Quality statement 3: Blood-borne viruses and sexually transmitted infections

Quality statement

People entering or transferring between prisons are tested for blood-borne viruses and assessed for risk of sexually transmitted infections.

Rationale

There are higher rates of blood-borne viruses and sexually transmitted infections in the prison population. Carrying out blood-borne virus testing when people enter or transfer between prisons, in line with Public Health England's blood-borne virus opt-out policy, means that if they do have a blood-borne virus they can receive support and treatment. In addition, they can also receive support for any underlying causes such as intravenous drug use. Assessing a person's risk of sexually transmitted infections, based on their sexual history, means they can receive necessary testing and treatment.

Quality measures

Structure

a) Evidence of local arrangements to test for blood-borne viruses when people enter or are transferred between prisons.

Data source: Local data collection including blood-borne virus testing protocols. The NHS England health and justice indicators of performance include data on the uptake of hepatitis B and C screening, and HIV testing.

b) Evidence of local arrangements to ensure that people entering or transferring between prisons are assessed for the risk of sexually transmitted infections.

Data source: Local data collection including sexual health policies.

Process

a) Proportion of second-stage health assessments for people entering or transferring between prisons where testing for blood-borne viruses takes place or has already been completed.

Numerator – the number in the denominator where testing for blood-borne viruses take place or has already been completed.

Denominator – the number of second-stage health assessments for people entering or transferring between prisons.

Data source: Local data collection including health records. The NHS England health and justice indicators of performance include data on the uptake of hepatitis B and C screening, and HIV testing.

b) Proportion of second-stage health assessments for people entering or transferring between prisons where assessment for the risk of sexually transmitted infections takes place or has already been completed.

Numerator – the number in the denominator where assessment for the risk of sexually transmitted infections takes place or has already been completed.

Denominator – the number of second-stage health assessments for people entering or transferring between prisons.

Data source: Local data collection including health records.

Outcome

a) The number of people diagnosed and treated for blood-borne viruses in prisons.

Data source: Local data collection including healthcare records. The NHS England health and justice indicators of performance include data on people diagnosed with hepatitis B or C being referred to a specialised service and receiving treatment within 18 weeks. They also include data on the number of people who are HIV positive who are seen by secondary care within 2 weeks.

b) The number of people diagnosed and treated for sexually transmitted infections in prisons.

Data source: Local data collection including healthcare records. The NHS England health and justice indicators of performance include data on the uptake of chlamydia screening.

What the quality statement means for different audiences

Service providers (providers of healthcare in prisons) ensure that systems are in place for people entering and transferring between prisons to have blood-borne virus testing in line with Public Health England's blood-borne virus opt-out policy and assessment for the risk of sexually transmitted infections at the second-stage health assessment. If people in prison are diagnosed with a blood-borne virus or sexually transmitted infection, they should ensure that systems are in place to provide treatment and support, including specialist referral.

Healthcare professionals (GPs, nurses and healthcare assistants in prisons) test people entering and transferring between prisons for blood-borne viruses and assess them for the risk of sexually transmitted infections based on their sexual history. They encourage people to discuss their possible risk factors and make them feel comfortable to do so.

Commissioners (NHS England) ensure that prison healthcare services have systems in place for people entering and transferring between prisons to have blood-borne virus testing in line with Public Health England's blood-borne virus opt-out policy and assessment for the risk of sexually transmitted infections at the second-stage health assessment. Specialist treatment and support services should be available to people in prison who are diagnosed with a blood-borne virus or sexually transmitted infection.

People going into prison or moving to a new prison have tests for HIV, hepatitis B and hepatitis C within 7 days of arriving at the prison. They also have their risk of sexually transmitted infections such as chlamydia or gonorrhoea assessed, based on the information they give about their sexual history. If, after testing, they are diagnosed with one of these viruses or infections they can be offered specialist referral, treatment and support.

Source guidance

Physical health of people in prison (2016) NICE guideline NG57, recommendations 1.1.23, 1.1.24 and 1.1.29

Definitions of terms used in this quality statement

Blood-borne virus testing

These are blood tests to identify whether a person has a blood-borne virus. The most common examples of blood-borne viruses are HIV, hepatitis B and hepatitis C.

[NICE guideline on physical health of people in prison, full guideline and expert opinion]

Assessment for the risk of sexually transmitted infections

This is done by using the person's sexual history and can be carried out at the second-stage health assessment.

[Adapted from NICE's guideline on physical health of people in prison, recommendation 1.1.29 and expert opinion]

Sexually transmitted infections (STIs)

Infections that are acquired through sexual contact, including chlamydia, genital warts, genital herpes, gonorrhoea and syphilis.

[NICE guideline on physical health of people in prison, full guideline and expert opinion]

Equality and diversity considerations

People should be provided with information that they can easily read and understand themselves, or with support, so they can communicate effectively with health services. Information should be in a format that suits their needs and preferences. It should be accessible to people who do not speak or read English, and it should be culturally appropriate. People should have access to an interpreter or advocate if needed.

For people with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's accessible information standard.

Some people who are at risk of sexually transmitted infections based on their sexual history may be vulnerable for example, because of abuse, or drug or alcohol dependency. Healthcare professionals should discuss the risk of sexually transmitted infections sensitively and in a supportive, non-judgemental way.