Prevalence and epidemiological correlates and treatment outcome of HCV infection in an Italian prison setting

Abstract

BackgroundThe aim of the present study is to test in the feasibility of a screening programme for HCV infection in an Italian prison and to evaluate the treatment outcomes.MethodSingle-centre cross-sectional study carried out in Milan-Opera. The HCV infection prevalence was calculated on the imprisoned population on the January 31 2006, the data on treatment over the following 2 years. Treatment option offered to HCV chronically infected patients was then analysed, reasons for not being treated was evaluated.ResultsOf the 965 inmates, 695 were enrolled in the study, 682 (98%) were males, the median age was 43 years. There were 131 (18.8%) foreigners and 564 (81.2%) Italians. HCV seroprevalence was 22.4%(95% CI:19.4%-25.7%), 60 subjects (38.4%) being HIV co-infected too. Prevalence of HCV infection was significantly higher in HIVAb positive (89.6%; 95% CI:79.7%-95.7%) than in HIVAb negative (15.15%; 95% CI 12.6%-18.3%) (p<0.001). Among Italian inmates HCVAb positivity was significantly higher than among foreigners (p=0.0154). Among HCVAb positive patients, 135 subjects were HCV-RNA positive. Forty-seven (36%) had major clinical contraindication to treatment, 18 (13%) refused the treatment, 7 (5%) moved to other Institute and 27 (20%) were not evaluated by infectious disease specialists. Fifteen patients (43%) who received treatment were considered responders, 9 (26%) were non responders/relapsers, 6 (17%) interrupted treatment due to side effects and 5 (14%) were released during treatment and lost in follow-up.ConclusionsThis study indicates that the proportion of patients in a prison setting receiving diagnosis and treatment for HCV infection remained low.

Prevalence of hepatitis C virus infection among prisoners in Iran: a systematic review and meta-analysis

“…Compared to international studies, this rate is higher than the prevalence reported among prisoners in Italy (22.4%) [ 27 ], in Brazil (2.4%) [ 17 ], and in France (4.8%) [ 28 ], and lower than the prevalence reported in California (34.3%) [ 29 ] and in Indonesia (34.1%) [ 30 ].…”

“…Even though numerous studies have assessed the cost-effectiveness of screening prisoners for HCV, there is a dearth of information specifically concerning Iran. Furthermore, despite the fact that HCV is very common in prisoners and threatens their health status and conditions, there is still no screening program in Iran as well as in many countries [ 27 ]. Over the past years, policies have been developed in Iran to improve the health situation in Iran’s prisons, but these efforts have not been sufficient and there is still a huge gap to be filled [ 31 ].…”

Epidemiological burden estimates for pathologies with a nonconstant risk

“…With regard to the 17 applicable records, the following records were discarded:Epidemiological surveys of populations in specific areas that featured high rates of HCV prevalence [9,10] ;Epidemiological surveys of hospitalized subjects and/or healthcare facilities [11] ;Epidemiological surveys of specific population subgroups, in particular drug addicts and the prison population [12,13] ;Surveys that did not specifically report the distribution of the prevalence by age group. [14–16] …”

“…Epidemiological surveys of specific population subgroups, in particular drug addicts and the prison population [12,13] ;…”

Current and forthcoming perspectives in linkage to care of hepatitis C virus infection: Assessment of an Italian focus group

“…Of these, around 30% are foreigners, and the annual turnover is 50%. It has been calculated that nearly one-fourth of the prison population is anti-HCV positive [38,39]. Unfortunately, there are still many limitations to improve HCV linkage to care in prisons, including overcrowding, fast site turnover, interactions with local health care services and bureaucratic issues related to the approval of drugs for prescription in prisons.…”