Hepatitis C prevalence in incarcerated settings between 2013–2021: a systematic review and meta-analysis

Abstract

Background The introduction of highly effective direct-acting antiviral therapy has changed the hepatitis C virus (HCV) treatment paradigm. However, a recent update on HCV epidemiology in incarcerated settings is necessary to accurately determine the extent of the problem, provide information to policymakers and public healthcare, and meet the World Health Organization's goals by 2030. This systematic review and meta-analysis were performed to determine the prevalence of HCV Ab and RNA in incarcerated settings. Methods For this systematic review and meta-analysis, we searched PubMed, Embase, Scopus, and Web of Science for papers published between January 2013 and August 2021. We included studies with information on the prevalence of HCV Ab or RNA in incarcerated settings. A random-effects meta-analysis was done to calculate the pooled prevalence and meta-regression to explore heterogeneity. Results Ninety-two unique sources reporting data for 36 countries were included. The estimated prevalence of HCV Ab ranged from 0.3% to 74.4%. HCV RNA prevalence (available in 46 sources) ranged from 0% to 56.3%. Genotypes (available in 19 sources) 1(a) and 3 were most frequently reported in incarcerated settings. HCV/HIV coinfection (available in 36 sources) was highest in Italy, Estonia, Pakistan, and Spain. Statistical analysis revealed that almost all observed heterogeneity reflects real differences in prevalence between studies, considering I2 was very high in the meta-analysis. Conclusions HCV in incarcerated settings is still a significant problem with a higher prevalence than in the general population. It is of utmost importance to start screening for HCV (Ab and RNA) in incarcerated settings to give clear, reliable and recent figures to plan further treatment. This is all in the context of meeting the 2030 WHO targets which are only less than a decade away. Trial registration PROSPERO: CRD42020162616

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“…On a broader scale, Dana Busschots et al's meta-analysis, which highlighted the extensive variability in HCV prevalence globally, places our study in a global context [26]. It brings to light Italy's position as one of the countries grappling with high HCV/HIV co-infection rates.…”

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“…These findings are consistent with the limited data available in the United States. A recent international meta‐analysis of hepatitis C prevalence in incarcerated settings estimated the prevalence of HCV antibody was 3%–34.6% and HCV RNA was 5.2%–13.6% when limited to US sources included 4 . However, the study noted the heterogeneity of the data, the lack of RNA prevalence in some studies and the lack of multi‐centre data that would be more representative of a whole country.…”

“…A recent international meta-analysis of hepatitis C prevalence in incarcerated settings estimated the prevalence of HCV antibody was 3%-34.6% and HCV RNA was 5.2%-13.6% when limited to US sources included. 4 However, the study noted the heterogeneity of the data, the lack of RNA prevalence in some studies and the lack of multi-centre data that would be more representative of a whole country. Another recent study based on survey data and public data to infer prevalence in the United States estimated that 15.2% of incarcerated persons in the United States were anti-HCV positive and that 8.7% were viremic.…”