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SEPTEMBER 2007
News and Literature Reviews
Tattooing in prisons - Not such a pretty picture Tattoos have recently grown in popularity; recent estimates assert that 10% to 16% of all U.S. adolescents between the ages of 12 and 18 have at least one tattoo. As the prevalence of tattoos increases, so does the risk of transmitting blood borne viruses (BBVs). Recent case studies in prisons have linked unsafe tattooing practices with HIV and hepatitis C virus (HCV) infection in persons with no prior history of intravenous drug use (IDU). Although tattooing is prohibited in most prisons, it is still a relatively common practice in most correctional facilities today and is often conducted without the use of clean needles and unused ink. Hellard et al. conducted a cross-sectional survey of tattoo and drug use history, along with HCV status, across the five largest correctional facilities in Victoria, Australia. The study surveyed 642 inmates in total, 133 of whom were female. A total of 449 prisoners (70%) reported having at least one tattoo. Of this group, 156 of inmates (35%) claimed to have been tattooed while in prison, while another 26 individuals (6%) reported to have been tattooed while in a juvenile detention facility. A significant portion of inmates who had received tattoos outside of prison said they had done so through the use of a nonprofessional tattoo artist. The study also demonstrated that prisoners who have a history of IDU were more likely to have at least one tattoo and were also more likely to have acquired a tattoo in prison. Prisoners who were tattooed in prison had a significantly higher risk of HCV-infection, even after adjusting for IDU history, tattooing outside of prison, body piercing, and length of time in prison. These findings raise questions as to whether or not correctional facilities should provide safer tattooing alternatives for incarcerated persons such as the use of professional tattoo artists and providing sterile tattooing equipment and training to inmates. Tattooing in prisons-Not such a pretty picture. Hellard, M et al. American Journal of Infection Control. 2006;35:477-80. Project ECHO: Linking University Specialists with Rural and Prison-Based Clinicians to Improve Care for People with Chronic Hepatitis C in New Mexico Specialists at the University of New Mexico School of Medicine have begun collaborating with rural clinicians, the Indian Health Service, and prisons in an effort to improve the quality and accessibility of healthcare for New Mexicans living with HCV. The effort, named the Project Extension for Community Healthcare Outcomes Project (Project ECHO), seeks to use telemedicine and distance-learning methods to discuss HCV case studies in patients at rural clinics. Project ECHO is designed to share the knowledge of HCV specialists with primary-care physicians, an endeavor of great importance given that nearly all of the counties in New Mexico are listed as medically underserved and almost half are considered to have health professional shortages. Although an estimated 32,000 New Mexicans are currently living with HCV, infectious disease specialists, gastroenterologists, and hepatologists with experience in HCV treatment are few and far between. As such, Project ECHO has used teleconferencing and videoconferencing; internet-based assessment tools; online presentations; and telephone, fax, and e-mail communications to connect specialists with health care providers across New Mexico. Project ECHO partner organizations, which are recruited through statewide health care conferences, conduct a one day training workshop for clinicians, after which clinicians shadow ECHO team members in the University of New Mexico HCV Clinic. Since Project ECHO's inception in June 2003, 173 clinics have been conducted and a total of 1,843 disease-management case studies have been presented. Moreover, health care providers in New Mexico have earned 2,997 hours of continuing education credits and 390 hours of on-site training through this project. In this way, Project ECHO has been an extreme success and is now being considered as a model of how to train primary-care physicians in providing quality care for other chronic medical conditions. Satellite ECHO projects are now underway in other parts of New Mexico and cover such areas as substance abuse disorders, rheumatology, and mental health disorders. The project's founders are hopeful that ECHO team's approach to strengthening the abilities of health care providers could be implemented in developing countries with a high prevalence of disease and limited health care resources. Project ECHO: Linking University Specialists with Rural and Prison-Based Clinicians to Improve Care for People with Chronic Hepatitis C in New Mexico. Arora, S. et al. Public Health Reports. 2007;122:74-77. Promoting HCV Treatment Completion for Prison Inmates: New York State's Hepatitis C Continuity Program This study sought to overcome some of the major barriers in providing HCV treatment to incarcerated persons in New York. In particular, Klein et al. focused their attention on how to best maintain continuity of HCV antiviral treatment for inmates, regardless of their length of stay in correctional facilities. Many correctional systems, including the New York State Department of Corrections Services (DOCS), have policies that do not allow for the initiation of HCV antiviral treatment for patients with limited time left in their sentence as continuation of therapy post-release was not assured. The Hepatitis C Continuity Program was established in an effort to allow inmates to be treated for HCV infection while in prison, regardless of their length of stay in the correctional setting, and to continue treatment through a community-based health care partner after their release. The Program used the combined efforts of the DOCS, the New York State Department of Health (DOH), the New York City public hospital system, and the Health and Hospitals Corporation (HHC) to establish connections between the correctional setting and community health care providers and social workers, as well as establish protocols for incorporating releasees into community health care settings. The DOCS manages most prerelease activities, including scheduling an initial post-release appointment and ensuring that antiviral drugs are given to each inmate upon their release. Hospital staff members work with parole officers in making further all medical appointments with the releasee. Twenty-one health care facilities in New York City now accept inmates and releasees for HCV monoinfection or HCV/HIV coinfection treatment. The urban and suburban locations of these facilities are such that they will be geographically accessible to an estimated 87.1% of releases being treated for HCV. The Hepatitis C Continuity Program demonstrates that it is possible to initiate HCV treatment for prisoners, regardless of their length of stay in prison. While it is perhaps too soon to evaluate the effectiveness of the Program, it is clear that both the individual releasees and society as a whole stand to benefit from this program's success. Promoting HCV Treatment Completion for Prison Inmates: New York State's Hepatitis C Continuity Program. Klein, S. et al. Public Health Reports. 2007;122:83-88. Compiled by: Christine Devore - IDCR Intern
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