread, said Barrett.
"These are the populations of folks who really would benefit from the … prevalence [of hepatitis C] going down. Meaning, the less there is floating around, the less likely you're going to run into it. And that's where treatment as prevention is very important. You're not treating one person, you're treating the four others who could get infected from that person."
In a statement, the Nova Scotia Health Authority said that there was a lack of clarity regarding coverage, which they are now looking to rectify, and that they are working with the group developing the province's Hepatitis C Elimination Program.
A missed opportunity
But the concentration of people with hepatitis C in correctional facilities isn't just a challenge — it's also an opportunity, according to health-care practitioners.
Jac Atkinson is a nurse practitioner with Mobile Outreach Street Health. She works with people who are homeless and insecurely housed, including those dealing with mental health and addiction issues — a population that's often in contact with the justice system.
She says a barrier to treating this population is the difficulty practitioners have in getting access to them.
"In corrections we have this extraordinary opportunity where … you have them hostage. So, they're not distracted, you know where they are, you can contact them, you can get blood work, you can do all those things," said Atkinson. "So we should be using that opportunity."
With files from Information Morning