Kirsten Mostad Pedersen, senior adviser

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1 Kirsten Mostad Pedersen, senior adviser
Norwegian Directorate of Health, Primary Health Care Services division , Dep for Minority Health and Rehabilitation This is from Bastøy in Oslofjorden, a relatively large prison. The inmates lives in houses taking care of their own household, buy groceries in the prisons shop. Inmates are often transferred from a prison with higher security and zones the last part of their sentence here. In accordance with the principle of normality, progression through a sentence should be aimed as much as possible at returning to the community. The longest prison sentence in Norway is 21 years, although the new Penal Code provides for a 30-year maximum sentence for crimes related to genocide, crimes against humanity or some other war crimes. The average sentence is around 8 months. Over 60 % of unconditional prison sentences are up to 3 months, and almost 90 % is less than a year. There is a one-man-one-cell policy based on the principle of a humane detention that has created some problems in the sense that the capacity not always has been sufficient to receive the number of sentenced persons. A “waiting list” for sentenced prisoners occurred, implying that one was released after the passing of the sentence and received a letter saying when to report at which prison at some point afterwards. This could take up to a year. Since this was considered bad practice and an extra punishment for the offender, extensive measures were taking to reduce this list. At the moment it has been reduced to some 25 % of its length. There are almost no escapes from prison in Norway and over 99 % of all prisoners on temporary leaves return on time. Some 3,600 full-time equivalent staff is employed in the prison service, and around 325 in probation. Riga, February 19

2 Prevalence Tuberculosis, HIV and Hepatitis C in Norway
2012 2013 2015 2016 TBC 378 401 318 293 HIV 242 234 211 220 Hepatitis C 1491 1320 1168 771 This a national overview, there is no specific statistics regarding inmates in prison. TBC – 70 % pulmonary – mainly immigrants from Africa and Asia. Low incidence in the etnical population HIV – totaly diagnosed 6064 ( 4105 men and 1959 women). In % immigrants infected before arriving Norway, 1/3 allready diagnosed before arriving N. Nearly 50 % of men infected have homosexual practise. Totaly 83 children. And 627 infected by needels. Hepatitt C – estimated 87 % addict using needles. Immigrants infected in their homeland 14 %(2015). Examinations done in Oslo by the field care shows that about 68 % of addicts are infected, and 62 % using public room for injection. 19/02/2019

3 Treating Hepatitis C in Norway
The specialized Health care responsible for treatment Free of charge for the infected Interferon + Ribavirin. Infected with cirrhosis + polymerase inhibitors Genotype 1 •Pasienter uten cirrhose behandles med sofosbuvir/ledipasvir (SOF/LDV) i 8 uker. Patients without cirrhosis treated with sofosbuvir / ledipasvir (SOF / LDV) for 8 weeks •Pasienter med cirrhose behandles med SOF/LDV eller ombitasvir/ritonavir-boosted paritaprevir (OBV/PTV/RTV) + dasabuvir (DSV) i 12 uker. Patients with cirrhosis treated with SOF / LDV or ombitasvir / ritonavir boosted paritaprevir (OBV / PTV / RTV) + dasabuvir (DSV) for 12 weeks. Genotype 2 •Pasienter som er 40 år eller yngre uten cirrhose behandles med pegylert inferferon alfa (pegIFN) + ribavirin (RBV) i 4 uker. Hvis HCV RNA ikke påvises i uke 4, behandles pasienten i totalt 12 uker. Hvis HCV RNA påvises bør behandlingen avbrytes. Hvis det foreligger betydelig leverfibrose rebehandles pasienten med regimet for de som er eldre enn 40 år. •Pasienter som er eldre enn 40 år behandles med SOF + RBV i 12 uker. Genotype 3 •Pasienter som er 40 år eller yngre uten cirrhose behandles pegIFN + RBV i 4 uker. Hvis HCV RNA ikke påvises i uke 4, behandles pasienten i totalt 12 uker. Hvis HCV RNA påvises bør behandlingen avbrytes. Hvis det foreligger betydelig leverfibrose rebehandles pasienten med regimet for de som er eldre enn 40 år. •Pasienter som er eldre enn 40 år og/eller har kompensert cirrhose behandles med pegIFN + SOF + RBV i 12 uker. ◦Pasienter med kontraindikasjoner mot interferon kan behandles med: ◾SOF+daklatasvir (DCV)+RBV i 12 uker (16 uker ved cirrhose). ◾SOF+RBV i 24 uker. Genotype 4 •Behandles med OBV/PTV/RTV eller SOF/LDV i 12 uker. 19/02/2019

4 Focus on Prisoners Health in Norway
Follow-up of Victoria Cramers survey (2014 SIFER) “The prevalence of mental disorders among convicted inmates in Norwegian prisons» Closing the gap between release – back to community Mapping disease incidence in Norwegian prisons Follow-up – knowlegde and competence for health personell working in prison. Emphazing cooperation between health and the sentence autorities on all levell. 19/02/2019