Theme: Models of Care Year: 2022
Background:
BBV infection is higher in those frequently interacting with the criminal justice system. Opt-out
testing is offered in Scottish prisons. Police Custody suites have healthcare provision and are an
opportunity to diagnose BBV in those that are not subsequently incarcerated but are similarly at risk
and engage poorly in conventional healthcare. DBS samples offer an alternative to venous blood,
allowing BBV testing to occur in this setting.
Description of model of care/intervention:
Between 25/9/21 and 10/12/21 DBS PCR BBV testing was offered to all detainees referred to
healthcare in police custody after arrest. Nurse teams were trained in the process. Consent was
obtained. A clinical pathway was developed.
Effectiveness:
117 were offered DBS PCR. 4/117 (3.4%) underwent DBS BBV testing-all negative. 113/117 (96.5%)
did not undergo DBS PCR testing. Test was not done due to intoxication 13/113 (11.5%), known
hepatitis C infection in follow up or treatment in 6/113 (5.3%), mental health crisis or physical injury
in 3/113 (2.6%), non-English speaking in 2/113 (1.76%), refused without reason given in 47/113
(41.6%), recent BBV testing through other services in 14/113 (12.4%) and declined by patient as no
perceived BBV risk 20/113 (17.9%). The reason was unrecorded in 9/113 (7.9%). 2/113 (1.76%) were
freed from custody prior to testing.
Conclusion and next steps:
A low proportion undertook testing. No new positive cases were identified. This reflects a setting in
which acute crises in addiction and mental health are common. The immediate health issues in
police custody focus on addiction and suicide management. Patients and staff may not perceive BBV
testing to immediately important. Harm reduction and signposting for BBV management may be
more effective in this setting. A further evaluation of staff perception of barriers to testing is
planned. Further training after feedback to staff may improve testing figures.
Disclosure of Interest Statement:
All authors declare no conflicts of interest. No sources of funding or support were sought or received
for this work.