Incidence and correlates of hepatitis C virus infection in a large cohort of prisoners who have injected drugs

Abstract

BackgroundHepatitis C virus (HCV) infection is common among prisoners, particularly those with a history of injecting drug use (IDU). Incarcerated people who inject drugs frequently report high-risk injecting practices both in prison and in the community. In spite of rising morbidity and mortality, utilisation of HCV-related services in Australia has been persistently low. This study aimed to describe the incidence, prevalence and correlates of HCV seropositivity in a large cohort of prisoners who have injected drugs, and to identify correlates of receiving confirmation of active infection.MethodsData-linkage to a State-wide statutory notifiable diseases surveillance system was used to investigate the incidence of notified HCV seropositivity, seroconversion and confirmed HCV infection in a cohort of 735 prisoners with a history of IDU, over 14 years of follow up. Hepatitis C test results from prison medical records were used to identify correlates of testing positive in prison.ResultsThe crude incidence of HCV notification was 5.1 cases per 100 person-years. By the end of follow up, 55.1% of the cohort had been the subject of a HCV-related notification, and 47.4% of those tested in prison were HCV seropositive. In multivariable analyses, injecting in prison was strongly associated with HCV seropositivity, as was opioid use compared to injection of other drugs. The rate of reported diagnostic confirmation among those with notified infections was very low, at 6.6 confirmations per 100 seropositive participants per year.ConclusionsInjecting drugs in prison was strongly associated with HCV seropositivity, highlighting the need for increased provision of services to mitigate the risk of transmission within prisons. Once identified as seropositive through screening, people with a history of IDU and incarceration may not be promptly receiving diagnostic services, which are necessary if they are to access treatment. Improving access to HCV-related services will be of particular importance in the coming years, as HCV-related morbidity and mortality is increasing, and next generation therapies are becoming more widely available.

Hepatitis C and associated risks in prisons: an integrative review Hepatite C e riscos associados em presídios: uma revisão integrativa

“…The prevalence of HCV among the individuals tested was 47.4%. 15 Regarding the association of Hepatitis C with the use of injecting drugs in the incarcerated population, this finding was in agreement with another investigation in which the prevalence of HCV was 80%. 16 The study carried out at the philanthropic, private and public drug treatment centers of Goiânia (GO) and Campo Grande (MS), with a sample of 691 users, of which 102 were IDUs and 589 non-injecting drug users ( NIDU).…”

The naked truth about HIV and risk taking in Swedish prisons: A qualitative study

“…Prevalence of injective drug use (IDU) in prisons has been shown to vary from 2.4% to 74%, depending upon the setting [ 2 ]. In one study from Australia, 46% of the 355 participants with a history of IDU continued to inject drugs while imprisoned and in another Australian study 39.2% of the 735 prisoners reported having injected drugs in the prison [ 7 , 8 ]. Studies have shown that although injective drug usage diminishes during incarceration, needles are shared more frequently [ 9 ].…”

History of detention and the risk of hepatitis C among people who inject drugs in Germany

“…In the only existing, representative study of the German prison population from 2007, 33% of PWID reported injecting in prison (Eckert, 2008). Similar rates have been found in countries like Australia, Denmark, and Greece; however, the lifetime prevalence of injecting in prison has been reported at significantly higher rates (Dolan et al, 2010;Snow et al, 2014;Luciani et al, 2014;Christensen et al, 2000;Malliori et al, 1998). To a certain extent, prisons also serve as a place where injecting drug use is initiated (Eckert, 2008;Taylor et al, 1995;Butler et al, 2004).…”