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Wurcel AG, Guardado R, Beckwith CG. Hepatitis C Virus Is Associated With Increased Mortality Among Incarcerated Hospitalized Persons in Massachusetts. Open Forum Infect Dis 2021; 8:ofab579. [PMID: 34934776 PMCID: PMC8684448 DOI: 10.1093/ofid/ofab579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/15/2021] [Indexed: 11/29/2022] Open
Abstract
Hepatitis C virus (HCV) is curable, but incarcerated populations face barriers to treatment. In a cohort of incarcerated hospitalized patients in Boston, Massachusetts, HCV infection was associated with increased mortality. Access to HCV treatment in carceral settings is crucial to avoid unnecessary death and to support HCV elimination efforts.
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Affiliation(s)
- Alysse G Wurcel
- Division of Geographic Medicine and Infectious Diseases, Department of Medicine Tufts Medical Center, Boston, Massachusetts, USA.,Tufts University School of Medicine, Boston Massachusetts, USA
| | - Rubeen Guardado
- Division of Geographic Medicine and Infectious Diseases, Department of Medicine Tufts Medical Center, Boston, Massachusetts, USA
| | - Curt G Beckwith
- Division of Infectious Diseases, Alpert Medical School of Brown University, The Miriam Hospital, Providence, Rhode Island, USA
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2
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Dan-Nwafor CC, Adeoye I, Aderemi K, Onuoha M, Adedire E, Bashorun A, Osunkwo D, Gidado S, Balogun M, Idris S, Ade-Yusuf I, Udom E, Nguku P. Serological markers and risk factors associated with Hepatitis B virus infection among Federal Capital Territory prison inmates, Nigeria: Should we be concerned? PLoS One 2021; 16:e0248045. [PMID: 33705419 PMCID: PMC7951833 DOI: 10.1371/journal.pone.0248045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 02/18/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Hepatitis B virus (HBV) infection is hyper-endemic in Nigeria. Prisons are high-risk environments for the spread of infectious diseases. Worldwide, seroprevalence of HBV infection is substantially higher among individuals in correctional facilities when compared to general population. We determined the seroprevalence and risk factors associated with HBV infection among Kuje prison inmates, Nigeria. Material and methods We conducted a prison facility based cross-sectional study. Interviewer administered questionnaires were used to obtain information on participants socio-demographic characteristics, HBV risk factors, previous HBV test and vaccination history. Blood samples collected from participants were analysed for HBsAg, HBsAb, HBcAb, HBeAg and HBeAb markers using rapid lateral chromatographic immunoassay kit. Univariate, bivariate, and multivariate analysis were performed. Results A total of 271 inmates (63 convicts and 208 awaiting trial inmates) were recruited into the study as participants. The mean age of the participants was 32.7 SD±9 years. HBV seroprevalence (HBsAg) of 13.7% (95% CI: 9.8–18.3) was found. 55.4% (95% CI: 49.2–61.4) of inmates were susceptible to HBV infection, 20.7% (95%CI; 16.0–26.0) had past HBV infection while 10.3% (95% CI: 7.0–14.6) had acquired natural or artificial HBV immunity. Factors found to be associated with current HBV infection (HBsAg) include age-group ≤25years (aOR = 8.0,95% CI: 2.9–22.3), being ever married (aOR = 4.2, 95% CI: 1.7–10.4) and history of alcohol consumption (aOR = 3.4, 95% CI: 1.3–8.4). Conclusion This study reveals a high seroprevalence of HBV infection among Kuje Prison inmates, hence the need to introduce prison-focused health intervention initiatives such as HBV screening, vaccination and care to reduce the transmission of HBV infection among inmates and ultimately the general population.
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Affiliation(s)
- Chioma Cindy Dan-Nwafor
- Nigeria Field Epidemiology and Laboratory Training Programme, Decatur, Georgia, United States of America
- * E-mail:
| | - Ikeola Adeoye
- Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria
| | - Kehinde Aderemi
- Department of Medical Microbiology and Parasitology, College of Medicine University of Ibadan, Ibadan, Nigeria
| | - Martins Onuoha
- Nigeria Field Epidemiology and Laboratory Training Programme, Decatur, Georgia, United States of America
- Nigerian Prisons Service Headquarters, Abuja, Nigeria
| | - Elizabeth Adedire
- Nigeria Field Epidemiology and Laboratory Training Programme, Decatur, Georgia, United States of America
| | - Adebobola Bashorun
- Nigeria Field Epidemiology and Laboratory Training Programme, Decatur, Georgia, United States of America
| | - Damaris Osunkwo
- Nigeria Field Epidemiology and Laboratory Training Programme, Decatur, Georgia, United States of America
| | - Saheed Gidado
- Nigeria Field Epidemiology and Laboratory Training Programme, Decatur, Georgia, United States of America
| | - Muhammad Balogun
- Nigeria Field Epidemiology and Laboratory Training Programme, Decatur, Georgia, United States of America
| | - Suleiman Idris
- Department of Community Medicine, Ahmadu Bello University, Zaria, Nigeria
| | | | - Ekpedeme Udom
- Nigerian Prisons Service Headquarters, Abuja, Nigeria
| | - Patrick Nguku
- Nigeria Field Epidemiology and Laboratory Training Programme, Decatur, Georgia, United States of America
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Nasir M, Wu GY. HEV and HBV Dual Infection: A Review. J Clin Transl Hepatol 2020; 8:313-321. [PMID: 33083255 PMCID: PMC7562801 DOI: 10.14218/jcth.2020.00030] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/29/2020] [Accepted: 06/07/2020] [Indexed: 12/17/2022] Open
Abstract
Hepatitis E virus (HEV) is a global health problem, affecting about 20 million people worldwide. There is significant overlap of hepatitis B virus (HBV) and HEV endemicity in many Asian countries where dual infections with HEV and HBV can occur. Though the clinical course of HEV is largely self-limited, HEV superinfection in patients with chronic hepatitis B (CHB) can result in acute exacerbation of underlying CHB. HEV superinfection in patients with CHB-related cirrhosis has been identified as a risk factor for decompensated cirrhosis and an independent predictor of mortality. Whereas acute HEV infection in pregnancy can cause fulminant liver failure, the few studies on pregnant patients with dual HBV and HEV infection have shown a subclinical course. Immunosuppression is a risk factor for the development of chronic HEV infection, which can be managed by decreasing the dose of immune-suppressants and administering ribavirin. Vaccination for HEV has been developed and is in use in China but its efficacy in patients with CHB has yet to be established in the USA. In this review, we appraise studies on dual infection with HEV and HBV, including the effect of HEV superinfection and coinfection in CHB, management strategies used and the role of active vaccination in the prevention of HEV.
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Affiliation(s)
- Myra Nasir
- Department of Medicine, Division of Gastroenterology-Hepatology, University of Connecticut Health Center, Farmington, CT, USA
- Correspondence to: Myra Nasir, Department of Medicine, Division of Gastroenterology-Hepatology, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030, USA. Tel: +1-860-470-6616, E-mail:
| | - George Y. Wu
- Department of Medicine, Division of Gastroenterology-Hepatology, University of Connecticut Health Center, Farmington, CT, USA
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Rezende GR, Lago BV, Puga MA, Bandeira LM, Pompilio MA, Castro V, Tanaka TS, Cesar GA, Oliveira S, Yassuda R, Simionatto S, Weis S, Basílio SF, Croda J, Motta-Castro A. Prevalence, incidence and associated factors for HBV infection among male and female prisoners in Central Brazil: A multicenter study. Int J Infect Dis 2020; 96:298-307. [PMID: 32315810 DOI: 10.1016/j.ijid.2020.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/06/2020] [Accepted: 04/08/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Prison populations are at high risk for hepatitis B virus (HBV) infection. The aim of this study was to assess the prevalence, incidence, HBV associated factors and circulating genotypes/subtypes. METHODS A total of 3,368 prisoners from 12 closed prisons were randomly recruited for a cross-sectional study. In addition, a cohort study was conducted 12 months later and included 1,656 individuals. Participants underwent an interview and blood collection for the detection of HBV serological markers and HBV-DNA phylogenetic analysis. RESULTS HBV exposure (anti-HBc+) was 9.8% (95% CI: 8.8-10.8); 11.2% were female and 9.6% were male. HBsAg+ was 0.6%. Only 31.4% of the participants had HBV vaccination-like profile (anti-HBs+ alone; 30.4% male vs. 36.8% female; p=0.004). Most individuals were susceptible to HBV (60.2% female vs. 52.2% male, p=0.001). HBV isolates were classified as genotypes A (45.4%), D (27.3%) and F (27.3%). In males, HBV exposure was associated with increased age. Male prisoners had more evidence of HCV/HBV co-infection (10.7%) than females (3.4%) and the frequency of Treponema pallidum infection among prisoners who had been exposed to HBV was higher in female prisoners when compared with male (39.7% vs. 19.1%). The incidence of HBV was 0.18/100 person-years (95% CI: 0.12%-0.25%). CONCLUSIONS Our results indicate a high prevalence of HBV exposure in prisoners. Despite the low incidence of this infection, the occurrence of new cases indicates the need to implement preventive measures.
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Affiliation(s)
- G R Rezende
- Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - B V Lago
- Fiocruz, Oswaldo Cruz Institute, Rio de Janeiro, RJ, Brazil; Immunobiological Technology Institute, Fiocruz, RJ, Brazil.
| | - M A Puga
- Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - L M Bandeira
- Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - M A Pompilio
- Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Vol Castro
- Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - T S Tanaka
- Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - G A Cesar
- Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Smvl Oliveira
- Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Rts Yassuda
- Division of Health, State Agency of the Administration of Prisons, MS, Brazil
| | - S Simionatto
- Federal University of Grande Dourados, Dourados, MS, Brazil
| | - Sms Weis
- Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - S F Basílio
- Division of Health, State Agency of the Administration of Prisons, MS, Brazil
| | - J Croda
- Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil; Fiocruz Mato Grosso do Sul, Oswaldo Cruz Foundation, Brazil
| | - Arc Motta-Castro
- Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil; Fiocruz Mato Grosso do Sul, Oswaldo Cruz Foundation, Brazil.
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Overton K, Clegg J, Pekin F, Wood J, McGrath C, Lloyd A, Post JJ. Outcomes of a nurse-led model of care for hepatitis C assessment and treatment with direct-acting antivirals in the custodial setting. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 72:123-128. [DOI: 10.1016/j.drugpo.2019.02.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 02/28/2019] [Accepted: 02/28/2019] [Indexed: 12/13/2022]
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Silva TMPM, Ferreto LED, Follador FAC, Vieira AP, Yamada RS, Lucio LC, Titon JP, Torres RH, Amaral GCD, Coelho HC. Characteristics associated with anti-HCV serological markers in prisoners in the state of Paraná, Brazil: a case-control study. Braz J Infect Dis 2019; 23:173-181. [PMID: 31228459 PMCID: PMC9428240 DOI: 10.1016/j.bjid.2019.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/16/2019] [Accepted: 05/21/2019] [Indexed: 12/02/2022] Open
Abstract
Background The prison system in Paraná, Brazil, is experiencing serious problems related to the increasing number of prisoners. Control of hepatitis C virus (HCV) has become more intense because the incarcerated population is considered a high-risk group for contagious diseases due to the favorable conditions found in prisons for the spread of these morbidities. The objective of this study was to identify features associated with hepatitis C infection among male prisoners in correctional institutions of Paraná state, Brazil. Methods This was a case-control study (27 cases and 54 controls) of men incarcerated in 11 penitentiaries in Paraná, Brazil. Information was obtained through a questionnaire in a cross-sectional epidemiological survey on HCV infection during the period from May 2015 to December 2016. Eligible men were recruited after testing positive for anti-HCV antibodies. Cases and controls were selected based on serological results of enzyme-linked immunosorbent assays and were matched by age, location of the penitentiary, and time in prison. Logistic regression analysis was used to identify risk factors for HCV seropositivity. Results The main significant independent risk factor for the acquisition of HCV infection was the use of injectable drugs (OR = 4.00; 95%CI:1.41–11.35; p < 0.001). Conclusions This study provides evidence that HCV infection is associated with drug use by this population. This information is pivotal for tailoring prevention programs and guiding specific socioeducational measures that aim to reduce or prevent HCV transmission within the prison setting.
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Affiliation(s)
- Tânia Maria Pazin Marques Silva
- Western Paraná State University, Department of Life Sciences, Postgraduate Program in Applied Health Sciences, Francisco Beltrão, PR, Brazil
| | - Lirane Elize Defante Ferreto
- Western Paraná State University, Department of Life Sciences, Postgraduate Program in Applied Health Sciences, Francisco Beltrão, PR, Brazil.
| | - Franciele Ani Caovilla Follador
- Western Paraná State University, Department of Life Sciences, Postgraduate Program in Applied Health Sciences, Francisco Beltrão, PR, Brazil
| | - Ana Paula Vieira
- Western Paraná State University, Department of Life Sciences, Postgraduate Program in Applied Health Sciences, Francisco Beltrão, PR, Brazil
| | - Roberto Shigueyasu Yamada
- Western Paraná State University, Department of Life Sciences, General Surgery Residency Program, Francisco Beltrão, PR, Brazil
| | - Léia Carolina Lucio
- Western Paraná State University, Department of Life Sciences, Postgraduate Program in Applied Health Sciences, Francisco Beltrão, PR, Brazil
| | - Joana Perotta Titon
- Western Paraná State University, Department of Life Sciences, General Surgery Residency Program, Francisco Beltrão, PR, Brazil
| | - Renata Himovski Torres
- Division of Public Security and Penitentiary Administration, Penitentiary Deparment, Curitiba, PR, Brazil
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Cooke GS, Andrieux-Meyer I, Applegate TL, Atun R, Burry JR, Cheinquer H, Dusheiko G, Feld JJ, Gore C, Griswold MG, Hamid S, Hellard ME, Hou J, Howell J, Jia J, Kravchenko N, Lazarus JV, Lemoine M, Lesi OA, Maistat L, McMahon BJ, Razavi H, Roberts T, Simmons B, Sonderup MW, Spearman CW, Taylor BE, Thomas DL, Waked I, Ward JW, Wiktor SZ. Accelerating the elimination of viral hepatitis: a Lancet Gastroenterology & Hepatology Commission. Lancet Gastroenterol Hepatol 2019; 4:135-184. [PMID: 30647010 DOI: 10.1016/s2468-1253(18)30270-x] [Citation(s) in RCA: 355] [Impact Index Per Article: 71.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 08/10/2018] [Accepted: 08/13/2018] [Indexed: 01/26/2023]
Abstract
Viral hepatitis is a major public health threat and a leading cause of death worldwide. Annual mortality from viral hepatitis is similar to that of other major infectious diseases such as HIV and tuberculosis. Highly effective prevention measures and treatments have made the global elimination of viral hepatitis a realistic goal, endorsed by all WHO member states. Ambitious targets call for a global reduction in hepatitis-related mortality of 65% and a 90% reduction in new infections by 2030. This Commission draws together a wide range of expertise to appraise the current global situation and to identify priorities globally, regionally, and nationally needed to accelerate progress. We identify 20 heavily burdened countries that account for over 75% of the global burden of viral hepatitis. Key recommendations include a greater focus on national progress towards elimination with support given, if necessary, through innovative financing measures to ensure elimination programmes are fully funded by 2020. In addition to further measures to improve access to vaccination and treatment, greater attention needs to be paid to access to affordable, high-quality diagnostics if testing is to reach the levels needed to achieve elimination goals. Simplified, decentralised models of care removing requirements for specialised prescribing will be required to reach those in need, together with sustained efforts to tackle stigma and discrimination. We identify key examples of the progress that has already been made in many countries throughout the world, demonstrating that sustained and coordinated efforts can be successful in achieving the WHO elimination goals.
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Affiliation(s)
- Graham S Cooke
- Division of Infectious Diseases, Imperial College London, London, UK.
| | | | | | - Rifat Atun
- Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA
| | | | - Hugo Cheinquer
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | | | - Jordan J Feld
- Toronto Center for Liver Disease, Toronto General Hospital, Toronto, Canada
| | | | - Max G Griswold
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | | | - JinLin Hou
- Hepatology Unit and Department of Infectious Diseases, Nanfang Hospital, Guangzhou, China
| | - Jess Howell
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Jidong Jia
- Liver Research Center, Beijing Friendship Hospital, Beijing, China
| | | | - Jeffrey V Lazarus
- Health Systems Research Group, Barcelona Institute for Global Health (ISGlobal), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Maud Lemoine
- Division of Surgery and Cancer, Imperial College London, London, UK
| | | | | | - Brian J McMahon
- Liver Disease and Hepatitis Program, Alaska Native Tribal Health Consortium, Anchorage, AL, USA
| | - Homie Razavi
- Center for Disease Analysis Foundation, Lafayette, CO, USA
| | | | - Bryony Simmons
- Division of Infectious Diseases, Imperial College London, London, UK
| | - Mark W Sonderup
- Division of Hepatology, Department of Medicine, University of Cape Town, South Africa
| | - C Wendy Spearman
- Division of Hepatology, Department of Medicine, University of Cape Town, South Africa
| | | | - David L Thomas
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Imam Waked
- National Liver Institute, Menoufiya University, Egypt
| | - John W Ward
- Program for Viral Hepatitis Elimination, Task Force for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stefan Z Wiktor
- Department of Global Health, University of Washington, Seattle, WA, USA
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Gétaz L, Casillas A, Siegrist CA, Chappuis F, Togni G, Tran NT, Baggio S, Negro F, Gaspoz JM, Wolff H. Hepatitis B prevalence, risk factors, infection awareness and disease knowledge among inmates: a cross-sectional study in Switzerland’s largest pre-trial prison. J Glob Health 2018; 8:020407. [DOI: 10.7189/jogh.08.020407] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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9
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Coinfections between Persistent Parasitic Neglected Tropical Diseases and Viral Infections among Prisoners from Sub-Saharan Africa and Latin America. J Trop Med 2018; 2018:7218534. [PMID: 30532789 PMCID: PMC6247427 DOI: 10.1155/2018/7218534] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 08/23/2018] [Accepted: 10/03/2018] [Indexed: 12/12/2022] Open
Abstract
In Swiss prisons, more than 70% of detained people are foreigners and over one-third originate from sub-Saharan Africa or Latin America. These two regions are endemic for various tropical diseases and viral infections, which persist after migration to nonendemic countries. Parasitic infections (schistosomiasis; strongyloidiasis) and cooccurrent viral infections (HIV, hepatitis B (HBV), and hepatitis C (HCV)) are especially of concern for clinical care but have been neglected in empirical research. These diseases often remain silent for years before causing complications, especially if they occur concomitantly. Our research aimed to study the prevalence rates and coinfections of two neglected tropical diseases, namely, Strongyloides stercoralis and Schistosoma sp. and viral infections among sub-Saharan Africans (SSA) and Latin Americans (LA) in Switzerland's largest pretrial prison. We carried out a cross-sectional prevalence study using a standardized questionnaire and serological testing. Among the 201 participants, 85.6% were SSA and 14.4% LA. We found the following prevalence ratios: 3.5% of HIV (4.1% in SSA, 0% in LA), 12.4% of chronic HBV (14.5% in SSA, 0% in LA), 2.0% of viraemic HCV (1.7% in SSA, 3.4% in LA), and 8.0% of strongyloidiasis (8.1% in SSA, 6.9% in LA). The serological prevalence of schistosomiasis among SSA was 20.3% (not endemic in Latin America). Two infections were simultaneously detected in SSA: 4.7% were coinfected with schistosomiasis and chronic HBV. Four other coinfections were detected among SSA: schistosomiasis-HIV, HIV-chronic HBV, HIV-HCV, and schistosomiasis-strongyloidiasis. To conclude, the high prevalence rates of persistent viral and parasitic infections and their potential coinfections among SSA and LA detained migrants highlight the need to implement control strategies and programs that reach people in detention centers in nonendemic countries.
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Gétaz L, Casillas A, Siegrist CA, Chappuis F, Togni G, Tran NT, Baggio S, Negro F, Gaspoz JM, Wolff H. Hepatitis B prevalence, risk factors, infection awareness and disease knowledge among inmates: a cross-sectional study in Switzerland's largest pre-trial prison. J Glob Health 2018. [PMID: 30140433 PMCID: PMC6076584 DOI: 10.7189/jogh-08-020407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background Hepatitis B virus (HBV) is a major health concern in prison, but data are scarce in European prisons. This study aims to measure the prevalence of HBV infection, risk factors, awareness about infection, and HBV knowledge among inmates in Switzerland’s largest pre-trial prison. Methods Serological blood tests (HBsAg, anti-HBs, and anti-HBc) and a standardized socio-demographic and sexual health survey were offered to consenting prisoners in 2009 and 2011. HBV knowledge was assessed using a standardized questionnaire among participants recruited in 2009. Findings A total of 273 male participants were included in the study (116 participants answered the HBV knowledge survey), with 38.1% originating from Eastern Europe, 28.2% from sub-Saharan Africa, 14.3% from North Africa, and 9.5% from Latin America. The prevalence of anti-HBc (resolved/chronic infection) was 38.2% and the prevalence of HBsAg (chronic infection) was 5.9%; 14% of participants had vaccine-acquired immunity (anti-HBs positive/anti-HBc negative). We estimated that 15.5% of people living in Geneva having chronic infection go through the Geneva’s prison. Region of origin was significantly associated with chronic/resolved HBV infection (P < 0.001): 72.2% of participants from sub-Saharan African, 34.6% from Eastern Europe and 13.2% from other regions. In terms of chronic infection, 15.6% of participants from sub-Saharan Africa were positive for HBsAg, vs 2% of those from other regions (P < 0.001). In stratified analyses, region of origin remained significantly associated with HBV infection. Among those with chronic infection, only 12.5% were aware of their status. A minority of inmates knew how HBV could be transmitted. Conclusions The primary factor associated with HBV infection in this study was the geographical region of origin of participants. Given the high HBV prevalence found in this prison population, a targeted testing and vaccination approach based on prisoners’ region of origin would be a cost-effective strategy when resources are limited. Additionally, identification of at-risk people should not rely on sensitive questions nor self-reported history of HBV. An inclusive approach to global health needs to incorporate prison population, as incarcerated people have a disproportionate burden of HBV infection and because an important proportion of hard-to-reach chronic HBV infected people go through the incarceration system.
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Affiliation(s)
- Laurent Gétaz
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.,Division of Tropical and Humanitarian Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Alejandra Casillas
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Claire-Anne Siegrist
- Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland.,World Health Organization Collaborating Centre for Vaccine Immunology, University of Geneva, Geneva, Switzerland
| | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | | | - Nguyen-Toan Tran
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.,Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology, Sydney, Australia
| | - Stéphanie Baggio
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Francesco Negro
- Division of Gastroenterology and Hepatology and Division of Clinical Pathology, University Hospital, Geneva, Switzerland
| | - Jean-Michel Gaspoz
- Department of Primary Care, Community Medicine, and Emergencies, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Hans Wolff
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
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11
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Getaz L, Casillas A, Motamed S, Gaspoz JM, Chappuis F, Wolff H. Hepatitis A immunity and region-of-origin in a Swiss prison. Int J Prison Health 2017; 12:98-105. [PMID: 27219907 DOI: 10.1108/ijph-10-2015-0033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose - The environmental and demographic characteristics of closed institutions, particularly prisons, precipitate morbidity during hepatitis A virus (HAV) outbreaks. Given the high prevalence of chronic liver disease and other risk factors in the prison setting, the purpose of this paper is to examine HAV-immunity and its associated factors in this population. Design/methodology/approach - The cross-sectional study was conducted in 2009: a serology screening for HAV IgG was carried out among 116 inmates in Switzerland's largest pre-trial prison. Other participant characteristics were collected through a structured face-to-face questionnaire with a physician. Findings - In terms of significant demographics, Africa (53.5 percent) and the Balkans/Eastern Europe (36.2 percent) were the main regions of origin; a minority of inmates were from Western Europe (6.9 percent), Latin America (2.6 percent) or Asia (0.9 percent). The authors identified hepatitis A antibody-negative serology (lack of immunity) in five out of 116 prisoners (4.3 percent, 95 percent CI 1.4-9.7). Among participants of European origin alone, five out of 50 inmates were hepatitis A antibody-negative (10 percent, 95 percent CI 3.3-21.8), whereas the 66 inmates from other all continents were hepatitis A antibody-positive (immune) (p=0.026). Originality/value - In this prison population composed of mostly African migrants, hepatitis A immunity was high. This reaffirms that region of origin is highly associated with childhood immunity against HAV. HAV vaccination should take into account a patient's area of origin and his/her risk factors for systemic complications, if ever infected. This targeted strategy would offer herd immunity, and seek out the most vulnerable individuals who are potentially at risk of new exposure in this precarious setting.
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Affiliation(s)
- Laurent Getaz
- Division of Penitentiary Medicine and Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Alejandra Casillas
- Division of Penitentiary Medicine and Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Sandrine Motamed
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Jean-Michel Gaspoz
- Division of Primary Care Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Francois Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Hans Wolff
- Division of Penitentiary Medicine and Psychiatry, Geneva University Hospitals, Geneva, Switzerland
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12
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Mina MM, Herawati L, Butler T, Lloyd A. Hepatitis C in Australian prisons: a national needs assessment. Int J Prison Health 2016; 12:3-16. [PMID: 26933988 DOI: 10.1108/ijph-08-2015-0025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE Hepatitis C (HCV) infections are prevalent in custodial settings worldwide, yet provision of antiviral therapies is uncommon. Approximately 30,000 prisoners are held in Australian prisons at any one time, with more than 30 per cent testing positive for HCV antibodies. Prisoners have been identified in the National Hepatitis C Strategy as a priority population for assessment and treatment. The purpose of this paper is to examine the rates of HCV testing and treatment, as well as barriers and opportunities for development of infrastructure for enhanced services. DESIGN/METHODOLOGY/APPROACH Interviews were conducted with 55 stakeholders from the correctional sector in each state and territory in Australia in two stages: service directors to gather quantitative data regarding rates of testing and treatment; and other stakeholders for qualitative information regarding barriers and opportunities. FINDINGS Of more than 50,000 individuals put in in custody in Australian prisons in 2013, approximately 8,000 individuals were HCV antibody positive, yet only 313 prisoners received antiviral treatment. The barriers identified to assessment and treatment at the prisoner-level included: fear of side effects and the stigma of being identified to custodial authorities as HCV infected and a likely injecting drug user. Prisoners who came forward may be considered unsuitable for treatment because of prevalent mental health problems and ongoing injecting drug use. Provision of specialist hepatitis nurses and consultants were the most frequently recommended approaches to how prison hepatitis services could be improved. ORIGINALITY/VALUE Many personal and systems-level barriers relevant to the delivery of HCV treatment services in the custodial setting were identified. Ready access to skilled nursing and medical staff as well as direct acting antiviral therapies will allow the prison-sector to make a major contribution to control of the growing burden of HCV disease.
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Affiliation(s)
- Michael Mokhlis Mina
- Inflammation and Infection Research Centre (IIRC), School of Medical Sciences, University of New South Wales, Australia
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13
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Aspinall EJ, Mitchell W, Schofield J, Cairns A, Lamond S, Bramley P, Peters SE, Valerio H, Tomnay J, Goldberg DJ, Mills PR, Barclay ST, Fraser A, Dillon JF, Martin NK, Hickman M, Hutchinson SJ. A matched comparison study of hepatitis C treatment outcomes in the prison and community setting, and an analysis of the impact of prison release or transfer during therapy. J Viral Hepat 2016; 23:1009-1016. [PMID: 27509844 PMCID: PMC5558600 DOI: 10.1111/jvh.12580] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 07/07/2016] [Indexed: 01/02/2023]
Abstract
Prisoners are a priority group for hepatitis C (HCV) treatment. Although treatment durations will become shorter using directly acting antivirals (DAAs), nearly half of prison sentences in Scotland are too short to allow completion of DAA therapy prior to release. The purpose of this study was to compare treatment outcomes between prison- and community-based patients and to examine the impact of prison release or transfer during therapy. A national database was used to compare treatment outcomes between prison treatment initiates and a matched community sample. Additional data were collected to investigate the impact of release or transfer on treatment outcomes. Treatment-naïve patients infected with genotype 1/2/3/4 and treated between 2009 and 2012 were eligible for inclusion. 291 prison initiates were matched with 1137 community initiates: SVRs were 61% (95% CI 55%-66%) and 63% (95% CI 60%-66%), respectively. Odds of achieving a SVR were not significantly associated with prisoner status (P=.33). SVRs were 74% (95% CI 65%-81%), 59% (95% CI 42%-75%) and 45% (95% CI 29%-62%) among those not released or transferred, transferred during treatment, or released during treatment, respectively. Odds of achieving a SVR were significantly associated with release (P<.01), but not transfer (P=.18). Prison-based HCV treatment achieves similar outcomes to community-based treatment, with those not released or transferred during treatment doing particularly well. Transfer or release during therapy should be avoided whenever possible, using anticipatory planning and medical holds where appropriate.
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Affiliation(s)
- E J Aspinall
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- Health Protection Scotland, NHS National Services Scotland, Glasgow, UK
| | - W Mitchell
- NHS Forth Valley Viral Hepatitis Service, Stirling, UK
| | - J Schofield
- Public Health Protection Unit, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - A Cairns
- Western General Hospital, Edinburgh, UK
| | - S Lamond
- Western General Hospital, Edinburgh, UK
| | - P Bramley
- NHS Forth Valley Viral Hepatitis Service, Stirling, UK
| | | | - H Valerio
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- Health Protection Scotland, NHS National Services Scotland, Glasgow, UK
| | - J Tomnay
- Crosshouse Hospital, Kilmarnock, UK
| | - D J Goldberg
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- Health Protection Scotland, NHS National Services Scotland, Glasgow, UK
| | - P R Mills
- Gartnavel General Hospital, Glasgow, UK
| | - S T Barclay
- Walton Liver Clinic, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - A Fraser
- Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - J F Dillon
- Ninewells Hospital and Medical School, NHS Tayside, Dundee, UK
| | - N K Martin
- Division of Global Public Health, University of California San Diego, San Diego, CA, USA
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - M Hickman
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - S J Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- Health Protection Scotland, NHS National Services Scotland, Glasgow, UK
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14
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Jaquet A, Wandeler G, Tine J, Dagnra CA, Attia A, Patassi A, Ndiaye A, de Ledinghen V, Ekouevi DK, Seydi M, Dabis F. HIV infection, viral hepatitis and liver fibrosis among prison inmates in West Africa. BMC Infect Dis 2016; 16:249. [PMID: 27267370 PMCID: PMC4895802 DOI: 10.1186/s12879-016-1601-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 05/27/2016] [Indexed: 12/26/2022] Open
Abstract
Background Prisoners represent a vulnerable population for blood-borne and sexually transmitted infections which can potentially lead to liver fibrosis and ultimately cirrhosis. However, little is known about the prevalence of liver fibrosis and associated risk factors among inmates in sub-Saharan Africa. Methods Screening of liver fibrosis was undertaken in a randomly selected sample of male inmates incarcerated in Lome, Togo and in Dakar, Senegal using transient elastography. A liver stiffness measurement ≥9.5 KPa was retained to define the presence of a severe liver fibrosis. All included inmates were also screened for HIV, Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) infection. Substances abuse including alcohol, tobacco and cannabis use were assessed during face-to-face interviews. Odds Ratio (OR) estimates were computed with their 95 % Confidence Interval (CI) to identify factors associated with severe liver fibrosis. Results Overall, 680 inmates were included with a median age of 30 years [interquartile range: 24–35]. The prevalence of severe fibrosis was 3.1 % (4.9 % in Lome and 1.2 % in Dakar). Infections with HIV, HBV and HCV were identified in 2.6 %, 12.5 % and 0.5 % of inmates, respectively. Factors associated with a severe liver fibrosis were HIV infection (OR = 7.6; CI 1.8–32.1), HBV infection (OR = 4.8; CI 1.8–12.8), HCV infection (OR = 52.6; CI 4.1–673.8), use of traditional medicines (OR = 3.7; CI 1.4–10.1) and being incarcerated in Lome (OR = 3.3; CI 1.1–9.8) compared to Dakar. Conclusions HIV infection and viral hepatitis infections were identified as important and independent determinants of severe liver fibrosis. While access to active antiviral therapies against HIV and viral hepatitis expands in Africa, adapted strategies for the monitoring of liver disease need to be explored, especially in vulnerable populations such as inmates.
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Affiliation(s)
- Antoine Jaquet
- Université Bordeaux, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, F-33000, Bordeaux, France. .,INSERM, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, F-33000, Bordeaux, France.
| | - Gilles Wandeler
- Service de maladies infectieuses et tropicales, CRCF, CHU de Fann, Dakar, Sénégal.,Department of Infectious Diseases, University Hospital Bern, Bern, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Judicaël Tine
- Service de maladies infectieuses et tropicales, CRCF, CHU de Fann, Dakar, Sénégal
| | - Claver A Dagnra
- Service de virologie, BIOLIM, Université de Lomé, Lomé, Togo
| | - Alain Attia
- Service de hépato-gastroentérologie, CHU de Yopougon, Abidjan, Côte d'Ivoire
| | - Akouda Patassi
- Service de maladies infectieuses et tropicales, CHU Sylvanus Olympio, Lomé, Togo
| | | | - Victor de Ledinghen
- Centre d'investigation de la fibrose hepatique, Hopital Haut-Leveque, CHU de Bordeaux & INSERM U1053, Université de Bordeaux, Bordeaux, France
| | - Didier K Ekouevi
- Université Bordeaux, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, F-33000, Bordeaux, France.,INSERM, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, F-33000, Bordeaux, France.,Département de Santé Publique, Faculté des Sciences de la santé, Université de Lomé, Lomé, Togo
| | - Moussa Seydi
- Service de maladies infectieuses et tropicales, CRCF, CHU de Fann, Dakar, Sénégal
| | - François Dabis
- Université Bordeaux, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, F-33000, Bordeaux, France.,INSERM, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, F-33000, Bordeaux, France
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15
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Bretaña NA, Boelen L, Bull R, Teutsch S, White PA, Lloyd AR, Luciani F. Transmission of Hepatitis C Virus among Prisoners, Australia, 2005-2012. Emerg Infect Dis 2016; 21:765-74. [PMID: 25897788 PMCID: PMC4414091 DOI: 10.3201/eid2105.141832] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Ongoing transmission is associated with drug injection. Hepatitis C virus (HCV) is predominantly transmitted between persons who inject drugs. For this population, global prevalence of HCV infection is high and incarceration is common and an independent risk factor for HCV acquisition. To explore HCV transmission dynamics in incarcerated populations, we integrated virus sequences with risk behavior and spatiotemporal data and analyzed transmission clusters among prisoners in Australia. We detected 3 clusters of recent HCV transmission consisting of 4 likely in-custody transmission events involving source/recipient pairs located in the same prison at the same time. Of these 4 events, 3 were associated with drug injecting and equipment sharing. Despite a large population of prisoners with chronic HCV, recent transmission events were identified in the prison setting. This ongoing HCV transmission among high-risk prisoners argues for expansion of prevention programs to reduce HCV transmission in prisons.
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16
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Scott N, McBryde E, Kirwan A, Stoové M. Modelling the Impact of Condom Distribution on the Incidence and Prevalence of Sexually Transmitted Infections in an Adult Male Prison System. PLoS One 2015; 10:e0144869. [PMID: 26658518 PMCID: PMC4691199 DOI: 10.1371/journal.pone.0144869] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 11/24/2015] [Indexed: 11/18/2022] Open
Abstract
Aims To determine the effects of 1) a condom distribution program and 2) a condom distribution program combined with opt-out sexually transmitted infection (STI) screening on the transmission and prevalence of STIs in a prison system. Methods Using data from an implementation evaluation of a state-wide prison condom program and parameter estimates from available literature, a deterministic model was developed to quantify the incidence and prevalence of sexually transmitted HIV, hepatitis B, chlamydia, syphilis and gonorrhoea across 14 Victorian prisons. The model included individual prison populations (by longer (>2 years) or shorter sentence lengths) and monthly prisoner transfers. For each STI, simulations were compared: without any intervention; with a condom distribution program; and with a combined condom and opt-out STI screening at prison reception intervention program. Results Condoms reduced the annual incidence of syphilis by 99% (N = 66 averted cases); gonorrhoea by 98% (N = 113 cases); hepatitis B by 71% (N = 5 cases); chlamydia by 27% (N = 196 cases); and HIV by 50% (N = 2 cases every 10 years). Condom availability changed the in-prison epidemiology of gonorrhoea and syphilis from self-sustaining to levels unlikely to result in infection outbreaks; however, condoms did not reduce chlamydia prevalence below a self-sustaining level due to its high infectiousness, high prevalence and low detection rate. When combined with a screening intervention program, condoms reduced chlamydia prevalence further, but not below a self-sustaining level. The low prevalence of HIV and hepatitis B in Australian prisons meant the effects of condoms were predicted to be small. Conclusion Condoms are predicted to effectively reduce the incidence of STIs in prison and are predicted to control syphilis and gonorrhoea transmission, however even combined with a screening on arrival program may be insufficient to reduce chlamydia prevalence below self-sustaining levels. To control chlamydia transmission additional screening of the existing prison population would be required.
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Affiliation(s)
- Nick Scott
- Centre for Population Health, Burnet Institute, Melbourne, VIC 3004, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, VIC 3008, Australia
- * E-mail:
| | - Emma McBryde
- Centre for Population Health, Burnet Institute, Melbourne, VIC 3004, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD 4811, Australia
- Department of Medicine, The University of Melbourne, Parkville, VIC 3050, Australia
| | - Amy Kirwan
- Centre for Population Health, Burnet Institute, Melbourne, VIC 3004, Australia
| | - Mark Stoové
- Centre for Population Health, Burnet Institute, Melbourne, VIC 3004, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, VIC 3008, Australia
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17
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Nguyen JT, Rich JD, Brockmann BW, Vohr F, Spaulding A, Montague BT. A Budget Impact Analysis of Newly Available Hepatitis C Therapeutics and the Financial Burden on a State Correctional System. J Urban Health 2015; 92:635-49. [PMID: 25828149 PMCID: PMC4524840 DOI: 10.1007/s11524-015-9953-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Hepatitis C virus (HCV) infection continues to disproportionately affect incarcerated populations. New HCV drugs present opportunities and challenges to address HCV in corrections. The goal of this study was to evaluate the impact of the treatment costs for HCV infection in a state correctional population through a budget impact analysis comparing differing treatment strategies. Electronic and paper medical records were reviewed to estimate the prevalence of hepatitis C within the Rhode Island Department of Corrections. Three treatment strategies were evaluated as follows: (1) treating all chronically infected persons, (2) treating only patients with demonstrated fibrosis, and (3) treating only patients with advanced fibrosis. Budget impact was computed as the percentage of pharmacy and overall healthcare expenditures accrued by total drug costs assuming entirely interferon-free therapy. Sensitivity analyses assessed potential variance in costs related to variability in HCV prevalence, genotype, estimated variation in market pricing, length of stay for the sentenced population, and uptake of newly available regimens. Chronic HCV prevalence was estimated at 17% of the total population. Treating all sentenced inmates with at least 6 months remaining of their sentence would cost about $34 million-13 times the pharmacy budget and almost twice the overall healthcare budget. Treating inmates with advanced fibrosis would cost about $15 million. A hypothetical 50% reduction in total drug costs for future therapies could cost $17 million to treat all eligible inmates. With immense costs projected with new treatment, it is unlikely that correctional facilities will have the capacity to treat all those afflicted with HCV. Alternative payment strategies in collaboration with outside programs may be necessary to curb this epidemic. In order to improve care and treatment delivery, drug costs also need to be seriously reevaluated to be more accessible and equitable now that HCV is more curable.
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Affiliation(s)
- John T. Nguyen
- />Brown University School of Public Health, Providence, RI USA
| | - Josiah D. Rich
- />Department of Medicine, Warren Alpert School of Medicine at Brown University, Providence, RI USA
- />Division of Infectious Diseases, Miriam Hospital, Providence, RI USA
- />Center for Prisoner Health and Human Rights, Providence, RI USA
- />Department of Epidemiology, Brown University School of Public Health, Providence, RI USA
| | | | - Fred Vohr
- />Medical Programs, Rhode Island Department of Corrections, Cranston, RI USA
| | - Anne Spaulding
- />Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA USA
| | - Brian T. Montague
- />Department of Medicine, Warren Alpert School of Medicine at Brown University, Providence, RI USA
- />Division of Infectious Diseases, Miriam Hospital, Providence, RI USA
- />Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI USA
- />The Miriam Hospital, Providence, RI USA
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18
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Sequera VG, Valencia S, García-Basteiro AL, Marco A, Bayas JM. Vaccinations in prisons: A shot in the arm for community health. Hum Vaccin Immunother 2015; 11:2615-26. [PMID: 26158401 PMCID: PMC4685700 DOI: 10.1080/21645515.2015.1051269] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 04/27/2015] [Accepted: 05/10/2015] [Indexed: 02/08/2023] Open
Abstract
From the first day of imprisonment, prisoners are exposed to and expose other prisoners to various communicable diseases, many of which are vaccine-preventable. The risk of acquiring these diseases during the prison sentence exceeds that of the general population. This excess risk may be explained by various causes; some due to the structural and logistical problems of prisons and others to habitual or acquired behaviors during imprisonment. Prison is, for many inmates, an opportunity to access health care, and is therefore an ideal opportunity to update adult vaccination schedules. The traditional idea that prisons are intended to ensure public safety should be complemented by the contribution they can make in improving community health, providing a more comprehensive vision of safety that includes public health.
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Affiliation(s)
| | - Salomé Valencia
- Preventive Medicine and Epidemiology Service; Hospital Clínic of Barcelona; Barcelona, Spain
| | - Alberto L García-Basteiro
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB); Hospital Clínic - Universitat de Barcelona, Rossello, Barcelona, Spain
- Centro de Investigação em Saude de Manhiça (CISM); Maputo, Mozambique
| | - Andrés Marco
- Health Services of Barcelona Men's Penitentiary Center; Barcelona, Spain
| | - José M Bayas
- Preventive Medicine and Epidemiology Service; Hospital Clínic of Barcelona; Barcelona, Spain
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB); Hospital Clínic - Universitat de Barcelona, Rossello, Barcelona, Spain
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19
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Nursing case management, peer coaching, and hepatitis a and B vaccine completion among homeless men recently released on parole: randomized clinical trial. Nurs Res 2015; 64:177-89. [PMID: 25932697 DOI: 10.1097/nnr.0000000000000083] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although hepatitis A virus (HAV) and hepatitis B virus (HBV) infections are vaccine-preventable diseases, few homeless parolees coming out of prisons and jails have received the hepatitis A and B vaccination series. OBJECTIVES The study focused on completion of the HAV and HBV vaccine series among homeless men on parole. The efficacy of three levels of peer coaching (PC) and nurse-delivered interventions was compared at 12-month follow-up: (a) intensive peer coaching and nurse case management (PC-NCM); (b) intensive PC intervention condition, with minimal nurse involvement; and (c) usual care (UC) intervention condition, which included minimal PC and nurse involvement. Furthermore, we assessed predictors of vaccine completion among this targeted sample. METHODS A randomized control trial was conducted with 600 recently paroled men to assess the impact of the three intervention conditions (PC-NCM vs. PC vs. UC) on reducing drug use and recidivism; of these, 345 seronegative, vaccine-eligible subjects were included in this analysis of completion of the Twinrix HAV/HBV vaccine. Logistic regression was added to assess predictors of completion of the HAV/HBV vaccine series and chi-square analysis to compare completion rates across the three levels of intervention. RESULTS Vaccine completion rate for the intervention conditions were 75.4% (PC-NCM), 71.8% (PC), and 71.9% (UC; p = .78). Predictors of vaccine noncompletion included being Asian and Pacific Islander, experiencing high levels of hostility, positive social support, reporting a history of injection drug use, being released early from California prisons, and being admitted for psychiatric illness. Predictors of vaccine series completion included reporting having six or more friends, recent cocaine use, and staying in drug treatment for at least 90 days. DISCUSSION Findings allow greater understanding of factors affecting vaccination completion in order to design more effective programs among the high-risk population of men recently released from prison and on parole.
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20
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Roux P, Sagaon-Teyssier L, Lions C, Fugon L, Verger P, Carrieri MP. HCV seropositivity in inmates and in the general population: an averaging approach to establish priority prevention interventions. BMJ Open 2014; 4:e005694. [PMID: 25331969 PMCID: PMC4202016 DOI: 10.1136/bmjopen-2014-005694] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Despite the fact that a considerable portion of hepatitis C virus (HCV) positive individuals are viraemic, the risk of transmitting HCV to others is context dependent. Prison is a particularly risky environment as HCV prevention tools are often unavailable. Using data from a cross-sectional study conducted in centres for HCV testing in southeastern France, we aimed to compare the patterns of risk factors in HCV-positive inmates with those in the general population. SETTING 26 centres for HIV/HCV testing in southeastern France (23 in the general population and 3 in prison). PRIMARY OUTCOME MEASURE HCV seropositivity measured with ELISA test. METHODS A propensity score method to ensure that the general and inmate populations could be compared and a multimodel averaging to estimate the degree (strong, weak, none) of the association of a number of specific factors with HCV seropositivity in each group. RESULTS Among the 52,082 participants, HCV infection prevalence was 1.5% and 5.2% in the general (n=46,125) and inmate (n=5957) populations, respectively. In both populations, 'drug injection without snorting' and 'drug injection with snorting' were very strongly associated with HCV seropositivity. Among inmates, 'drug snorting alone' (OR (95% CI) 2.21 (1.39 to 3.52) was also a strong correlate while tattoos, piercings (OR (95% CI) 1.22 (0.92 to 1.61)) and the sharing of toiletry items (OR (95% CI) 1.44 (0.84 to 2.47)) were weak correlates. CONCLUSIONS The pattern of risk factors associated with HCV seropositivity is different between the general and prison populations, injection and snorting practices being more prevalent in the latter. Access to prevention measures in prisons is not only a public health issue but also a human right for inmates who deserve equity of care and prevention.
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Affiliation(s)
- P Roux
- INSERM UMR912 (SESSTIM), Marseille, France
- Université Aix Marseille, IRD, UMR-S912, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France
| | - L Sagaon-Teyssier
- INSERM UMR912 (SESSTIM), Marseille, France
- Université Aix Marseille, IRD, UMR-S912, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France
| | - C Lions
- INSERM UMR912 (SESSTIM), Marseille, France
- Université Aix Marseille, IRD, UMR-S912, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France
| | - L Fugon
- INSERM UMR912 (SESSTIM), Marseille, France
- Université Aix Marseille, IRD, UMR-S912, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France
- AIDES, Tour Essor, Pantin, France
| | - P Verger
- INSERM UMR912 (SESSTIM), Marseille, France
- Université Aix Marseille, IRD, UMR-S912, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France
| | - M P Carrieri
- INSERM UMR912 (SESSTIM), Marseille, France
- Université Aix Marseille, IRD, UMR-S912, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France
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21
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Boelen L, Teutsch S, Wilson DP, Dolan K, Dore GJ, Lloyd AR, Luciani F. Per-event probability of hepatitis C infection during sharing of injecting equipment. PLoS One 2014; 9:e100749. [PMID: 25000496 PMCID: PMC4085033 DOI: 10.1371/journal.pone.0100749] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 05/29/2014] [Indexed: 02/03/2023] Open
Abstract
Background Shared injecting apparatus during drug use is the premier risk factor for hepatitis C virus (HCV) transmission. Aims To estimate the per-event probability of HCV infection during a sharing event, and the transmission probability of HCV from contaminated injecting apparatus. Methods Estimates were obtained using a maximum likelihood method with estimated IDU and sharing events obtained from behavioural data. Settings Cohort study in multiple correction centres in New South Wales, Australia Participants Subjects (N = 500) with a lifetime history of injecting drug use (IDU) who were followed up between 2005 and 2012. During follow-up, interviews for risk behaviours were taken and blood sampling (HCV-antibody and RNA testing) was performed. Measurements Self-reported frequencies of injecting drugs and sharing events, as well as other risk behaviours and details on the nature of injecting events. Findings The best estimate of the per-event probability of infection was 0.57% (CI: 0.32–1.05%). A sensitivity analysis on the likely effect of under-reporting of sharing of the injecting apparatus indicated that the per event infection probability may be as low as 0.17% (95% CI: 0.11%–0.25%). The transmission probability was similarly shown to range up to 6%, dependent on the presumed prevalence of the virus in injecting equipment. Conclusions The transmission probability of HCV during a sharing event is small. Hence, strategies to reduce the frequency and sharing of injecting equipment are required, as well as interventions focused on decreasing the per event risk.
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Affiliation(s)
- Lies Boelen
- Inflammation and Infection Research Centre, School of Medical Sciences, The University of New South Wales, Sydney, Australia
- Section of Immunology, School of Medicine, Imperial College, London, United Kingdom
| | - Suzy Teutsch
- Inflammation and Infection Research Centre, School of Medical Sciences, The University of New South Wales, Sydney, Australia
| | - David P. Wilson
- The Kirby Institute, The University of New South Wales, Sydney, Australia
| | - Kate Dolan
- National Drug and Alcohol Research Centre, The University of New South Wales, Sydney, Australia
| | - Greg J. Dore
- The Kirby Institute, The University of New South Wales, Sydney, Australia
| | - Andrew R. Lloyd
- Inflammation and Infection Research Centre, School of Medical Sciences, The University of New South Wales, Sydney, Australia
| | - Fabio Luciani
- Inflammation and Infection Research Centre, School of Medical Sciences, The University of New South Wales, Sydney, Australia
- * E-mail:
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22
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McNamara BC, Losikoff PT, Huguenin L, Macalino GE, Rich JD, Gregory SH. Increasing hepatitis C prevalence and associated risk behaviors among incarcerated young adults. J Urban Health 2014; 91:376-82. [PMID: 23722268 PMCID: PMC3978152 DOI: 10.1007/s11524-013-9807-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This study sought to assess the rate of hepatitis C virus (HCV) infection and associated risk factors in young adults 18-28 years of age who were incarcerated in the Rhode Island Department of Corrections. The majority of participants reported injection drug use and engaged in high-risk behaviors such as needle sharing. Despite having these risk factors and believing themselves to be at risk, the majority of youths reported no prior HCV testing. Correctional facilities present a unique opportunity to detect HCV infection and provide risk reduction education to young adults, the population with the highest rates of new infections in the US. Seventy-two incarcerated individuals with a history of drug use were approached to participate in the study; 68 completed the screening and interview. The rate of HCV infection among adults <30 years of age and incarcerated at the Rhode Island Department of Corrections in 2011 was high (24%). In 1998, the rate of HCV among inmates <30 years of age at the same facility was only 11.4%. These data follow the same increase in HCV infection rates among young adults observed in non-incarcerated young adults across the nation. HCV is the leading cause of liver failure and hepatocellular carcinoma in the US. Despite a decline and leveling in HCV incidence nationwide, alarming increases in HCV rates among adolescents and young adults have been reported during the period between the years 1992 and 2005. This disquieting epidemic is attributable to injection drug use amongst young adults.
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Affiliation(s)
| | - Phyllis T. Losikoff
- />Department of Medicine, Rhode Island Hospital, Providence, RI 02903 USA
- />Warren Alpert Medical School of Brown University, Providence, RI USA
| | - Linda Huguenin
- />Department of Medicine, Rhode Island Hospital, Providence, RI 02903 USA
| | - Grace E. Macalino
- />Infectious Disease Clinical Research Program USUHS, Rockville, MD USA
| | - Josiah D. Rich
- />Department of Medicine, Rhode Island Hospital, Providence, RI 02903 USA
- />Warren Alpert Medical School of Brown University, Providence, RI USA
- />The Center for Prisoner Health and Human Rights, Providence, RI USA
| | - Stephen H. Gregory
- />Department of Medicine, Rhode Island Hospital, Providence, RI 02903 USA
- />Warren Alpert Medical School of Brown University, Providence, RI USA
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Post JJ, Arain A, Lloyd AR. Enhancing assessment and treatment of hepatitis C in the custodial setting. Clin Infect Dis 2014; 57 Suppl 2:S70-4. [PMID: 23884069 DOI: 10.1093/cid/cit265] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Acute and chronic hepatitis C (HCV) infections are prevalent in custodial settings worldwide, yet provision of antiviral therapies is uncommon. This disparity between the burden of disease and hepatitis service delivery reflects the marginalized patient population, which features high rates of injection drug use and poor mental health. In addition, the prison environment is intended for deprivation of liberty and not healthcare. Screening for HCV infections is provided in most jurisdictions, but uptake rates remain low. Assessment and treatment of inmates is often provided only by community-based services. Despite these challenges, assessment and treatment of inmates with chronic HCV via prison-based services has been shown to be feasible and effective. These services offer the potential to substantively increase HCV treatment uptake and reduce the burden of disease for the community at large. Improvements in the efficacy of HCV therapies via direct-acting antivirals, which also offer reduced treatment duration and decreased toxicities, mean that prison health services will be well placed for the treatment of large numbers of people with HCV who do not access health services in the community.
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Affiliation(s)
- Jeffrey J Post
- Department of Infectious Diseases, Prince of Wales Hospital, Randwick, Australia
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Harris M, Rhodes T. Hepatitis C treatment access and uptake for people who inject drugs: a review mapping the role of social factors. Harm Reduct J 2013; 10:7. [PMID: 23651646 PMCID: PMC3686576 DOI: 10.1186/1477-7517-10-7] [Citation(s) in RCA: 187] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 04/13/2013] [Indexed: 02/06/2023] Open
Abstract
Background Evidence documents successful hepatitis C virus (HCV) treatment outcomes for people who inject drugs (PWID) and interest in HCV treatment among this population. Maximising HCV treatment for PWID can be an effective HCV preventative measure. Yet HCV treatment among PWID remains suboptimal. This review seeks to map social factors mediating HCV treatment access. Method We undertook a review of the social science and public health literature pertaining to HCV treatment for PWID, with a focus on barriers to treatment access, uptake and completion. Medline and Scopus databases were searched, supplemented by manual and grey literature searches. A two step search was taken, with the first step pertaining to literature on HCV treatment for PWID and the second focusing on social structural factors. In total, 596 references were screened, with 165 articles and reports selected to inform the review. Results Clinical and individual level barriers to HCV treatment among PWID are well evidenced. These include patient and provider concerns regarding co-morbidities, adherence, and side effect management. Social factors affecting treatment access are less well evidenced. In attempting to map these, key barriers fall into the following domains: social stigma, housing, criminalisation, health care systems, and gender. Key facilitating factors to treatment access include: combination intervention approaches encompassing social as well as biomedical interventions, low threshold access to opiate substitution therapy, and integrated delivery of multidisciplinary care. Conclusion Combination intervention approaches need to encompass social interventions in relation to housing, stigma reduction and systemic changes in policy and health care delivery. Future research needs to better delineate social factors affecting treatment access.
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Affiliation(s)
- Magdalena Harris
- Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H9SH, UK.
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25
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Lloyd AR, Clegg J, Lange J, Stevenson A, Post JJ, Lloyd D, Rudge G, Boonwaat L, Forrest G, Douglas J, Monkley D. Safety and effectiveness of a nurse-led outreach program for assessment and treatment of chronic hepatitis C in the custodial setting. Clin Infect Dis 2013; 56:1078-84. [PMID: 23362288 DOI: 10.1093/cid/cis1202] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The global burden of disease attributable to chronic hepatitis C virus (HCV) is very large, yet the uptake of curative antiviral therapies remains very low, reflecting the marginalized patient population and the arduous nature of current treatments. METHODS The safety and effectiveness of a nurse-led model of care of inmates with chronic HCV was evaluated in 3 Australian correctional centers. The model featured protocol-driven assessment, triage, and management of antiviral therapy by specifically trained nurses, with specialist physician support utilizing telemedicine. Outcomes were evaluated qualitatively with key informant interviews, and quantitatively with patient numbers completing key clinical milestones and adverse events. RESULTS A total of 391 patients with chronic HCV infection were enrolled, of whom 141 (36%) completed the clinical and laboratory evaluations for eligibility for antiviral therapy over 24 months. Treatment was initiated in 108 patients (28%), including 85 (79%) triaged for specialist review conducted by telemedicine only. The demographic and clinical characteristics of the patients who entered the model and completed workup and those who initiated treatment featured a high prevalence of individuals of indigenous background, injection drug users, and those with psychiatric disorder. Serious adverse events occurred in 13 of 108 treated patients (12%) with discontinuation in 8 (7%). The sustained virologic response rate among those with complete follow-up data (n=68) was 69%, and by intention-to treat analysis was 44%. CONCLUSIONS This nurse-led and specialist-supported assessment and treatment model for inmates with chronic HCV offers potential to substantively increase treatment uptake and reduce the burden of disease.
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Affiliation(s)
- Andrew R Lloyd
- Inflammation and Infection Research Centre, School of Medical Sciences, University of New South Wales,Sydney, Australia.
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26
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Peña-Orellana M, Hernández-Viver A, Caraballo-Correa G, Albizu-García CE. Prevalence of HCV risk behaviors among prison inmates: tattooing and injection drug use. J Health Care Poor Underserved 2011; 22:962-82. [PMID: 21841290 DOI: 10.1353/hpu.2011.0084] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Hepatitis C virus (HCV) is the most common blood-borne chronic viral infection in the United States and it is over represented in incarcerated populations. This study estimates if in prison tattooing is associated with self reported HCV infection in a probabilistic sample of 1,331 sentenced inmates in Puerto Rico prisons anonymously surveyed in 2004, who had previously been tested for HCV. Analysis were carried out with the total sample and among non-injectors (n=796) to control for injection drug use (IDU) and other confounders. Nearly 60% of inmates had acquired tattoos in prison. HCV was reported by 27% of subjects in the total sample and by 12% of non-injectors who had undergone tattoos in prison. IDU was the strongest predictor of HCV in the total sample (OR=5.6, 95% CI=3.2-9.7). Among non injectors, tattooing with reused needles or sharp objects and/ or reusing ink was positively associated with HCV self-report (OR=2.6, 95% CI=1.3-5.5). Tattooing is a common occurrence in this prison setting. Findings suggest that preventive interventions are required to reduce the risk of HCV transmission through unsterile tattooing and injection practices.
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Affiliation(s)
- Marisol Peña-Orellana
- Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
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27
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Nelson PK, Mathers BM, Cowie B, Hagan H, Des Jarlais D, Horyniak D, Degenhardt L. Global epidemiology of hepatitis B and hepatitis C in people who inject drugs: results of systematic reviews. Lancet 2011; 378:571-83. [PMID: 21802134 PMCID: PMC3285467 DOI: 10.1016/s0140-6736(11)61097-0] [Citation(s) in RCA: 945] [Impact Index Per Article: 72.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Injecting drug use is an important risk factor for transmission of viral hepatitis, but detailed, transparent estimates of the scale of the issue do not exist. We estimated national, regional, and global prevalence and population size for hepatitis C virus (HCV) and hepatitis B virus (HBV) in injecting drug users (IDUs). METHODS We systematically searched for data for HBV and HCV in IDUs in peer-reviewed databases (Medline, Embase, and PsycINFO), grey literature, conference abstracts, and online resources, and made a widely distributed call for additional data. From 4386 peer-reviewed and 1019 grey literature sources, we reviewed 1125 sources in full. We extracted studies into a customised database and graded them according to their methods. We included serological reports of HCV antibodies (anti-HCV), HBV antibodies (anti-HBc), or HBV surface antigen (HBsAg) in studies of IDUs with more than 40 participants (<100% HIV-positive) and sampling frames that did not exclude participants on the basis of age or sex. With endorsed decision rules, we calculated prevalence estimates with anti-HCV and anti-HBc as proxies for exposure and HBsAg as proxy for current infection. We combined these estimates with IDU population sizes to calculate the number of IDUs with positive HBV or HCV statuses. FINDINGS We located eligible reports with data for prevalence of anti-HCV in IDUs for 77 countries; midpoint prevalence estimates suggested 60-80% of IDUs had anti-HCV in 25 countries and more than 80% of IDUs did so in 12 countries. About 10.0 million (range 6.0-15.2) IDUs worldwide might be anti-HCV positive. China (1.6 million), USA (1.5 million), and Russia (1.3 million) had the largest such populations. We identified eligible HBsAg reports for 59 countries, with midpoint prevalence estimates of 5-10% in 21 countries and more than 10% in ten countries. Worldwide, we estimate 6.4 million IDUs are anti-HBc positive (2.3-9.7 million), and 1.2 million (0.3-2.7 million) are HBsAg positive. INTERPRETATION More IDUs have anti-HCV than HIV infection, and viral hepatitis poses a key challenge to public health. Variation in the coverage and quality of existing research creates uncertainty around estimates. Improved and more complete data and reporting are needed to estimate the scale of the issue, which will inform efforts to prevent and treat HCV and HBV in IDUs. FUNDING WHO and US National Institutes of Health (NIDA R01 DA018609).
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Affiliation(s)
- Paul K Nelson
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
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28
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Zhang G, Wang Q, Xu R. Therapeutics Based on microRNA: A New Approach for Liver Cancer. Curr Genomics 2011; 11:311-25. [PMID: 21286309 PMCID: PMC2944997 DOI: 10.2174/138920210791616671] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Revised: 04/11/2010] [Accepted: 04/16/2010] [Indexed: 12/12/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is a serious public health hazard. Polygenes involvement, accumulation of genetic and epigenetic changes and immune response of viral vector during gene therapy have resulted in the high mortality rate without marked change. To provide a safeguard for gene therapy and the feasibility for a clinical application, efforts have been focused predominantly upon constructing liver-targeted vector recently. MicroRNAs (miRNAs), a class of short endogenous RNAs, regulate the gene expression at the post-transcriptional level through imperfect base pairing with the 3′-untranslated region of target mRNAs. miRNAs, especially the liver-specific miRNA: miR-122, have multiple functions in liver development and abnormal expression of miRNAs could lead to liver diseases. Altered miRNA expressions have been observed in HCCs, viral hepatitis and hepatic fibrosis. The different expression profiles of miRNAs in HCC suggest that miRNAs may serve as either novel potential targets acting directly as oncogenes or therapeutic molecules working as tumor suppressor genes. Moreover, the abundance in general and liver specificity in particular, all together make them attractive to be considered as elements for hepatic specific targeting viral vector. This review describes recent progress in miRNA investigation on liver associated for better understanding the relationship between miRNA and liver cancer in order to raise prospects for therapy.
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Affiliation(s)
- G Zhang
- Institute of Molecular Medicine, Huaqiao University & Engineering Research Center of Molecular Medicine, Ministry of Education, Quanzhou, Fujian, 362021, China
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29
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Abstract
More than 10 million people are incarcerated worldwide; this number has increased by about a million in the past decade. Mental disorders and infectious diseases are more common in prisoners than in the general population. High rates of suicide within prison and increased mortality from all causes on release have been documented in many countries. The contribution of prisons to illness is unknown, although shortcomings in treatment and aftercare provision contribute to adverse outcomes. Research has highlighted that women, prisoners aged 55 years and older, and juveniles present with higher rates of many disorders than do other prisoners. The contribution of initiatives to improve the health of prisoners by reducing the burden of infectious and chronic diseases, suicide, other causes of premature mortality and violence, and counteracting the cycle of reoffending should be further examined.
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Affiliation(s)
- Seena Fazel
- Department of Psychiatry, University of Oxford, UK.
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30
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Teutsch S, Luciani F, Scheuer N, McCredie L, Hosseiny P, Rawlinson W, Kaldor J, Dore GJ, Dolan K, Ffrench R, Lloyd A, Haber P, Levy M. Incidence of primary hepatitis C infection and risk factors for transmission in an Australian prisoner cohort. BMC Public Health 2010; 10:633. [PMID: 20964864 PMCID: PMC2975656 DOI: 10.1186/1471-2458-10-633] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Accepted: 10/22/2010] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is common in prisoner populations, particularly those with a history of injecting drug use (IDU). Previous studies of HCV incidence have been based on small case numbers and have not distinguished risk events in prison from those in the community. METHODS HCV incidence was examined in a longitudinal cohort of 488 Australian prisoners with a history of IDU and documented to be seronegative within 12 months prior to enrollment. Inmates were tested for anti-HCV antibodies and viremia, and interviewed about demographic and behavioral risk factors for transmission. RESULTS The cohort was predominantly male (65%) with high rates of prior imprisonment (72%) and tattooing (73%), as well as longstanding IDU (mean 8.5 years). Ninety-four incident HCV cases were identified (incidence 31.6 per 100 person years). Independent associations were observed between incident infection and prior imprisonment (p = 0.02) and tattooing (p = 0.03), and surprisingly also with methadone maintenance treatment (MMT) (p < 0.001). CONCLUSIONS High rates of new HCV infection were found in this prisoner cohort reflecting their substantive risk behavior profile, despite having remained uninfected for many years. The association with MMT is challenging and highlights the need for better understanding of prison-specific HCV transmission risks, as well as the uptake and effectiveness of prevention programs.
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Affiliation(s)
- Suzy Teutsch
- School of Medical Sciences, The University of New South Wales, Sydney, New South Wales, Australia.
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31
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Imperial JC. Chronic hepatitis C in the state prison system: insights into the problems and possible solutions. Expert Rev Gastroenterol Hepatol 2010; 4:355-64. [PMID: 20528122 DOI: 10.1586/egh.10.26] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The prevalence of chronic hepatitis C virus (HCV) within the correctional system is estimated to be 10-20-times greater than that which is reported in the general population. High-risk behavioral patterns probably account for the greater estimates in this population. Recent observations of more than 780 patient-inmates infected with HCV within the California Department of Corrections suggest a very high prevalence of advanced fibrosis in this population. Observational studies performed in Texas have shown that the rates of chronic liver disease-related deaths have increased significantly between 1989 and 2003, especially among Hispanic patient-inmates. Viral hepatitis accounts for a significant number of these chronic liver disease-related deaths. Identification of high-risk patient-inmates infected with HCV, as well as appropriation of funds for their treatment, should result in a decreased rate of liver-related complications. This should translate into reduced morbidity and cost to correctional institutions, as well as to improved public health and safety.
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Affiliation(s)
- Joanne C Imperial
- Correctional Medicine Consultation Network, University of California, San Francisco, 1940 Bryant Street, San Francisco, CA 94110, USA.
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32
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Bevan G. Problem drug use the public health imperative: what some of the literature says. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2009; 4:21. [PMID: 20015369 PMCID: PMC2805619 DOI: 10.1186/1747-597x-4-21] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Accepted: 12/16/2009] [Indexed: 12/21/2022]
Abstract
Background With more than 200,000 problem drug users is contact with structured treatment services in England the public health imperative behind drug treatment is great. Problem drug use for many is a chronic and relapsing condition, where "cure" is often neither a reasonable or appropriate expectation and it can further be argued that in these circumstances problem drug use is no different from any number of chronic and enduring health conditions that are managed in the health care system and therefore should be conceptualised as such. Discussion A public health approach to drug treatment emphasises the need for drug users in or accessing treatment, to reduce their harmful drug use, reduce drug use related risks such as sepsis and overdose and stay alive for longer. However a public health perspective in relation to problem drug use isn't always either apparent or readily understood and to that end there is still a significant need to continue the arguments and debate that treatment and interventions for problem and dependent drug users need to extend beyond an individualistic approach. For the purposes of discussion in this article public and population health will be used interchangeably. Summary A recognition and acceptance that a public and population health approach to the management of problem drug users is sound public health policy also then requires a long term commitment in terms of staffing and resources where service delivery mirrors that of chronic condition management.
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Affiliation(s)
- Gez Bevan
- University of Sunderland, Faculty of Applied Sciences, Chester Rd, Sunderland, SR1 3SD, UK.
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Wakai S, Shelton D, Trestman RL, Kesten K. Conducting research in corrections: challenges and solutions. BEHAVIORAL SCIENCES & THE LAW 2009; 27:743-752. [PMID: 19743521 DOI: 10.1002/bsl.894] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Research in correctional settings has progressed from the exploitation of a vulnerable population in the years prior to 1978 to its current overly protective and restrictive state. With the considerable growth in the numbers of inmates with medical and mental health care needs, developing effective interventions to serve this population is paramount. There now appear to be signs of interest in and support for research with inmates by correctional agencies, academia, and health care organizations. Innes (2003) has articulated the following strategies for implementing research in prison: (1) gather stakeholders; (2) include one or more experienced research collaborators; (3) consider obtaining technical assistance from a university or the National Institute of Corrections (NIC); (4) define potential opportunities/interests that support the institution's mission; (5) develop a relationship with an IRB; (6) pilot a small proposal that is of interest and potential value to the organization. The authors illustrate the implementation of a study in a correctional system that uses these strategies.
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Affiliation(s)
- Sara Wakai
- Center for Correctional Mental Health Services Research, Department of Medicine-MC6210, University of Connecticut Health Center, Farmington, CT 06032, USA.
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