Hepatitis C in psychiatry inpatients: Testing rates, prevalence and risk behaviours

Objective: Estimates for the prevalence of hepatitis C among people with a serious mental illness are high compared with the general population. High-risk behaviours commonly associated with mental illness may contribute to the estimated increased prevalence. This study aims to assess the contribution of risk behaviours to blood-borne virus infection in psychiatric populations in Australia, and to determine whether a pre- and post-test education and counselling program increases the number of patients willing to be tested for hepatitis C. Method: The proportion of psychiatric inpatients being screened for hepatitis C at the Alfred Hospital over a 6-month period was obtained by retrospective review of the number of admissions and hepatitis C serology tests. The change in screening rate was prospectively recorded following the introduction of an education and voluntary screening program. In the study period, 346 people were approached and 84 (24%) agreed to participate. Pre- and post-test counselling, including a thorough risk assessment, were offered to all participants. Venous blood was tested for hepatitis C. A modified version of the Risk Behaviour Questionnaire was used to measure sexual and drug-related risk behaviour. Results: The proportion of inpatients being tested for hepatitis C increased from 9% in the 6 months prior to the study, to 18% during the study (p<0.01). The rate of hepatitis C in those consenting to testing was 19.4%. Participants reported high rates of risk-taking behaviours, including intravenous drug use and unprotected sex. Conclusions: An education and counselling program can increase rates of screening among psychiatric inpatients. There are high rates of risk-taking behaviour among this group of psychiatric inpatients, which may contribute to the higher prevalence of hepatitis C compared to the general population.