Seroprevalence of markers for hepatitis B, C and G in male and female prisoners--NSW, 1996

Seroprevalence and factors associated with hepatitis B virus exposure in the incarcerated population from southern Brazil

Hepatitis B viral infection (HBV) in prisons poses serious public health challenges because it significantly contributes to the increase in both morbidity and mortality indicators worldwide. Research has shown high HBV prevalence among inmates when compared to the general population. In this study, we estimated the prevalence of HBV exposure and its risk factors among 1,132 inmates detained in high security institutions. A cross-sectional, epidemiological study was carried out in 11 male-only prisons in the State of Paraná, Brazil, between May 2015 to December 2016. HBV exposure was explored using a variety of methods, including HBsAg, anti-HBs, and total anti-HBc. Data were analyzed using univariate and multivariate techniques. The overall prevalence of HBV exposure was 11.9% (95% CI: 10.9-12.8), totaling 135 individuals. In the multivariate analyses, risk factors that remained statistically significant were related to the penitentiary location (Francisco Beltrão; OR = 5.59; 95% CI: 3.32-9.42), age (over 30 years; OR = 5.78; 95% CI: 3.58-9.34), undergoing tattooing procedures in prison (OR = 1.64; 95% CI: 1.03-2.60), self-reported sexual activities with a known drug user (OR = 1.67; 95% CI: 1.12-2.48) and having a history of previous history of hepatitis B or C infection (OR = 2.62; 95% CI: 1.48-4.64). The findings indicate that public policies-including vaccination, early diagnosis, harm reduction strategies, and adequate treatment-should be designed and delivered in the same way for both the incarcerated and the general population in order to reduce the prevalence of HBV and its associated consequences.

Global prevalence of hepatitis C in prisoners: a comprehensive systematic review and meta-analysis

Hepatitis C virus (HCV), one of the most significant causes of liver inflammation, has a high annual mortality rate. The unfavorable hygiene conditions and inadequate health monitoring in many prisons increase the risk of blood-borne infections such as hepatitis C. The growing incidence of this disease among prisoners results in overspill transmission to the general population from undiagnosed prisoners that have been released. Therefore, the aim of this study was to investigate the prevalence of hepatitis C among the world's prison population. A systematic review and meta-analysis of studies on the prevalence of hepatitis C was carried out using the keywords "Prevalence", "Hepatitis C", and "Prisoner" in the Iranian and international databases SID, MagIran, Iran Doc, Science Direct, Scopus, PubMed, and Web of Science (WoS) from January 1990 to September 2020. After transferring the articles to the information management software EndNote and eliminating duplicate studies, the remaining studies were reviewed based on inclusion and exclusion criteria, three stages of primary and secondary evaluation, and qualitative evaluation. Comprehensive meta-analysis software and Begg and Mazumdar and I² tests were used for data analysis and assessment of dissemination bias, and heterogeneity, respectively. Out of 93 studies (22 from Asia, 26 from Europe, seven from Africa, 29 from America, and nine from Australia) with a total sample size of 145,823 subjects, the prevalence of hepatitis C in prisoners worldwide was estimated to be 17.7% (95% confidence interval, 15-20.7%). The highest prevalence of hepatitis C on the continents included in this study was reported in prisoners incarcerated in Australia and Oceania, with 28.4% (95% CI: 21.6-36.4) in nine studies, and Europe, with 25.1% (95% CI: 19.4-31.8) in 26 studies. All studies used an ELISA test for the detection of HCV antibodies. The results showed a prevalence of HCV of 17.7% in prisoners worldwide, ranging between 10 and 30% over five continents (Asia, Europe, America, Africa, and Australia and Oceania). The highest prevalence was reported in Australia and Oceania (28.4%), indicating the need to pay more attention to this issue on the continent. It is necessary to reduce the incidence of the disease in prisons by appropriate policy-making and the development of accurate and practical programs, including the distribution of free syringes and examination, testing, and screening of prisoners.

Hepatitis C treatment strategies in prisons: A cost-effectiveness analysis

In Australian prisons approximately 20% of inmates are chronically infected with hepatitis C virus (HCV), providing an important population for targeted treatment and prevention. A dynamic mathematical model of HCV transmission was used to assess the impact of increasing direct-acting antiviral (DAA) treatment uptake on HCV incidence and prevalence in the prisons in New South Wales, Australia, and to assess the cost-effectiveness of alternate treatment strategies. We developed four separate models reflecting different average prison lengths of stay (LOS) of 2, 6, 24, and 36 months. Each model considered four DAA treatment coverage scenarios of 10% (status-quo), 25%, 50%, and 90% over 2016–2045. For each model and scenario, we estimated the lifetime burden of disease, costs and changes in quality-adjusted life years (QALYs) in prison and in the community during 2016–2075. Costs and QALYs were discounted 3.5% annually and adjusted to 2015 Australian dollars. Compared to treating 10% of infected prisoners, increasing DAA coverage to 25%, 50%, and 90% reduced HCV incidence in prisons by 9–33% (2-months LOS), 26–65% (6-months LOS), 37–70% (24-months LOS), and 35–65% (36-months LOS). DAA treatment was highly cost-effective among all LOS models at conservative willingness-to-pay thresholds. DAA therapy became increasingly cost-effective with increasing coverage. Compared to 10% treatment coverage, the incremental cost per QALY ranged from $497-$569 (2-months LOS), -$280–$323 (6-months LOS), -$432–$426 (24-months LOS), and -$245–$477 (36-months LOS). Treating more than 25% of HCV-infected prisoners with DAA therapy is highly cost-effective. This study shows that treating HCV-infected prisoners is highly cost-effective and should be a government priority for the global HCV elimination effort.

The distribution and socioeconomic burden of Hepatitis C virus in South Australia: a cross-sectional study 2010-2016

BACKGROUND

Hepatitis C virus infection (HCV) is a communicable disease of increasing global importance with 1.75 million new infections and 400,000 related deaths annually. Until recently, treatment options have had low uptake and most infected people remain untreated. New Direct Acting Antiviral medications can clear the virus in around 95% of cases, with few side-effects. These medications are restricted in most countries but freely accessible in Australia, yet most people still remain untreated. This study applies a cross-sectional research design to investigate the socio-spatial distribution of HCV in South Australia, to identify vulnerable populations, and examine epidemiological factors to potentially inform future targeted strategies for improved treatment uptake.

METHOD

HCV surveillance data were sourced from South Australia's Communicable Diseases Control Branch and socio-economic population data from the Australian Bureau of Statistics from January 2010 to December 2016 inclusive. HCV cases were spatially mapped at postcode level. Multivariate logistic regression identified independent predictors of demographic risks for HCV notification and notification source.

RESULTS

HCV notifications (n = 3356) were seven times more likely to be from people residing in the poorest areas with high rates of non-employment (75%; n = 1876) and injecting drug use (74%; n = 1862) reported. Notifications among Aboriginal and Torres Strait Islander people were around six times that of non-Indigenous people. HCV notifications negatively correlated (Spearman's rho - 0.426; p < 0.001) with socio-economic status (residential postcode socio-economic resources Index). History of imprisonment independently predicted HCV diagnoses in lesser economically-resourced areas (RR1.5; p < 0.001). Independent predictors of diagnosis elsewhere than in general practices were non-employment (RR 4.6; p = 0.028), being male (RR 2.5; p < 0.001), and younger than mean age at diagnosis (RR 2.1; p = 0.006).

CONCLUSIONS

Most people diagnosed with HCV were from marginalised sub-populations. Given general practitioners are pivotal to providing effective HCV treatment for many people in Australia a most concerning finding was that non-employed people were statistically less likely to be diagnosed by general practitioners. These findings highlight a need for further action aimed at improving healthcare access and treatment uptake to help reduce the burden of HCV for marginalised people, and progress the vision of eliminating HCV as a major public health threat.

Prevalence of Hepatitis C Among Australian Aboriginal and Torres Strait Islander people: A Systematic Review and Meta-Analysis

CONTEXT

Aboriginal and Torres Strait Islanders (Aboriginal) account for approximately 3% of the Australian population. They have the poorest health, economic and social outcomes. Higher notification rates of hepatitis C antibodies (anti-HCV) have been reported among Aboriginal compared with non-Aboriginal people. The identification of Aboriginal people in national surveillance has some weaknesses, with only four of the eight jurisdictions included in national reporting. To address some of these limitations, we aim to estimate the pooled prevalence of anti-HCV among Aboriginal people in Australia.

EVIDENCE ACQUISITION

We searched the databases: Pubmed, Web of Science and Informit, and the New South Wales and Northern Territory Public Health Bulletins. A study was included if it reported the number of Aboriginal people testing positive for anti-HCV and the number tested for anti-HCV. A meta-analysis by population-group was conducted if three or more studies reported a prevalence estimate. Variables included: author, year of publication, study design, study period, gender (female, male), age, population group (Aboriginal people in prison, Aboriginal people who inject drugs), number testing anti-HCV positive, number tested for anti-HCV and prevalence (%). Due to a long time period, we separated the studies estimating the prevalence anti-HCV among Aboriginal people in prison into two time periods, 1994 - 2004 and 2005 - 2012.

RESULTS

Overall, 15 studies met our inclusion criteria. Among Aboriginal people in prison, the pooled prevalence of anti-HCV was 18.1% (95%CI: 6.6 - 29.7). The pooled prevalence among Aboriginal people in prison was 25.7% (95%CI: 4.1-47.3) in studies published between 1994 - 2004 and 14.5% (95%CI: 1.7 - 27.3) in studies published from 2005 - 2012. The pooled prevalence of anti-HCV was 58.7% (95%CI: 53.9 - 63.5) among Aboriginal people who inject drugs and 2.9% (95%CI: 0.30 - 6.1) among Aboriginal people who did not inject drugs, however there was significant heterogeneity (I(2) > 90.0%, P < 0.01). There was significant selection bias in the studies as most included individuals who inject drugs.

CONCLUSIONS

Our analysis shows that the overall prevalence of anti-HCV was significantly biased towards people who inject drugs; resulting in an over-estimation of anti-HCV prevalence among Aboriginal people. Our review highlights that unsafe injecting is the main transmission route for HCV infection among Aboriginal people in Australia.

The prevalence of isolated hepatitis B core antibody and its related risk factors among male injected drug users in Isfahan prisons

Background:

The prevalence of isolated hepatitis B core antibody (anti-HBc) varies between 1% and 30% in different populations. Isolated anti-HBc-positive patients who suffer from occult hepatitis B virus (HBV) infection have the potential to transmit HBV infection. So isolated anti-HBc screening is a valuable tool to prevent HBV transmission. Considering the importance of isolated anti-HBc screening and high prevalence of HBV among injected drug users (IDU) prisoners, we designed this study to evaluate the isolated anti-HBc positivity among inmates with the history of IDU in our area.

Materials and Methods:

We did this cross-sectional study from September 2009 to March 2010 among volunteer male IDU prisoners in Isfahan. Blood samples were taken from all of subjects and tested for HBV markers. Then a questionnaire containing socio-demographic, drug histories and high risk behaviors information was completed for all participants. Data analysis was done utilizing univariate analysis and multiple logistic regressions. A P < 0.05 was considered significant.

Results:

Totally 970 male IDU prisoners (mean age 32.6 ± 8.1) were included in our study. The prevalence of isolated HBc Ab was 4.5%. Isolated anti-HBc significantly was related to tooth filling (OR: 2.62, CI: 1.20-7.14) and imprisonment (OR: 3.95, CI: 1.39-11.18). We couldn’t find any relationship between isolated anti-HBc positivity and addiction duration, incarceration frequency, recent incarceration duration or number of injection per month.

Conclusion:

For screening high risk groups in parallel with hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb) and other viral markers, maybe it is better to check HBcAb too, because isolated HBcAb-positive patients may have occult hepatitis B infection which could transfer the infection to others.

Trends in HIV, hepatitis B and hepatitis C prevalence among Australian prisoners - 2004, 2007, 2010

OBJECTIVE

To report the prevalence of markers for HIV infection, hepatitis B and hepatitis C among Australian prison entrants.

DESIGN

Cross-sectional survey conducted over 2-week periods in 2004, 2007 and 2010.

SETTING

Reception prisons in New South Wales, Queensland, Tasmania and Western Australia.

PARTICIPANTS

Individuals entering prison from the community during the survey periods.

MAIN OUTCOME MEASURE

Prevalence of anti-HIV antibody (anti-HIV), hepatitis B surface antigen (HBsAg), anti-hepatitis B core antibody (anti-HBc) and anti-hepatitis C virus antibody (anti-HCV).

RESULTS

The study included 1742 prison entrants: 588 (33.8%) in 2004, 536 (30.8%) in 2007 and 618 (35.5%) in 2010. The age-standardised prevalence estimates for anti-HIV, HBsAg and anti-HBc were 0.4%, 2.3% and 21.7% respectively, and remained stable over the three survey periods. The age-standardised prevalence estimate for anti-HCV was 29.0%; it decreased over time (33.3% in 2004 v 23.2% in 2010; P = 0.001), and this coincided with a decrease in prison entrants reporting injecting drug use (58.3% [343/588] in 2004 v 45.3% [280/618] in 2010; P < 0.001). Among injecting drug users, the prevalence of anti-HCV was 57.2% and did not change significantly over time. Of those who were anti-HCV positive, 33.7% (140/415) were unaware of their infection status, and 74.3% (185/249) of those who tested positive for anti-HBc reported that they had never had hepatitis B.

CONCLUSIONS

HIV prevalence is low in the Australian prisoner population but transmission remains a risk. Despite a decrease in the proportion of prison entrants reporting injecting drug use, prevalence of hepatitis B and hepatitis C has remained high. Treatment and prevention initiatives should be prioritised for this population.

Increased mortality among Indigenous persons during and after release from prison in New South Wales

OBJECTIVE

To estimate the overall and cause specific mortality of Aboriginal offenders in New South Wales (NSW), Australia.

METHODS

The study cohort consisted of all Aboriginal men and women aged 18 years and older who had experienced full-time imprisonment in NSW between 1 January 1988 and 31 December 2002. Their data were linked probabilistically to the Australian National Death Index to obtain information on death. Standardised mortality ratios were calculated for all causes of death and adjusted for age, sex, and calendar year.

RESULTS

The cohort comprised 7,980 men and 1,373 women with 75,801 person years of observation. During a median follow-up period of 8.3 years, 485 men and 73 women died, giving an overall mortality rate of 733 and 755 deaths per 100,000 person-years. The risk of death in men was 4.8 (95% CI: 4.4-5.3) times and among women 12.6 (95% CI: 10.0-15.8) times that of the NSW residents, with a markedly elevated risk for almost all conditions. The leading cause of death was cardiovascular disease in men (112 deaths, 23%) and mental and behavioural disorders (17 deaths, 23%) in women. The risk of death was greatest following release from prison.

CONCLUSIONS AND IMPLICATIONS

High mortality rates for cardiovascular disease, a preventable and treatable condition, were seen among Aboriginal offenders. Prison has an important role to play in screening marginalised populations for a range of health conditions. This is particularly true for Indigenous offenders.

Are prisoners reliable survey respondents? A validation of self-reported traumatic brain injury (TBI) against hospital medical records

AIMS

To compare prisoners' self-reported history of TBI associated with hospital attendance with details extracted from relevant hospital medical records and to identify factors associated with the level of agreement between the two sources.

METHODS

From a sample of prison entrants, this study obtained a history of TBIs for which medical attention was sought at a hospital. Audit tools were developed for data extraction relevant to any possible TBI from records at a total of 23 hospitals located within New South Wales, Australia. The level of agreement between self-report and hospital records was compared in relation to demographic, psychological and criminographic characteristics.

RESULTS

Of the 200 participants in the study, 164 (82%) reported having sustained a past TBI giving a total of 420 separate TBI incidents. Of these, 156 (37%) were alleged to have resulted in attendance at a hospital emergency department including 112 (72%) at a hospital accessible for the validation exercise. For 93/112 (83%) of reported TBIs, a corresponding hospital medical record was located of which 78/112 (70%) supported the occurrence of a TBI. Lower education and a lifetime history of more than seven TBIs were associated with less agreement between self-report and medical record data with regard to specific details of the TBI.

CONCLUSIONS

Overall, these findings suggest that prisoners' self-report of TBI is generally accurate when compared with the 'gold standard' of hospital medical record. This finding is contrary to the perception of this group as 'dishonest' and 'unreliable'.

Incidence of primary hepatitis C infection and risk factors for transmission in an Australian prisoner cohort

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.

Gender differences in hepatitis C antibody prevalence and risk behaviours amongst people who inject drugs in Australia 1998-2008

BACKGROUND

Global prevalence of hepatitis C virus (HCV) is estimated to be around 3% with approximately 170 million people affected. In Australia, and in many other resource rich countries, injecting drug use is the single most important risk factor for acquiring HCV, with around a third of diagnoses occurring in women. This study aims to assess gender differences in hepatitis C antibody prevalence and associated risk behaviours amongst a large sample of PWID in Australia.

METHODS

During a one to two week period in October, PWID attending selected NSP sites are invited to participate in the Australian NSP Survey. Between 1998 and 2008, approximately 16,000 individuals completed a self-administered questionnaire and provided a capillary blood sample for HIV and HCV antibody testing. We stratified our sample by time since onset of injecting and analysed the demographic characteristics, injecting behaviours and antibody test results to determine gender differences.

RESULTS

Women were found to be at increased risk of exposure to hepatitis C in all duration of injection categories except those injecting for 17 or more years. In the early years of injecting, women also reported higher rates of receptive sharing of needles and syringe and ancillary equipment when compared to men. Last injecting heroin, methadone or buprenorphine was significantly associated with HCV antibody prevalence amongst both males and females injecting for less than 5 years.

CONCLUSION

Findings indicate that women are at greater risk than men of HCV infection during the early years of injection through higher rates of receptive sharing of needles and syringes and/or ancillary equipment. Our results suggest that women who are new to injecting, and Indigenous women in particular, should be identified as priority populations when developing and implementing harm reduction strategies that target people who inject illicit drugs.

Viral hepatitis B, C and HIV infection in Croatian prisons

Incarcerated persons comprise about 0.4% of the Croatian population, of whom 25-30% misuse drugs. We attempted to determine the structure of the prison population, prevalence of HBV, HCV, HIV markers, co-infections with HBV, HCV and HIV and acute HBV, HCV and HIV infection. In total, 25.9% of prisoners were positive for some markers for viral hepatitis (HBV 11.3%, HCV 8.3%, HBV/HCV 6.3%). Prevalence of HBV infection in intravenous drug users (IDUs) was 26.2% (highly promiscuous group 20.4%, individuals with psychiatric diseases and personality disorders 16.0%). HCV infection in IDUs was 52.0% and 4.9% in the highly promiscuous group. HBV/HCV co-infection was registered in 34.9% of prisoners positive for HBV markers (203/582). Acute HBV infection was detected in 0.5%, and HCV in 1.2%. Only 0.15% (5/3348) of prisoners were anti-HIV positive. It appears that individuals with psychiatric diseases and personality disorders could be an additional risk population for these viral infections.

Testing for sexually transmitted infections and blood borne viruses on admission to Western Australian prisons

Background

Prison populations are known to be at high risk of sexually transmitted infections (STIs) and blood borne viruses (BBVs). In accordance with State health guidelines, the Western Australian Department of Correctional Services' policy is to offer testing for STIs and BBVs to all new prison entrants. This audit was undertaken to assess the completeness and timeliness of STI and BBV testing among recent prison entrants in Western Australia, and estimate the prevalence of STIs and BBVs on admission to prison.

Methods

A retrospective audit of prison medical records was conducted among 946 individuals admitted to prison in Western Australia after the 1^st January 2005, and discharged between the 1^st January and 31^st December 2007 inclusive. Quota sampling was used to ensure adequate sampling of females, juveniles, and individuals from regional prisons. Main outcomes of interest were the proportion of prisoners undergoing STI and BBV testing, and the prevalence of STIs and BBVs.

Results

Approximately half the sample underwent testing for the STIs chlamydia and gonorrhoea, and almost 40% underwent testing for at least one BBV. Completeness of chlamydia and gonorrhoea testing was significantly higher among juveniles (84.1%) compared with adults (39.8%; p < 0.001), and Aboriginal prisoners (58.3%) compared with non-Aboriginal prisoners (40.4%; p < 0.001). Completeness of BBV testing was significantly higher among adults (46.5%) compared with juveniles (15.8%; p < 0.001) and males (43.3%) compared with females (33.1%; p = 0.001). Among prisoners who underwent testing, 7.3% had a positive chlamydia test result and 24.8% had a positive hepatitis C test result.

Conclusion

The documented coverage of STI and BBV testing among prisoners in Western Australia is not comprehensive, and varies significantly by age, gender and Aboriginality. Given the high prevalence of STIs and BBVs among prisoners, increased test coverage is required to ensure optimal use of the opportunity that prison admission presents for the treatment and control of STIs and BBVs among this high risk group.

A meta-analysis of the hepatitis C virus distribution in diverse racial/ethnic drug injector groups

Hepatitis C virus (HCV) is mostly transmitted through blood-to-blood contact during injection drug use via shared contaminated syringes/needles or injection paraphernalia. This paper used meta-analytic methods to assess whether HCV prevalence and incidence varied across different racial/ethnic groups of injection drug users (IDUs) sampled internationally. The 29 prevalence and 11 incidence studies identified as part of the HCV Synthesis Project were categorized into subgroups based on similar racial/ethnic comparisons. The effect estimate used was the odds or risk ratio comparing HCV prevalence or incidence rates in racial/ethnic minority groups versus those of majority status. For prevalence studies, the clearest disparity in HCV status was observed in the Canadian and Australian Aboriginal versus White comparison, followed by the US non-White versus White categories. Overall, Hispanic IDUs had greater HCV prevalence, and HCV prevalence in African-Americans was not significantly greater than that of Whites in the US. Aboriginal groups showed higher HCV seroconversion rates when compared to others, and African-Americans had lower seroconversion rates compared to other IDUs in the US. The findings suggest that certain minority groups have elevated HCV rates in comparison to other IDUs, which may be a consequence of stigma, discrimination, different risk behaviors or decreased access to health care, services and preventive education. Future research should seek to explicitly explore and explain racial/ethnic variations in HCV prevalence and incidence, and define the groups more precisely to allow for more accurate detection of possible racial/ethnic differences in HCV rates.

Meta-regression of hepatitis C virus infection in relation to time since onset of illicit drug injection: the influence of time and place

The authors examined the relation between time since onset of illicit drug injection (time at risk) and rates of hepatitis C virus (HCV) infection by using meta-regression. In 72 prevalence studies, median time since onset of injection was 7.24 years and median prevalence was 66.02%. The model showed statistically significant linear and quadratic effects of time at risk on HCV prevalence and significantly higher prevalence in developing and transitional countries and in earlier samples (1985-1995). In developed countries post-1995, mean fitted prevalence was 32.02% (95% confidence interval: 25.31, 39.58) at 1 year of injection and 53.01% (95% confidence interval: 40.69, 65.09) at 5 years. In developing/transitional countries post-1995, mean fitted HCV prevalence was 59.13% (95% confidence interval: 30.39, 82.74) at 1 year of injection. In 10 incidence studies, median time at risk was 5.29 years and median cumulative HCV incidence was 20.69%. Mean fitted cumulative incidence was 27.63% (95% confidence interval: 16.92, 41.70) at 1 year of drug injection. The authors concluded that time to HCV infection in developed countries has lengthened. More rapid onset of HCV infection in drug injectors in developing/transitional countries resembles an earlier era of the HCV epidemic in other regions.

The 2004 Australian prison entrants' blood-borne virus and risk behaviour survey

OBJECTIVES

To assess the prevalence of blood-borne viruses and associated risk factors among prison entrants at seven Australian prisons across four States.

DESIGN

Consecutive cross-sectional design. Voluntary confidential testing of all prison entrants for serological markers of human immunodeficiency virus (HIV), hepatitis C (HCV) and hepatitis B (HBV) over 14 consecutive days in May 2004. Demographic data and data related to risks for blood-borne virus transmission, such as sexual activity, body piercing, tattooing, and injecting drug use, were collected.

RESULTS

National prevalence for HIV was 1%, hepatitis B core antibody 20%, and hepatitis C antibody 34%. Fifty-nine per cent of participants had a history of injecting drug use. Among injecting drug users, the prevalence of HIV was 1%, hepatitis C antibody 56%, and hepatitis B core antibody 27%. Forty-one per cent of those screened reported a previous incarceration. In the multivariate model, Queensland and Western Australian (WA) prison entrants were significantly less likely to test positive to HCV than those in New South Wales (NSW). Amphetamine was the most commonly injected drug in Queensland, Tasmania and WA. In NSW, heroin was the most common drug injected. In the multivariate analysis a history of injecting drug use, being aged 30 years or more, and a prior incarceration were positively associated with hepatitis C infection. For hepatitis B core antibody, age over 30 years and a history of injecting drug use were associated with an increased risk.

CONCLUSIONS

The findings support the view that prisoner populations are vulnerable to blood-borne virus infection, particularly hepatitis B and C. Prisoner populations should be included in routine surveillance programs so as to provide a more representative picture of blood-borne virus epidemiology in Australia.

Aboriginal and non-Aboriginal health differentials in Australian prisoners

OBJECTIVE

Compare the self-reported physical and mental health of Aboriginal and non-Aboriginal prisoners in New South Wales (NSW).

DESIGN

Cross-sectional random sample.

SETTING

Twenty-nine correctional centres (27 male and two female) in NSW.

PARTICIPANTS

747 men (227 Aboriginal) and 167 women (29 Aboriginal) in full-time custody.

METHODS

Face to-face interviews were used to record self-reported health status.

RESULTS

Aboriginal prisoners differed significantly from non-Aboriginal inmates in several socio-demographic and criminographic factors. However, few differences were observed in health status between Aboriginal and non-Aboriginal men and women. After adjusting for age, Aboriginal men were more likely to report high blood pressure and diabetes. No differences were found in chronic health conditions in the female group. Aboriginal men had higher SF-36 scores than non-Aboriginal men on general health, vitality, and mental health. Aboriginal women had lower scores than non-Aboriginal women on social functioning and role-emotional but scored higher on the role-physical dimension. Aboriginal inmates were more likely to report seeing certain health professionals (doctors, dentists, drug and alcohol counsellors, and optometrists) in prison compared with the community.

CONCLUSIONS

The health of Aboriginal and non-Aboriginal prisoners is remarkably similar in this population group. Few differences were observed in self-reported chronic health conditions. Aboriginal prisoners report using prison health services more while in prison compared with the community. This highlights that for many, prison is a rare opportunity to contact health services.

Risk factors and seroprevalence of markers for hepatitis A, B and C in persons subject to homelessness in inner Sydney

OBJECTIVE

To determine the seroprevalence of hepatitis A, B and C and the prevalence of risk factors for blood-borne infections in persons subject to homelessness attending a medical clinic in inner Sydney.

METHOD

During 2003-05, 201 clients were enrolled in a prospective study to determine the acceptance, completion rates and immunogenicity of the standard vaccination schedule for hepatitis A and B. On enrolment, clients completed a risk factor assessment questionnaire and undertook pre-vaccination serological screening for hepatitis A, B and C.

RESULTS

Forty-five per cent (85/188) of clients were positive for anti-HCV antibodies; 32% (60/189) showed evidence of past infection with HBV (anti-HBc); and 48% (89/189) were positive for anti-HAV antibodies. It was not uncommon for clients to have multiple markers of hepatitis. A past history of injecting drug use was significantly associated with markers for hepatitis B and C; age predicted presence of anti-HAV. A verbal history of infection appeared more reliable for hepatitis C, but considerably less so for hepatitis A and B.

CONCLUSION

Persons subject to homelessness are at risk of blood-borne infection. The seroprevalence of markers for hepatitis B and C are higher than in the general population.

IMPLICATIONS

Despite the high proportion of clients with serological markers for hepatitis A and B, at least 69% of clients could potentially benefit from hepatitis A and/or B vaccination.

The effect of hepatitis C virus infection on health-related quality of life in prisoners

Hepatitis C virus (HCV) infection in prisoners represents an important public health problem. However, there is very little information about HCV-related health-related quality of life (HRQOL). We examined the effect of HCV antibody positivity, HCV viremia, and being a prisoner on prisoners'' HRQOL. Population-based health surveys incorporating HCV screening were conducted among prisoners at New South Wales (NSW), Australia, correctional centers in 1996 and 2001. HCV antibody and HCV RNA status were determined from venous blood sampling. HRQOL and mood status were assessed using the Short Form-36 (SF-36) Health Survey and Beck Depression Inventory (BDI). Comparison of HRQOL scores between HCV antibody negative, HCV antibody positive/non-viremic, and HCV antibody positive/viremic and assessment of temporal change in HRQOL between 1996 and 2001 within groups were made using ANCOVA adjusting for confounders. Factors associated with HRQOL were determined in linear regression models. Analyses between HCV antibody negative (n = 423), HCV positive/non-viremic (n = 89), and HCV positive/viremic (n = 178) prisoners found no measurable effect of HCV on HRQOL, including that attributable to HCV viremia. Compared to uninfected Australian population norms, prisoners had lower HRQOL irrespective of HCV status. The prevalence of 'moderate' to 'severe' depressive symptoms was greater in the HCV antibody positive/viremic group than the HCV antibody positive/non-viremic group or the HCV antibody negative group. Selected demographic factors (age), co-morbidity, severity of depressive symptoms and medical care utilization influenced HRQOL. There was evidence to support the effect of knowledge of HCV status on HRQOL. In conclusion, our findings contrast with previous studies in non-prisoner groups in which HCV infection appears to decrease overall HRQOL. Non-HCV factors may override HCV-specific HRQOL impairment in this population. Targeted management strategies are required to improve HRQOL of prisoners.

Hearing health of New South Wales prison inmates

OBJECTIVE

To assess the hearing health of New South Wales prison inmates.

METHODS

The method of testing hearing chosen was the rapid click-evoked otoacoustic emissions technique, from which two key variables were evaluated for early status of ear damage. Hearing variables, including hearing history and self-reported symptoms, were incorporated in a multivariate analysis of other health and demographic variables in the prison sample.

RESULTS

The analysis shows that the hearing acuity of prisoners is poor compared with the general Australian population. Variables significantly related to the hearing scores were history of hearing problems or having arthritis or diabetes. In this sample hearing did not interact with alcohol or drugs. Those testing positive for Hepatitis B Core-Antibody were also found to have poorer hearing than those without.

CONCLUSIONS AND IMPLICATIONS

Prisoners in general have poorer hearing than a normative Australian population. Some conditions have a significant impact on hearing, which may be due to associated medications. A previous history of ear problems was found to be significantly related to hearing acuity as was a history of exposure to noise. Health screening programs within the correctional system may need to include hearing loss prevention programs and medical follow-ups in relation to hearing health.

Prisoners are at risk for hepatitis C transmission

OBJECTIVE

Determine the incidence of hepatitis C virus antibodies among a cohort of prisoners.

DESIGN

Follow-up study of a random sample of prisoners who participated in a cross-sectional survey in 1996.

SETTING

29 correctional centres in New South Wales (Australia).

PARTICIPANTS

181 adult prisoners (163 men and 18 women).

RESULTS

The incidence of hepatitis C virus antibody among the 90 inmates who were seronegative at the first test in 1996 was 7.1 per 100 person-years (16 seroconverters). Among the 90 inmates, 37 had re-entered the prison system following release into the community and 53 had been continuously detained. The seroconversion rate was higher among the re-entrants compared with those who had been continuously incarcerated (10.8 vs. 4.5 per 100 person-years, p=0.07). However, when the data was stratified by injecting status, the serocon-version rate in the two groups was similar. Most of the seroconverters had histories of injecting drug users (14/16). The overall incidence among injectors was 19.3 per 100 person years (95% CI: 9.1-29.2).

CONCLUSIONS

Hepatitis C transmission occurs inside the prison with injecting drug use the likely cause. Among non-injectors, tattooing was the most likely mode of transmission. Harm minimisation measures with proven effectiveness need to be considered for this environment.

Screening for chronic hepatitis C: American College of Preventive Medicine practice policy statement

Hepatitis C is an under-diagnosed and prevalent bloodborne illness, resulting in chronic cirrhosis in up to 25% of those infected. While the overall prevalence in the United States is 1.7%, high-risk populations may have up to 80% prevalence. The mechanism of transmission is well understood, but effective preventive measures are hampered by economic, social, and political factors. Antiviral treatment is expensive, and efficacy ranges from 40% to 85%. The value of screening high-risk populations has been demonstrated, and should be expanded; however, there is insufficient evidence to recommend universal screening for adults.

Assessing the health of women in prison: a study from the United Kingdom

The number of women imprisoned in the United Kingdom is rising rapidly, but there is little research on their health and well-being. We could find no studies in which the researchers had used measures of subjective health status to gain a picture of the health of imprisoned women. This self-completed questionnaire study aimed to explore the usefulness of the Short Form 36 (SF-36) in a general female prison population. The scores of imprisoned women for all but 3 of the 8 dimensions were significantly lower than those for women in the social class with the worst health in the United Kingdom, confirming the very poor mental and physical health of this population.

The self-reported health status of prisoners in New South Wales

OBJECTIVE

To describe the physical health of the New South Wales prisoner population.

DESIGN

Cross-sectional random sample of adult men and women prisoners.

SETTING

29 New South Wales correctional centres (27 male and two female).

PARTICIPANTS

747 men and 167 women.

MAIN RESULTS

Despite the comparatively young population, 81% of women and 65% of men had at least one chronic health condition; 41% of men and 59% of women reported multiple health problems. The most common conditions were back problems, poor eyesight, arthritis, high blood pressure and asthma. Chronic conditions were more prevalent among women prisoners. Thirty-seven per cent of women and 28% of men rated their health as either 'poor' or 'fair' compared with 16% of women and 15% of men in the general NSW community. Psychiatric medication was more commonly prescribed to women than men (25% vs. 13%; p < 0.001). Similarly, methadone maintenance was more common among women than men (39% vs. 13%; p < 0.001).

CONCLUSION

Men and women prisoners in NSW have multiple chronic health conditions. While not desirable, incarceration presents an opportunity to initiate treatment to improve the health of this disadvantaged group.

Estimates of chronic hepatitis B virus infection in Australia, 2000

OBJECTIVES

To estimate the prevalence of chronic hepatitis B virus (HBV) infection in Australia and attributable proportions associated with specific demographic groups at higher risk of infection.

METHODS

Two methods were used to estimate prevalence of HBV surface antigen (HBsAg): (1) Population-based: results of a national serosurvey using sera collected opportunistically from laboratories across Australia were used for 1-59 year olds, with the HBsAg prevalence for 50-59 years extrapolated to the population aged 60 years and over; (2) Risk group-based: estimates for selected high-risk groups (injecting drug users, homosexual men, Indigenous Australians and people born in high-prevalence countries), using source data from antenatal HBV screening in central Sydney, HBV prevalence studies, and estimates for low-risk groups (first-time blood donors) were combined proportionally to their representation in the population.

RESULTS

Prevalence of HBsAg in the national serosurvey increased, with age, from 0.0% for 1-4 and 5-9 year olds to 1.3-1.8% for the 40-49 year age group. Australian population HBsAg prevalence based on minimum and adjusted estimates from this serosurvey were 91,500 (0.49%) and 163,000 (0.87%) infections, respectively. The risk group method estimated an Australian HBsAg prevalence of 88,000 infections (0.47%). Approximately 50% of people with chronic HBV infection were estimated to be immigrants from either South-East Asia (33.3%) or North-East Asia (16.2%).

CONCLUSION

The range of estimates for chronic HBV infection in Australia is broad, reflecting the uncertainty in source data. A national blood survey encompassing a large and representative population sample may help to provide more accurate estimates. A large proportion of people with chronic HBV infection are Asian born.

Oral health status of prison inmates--New South Wales, Australia

BACKGROUND

This paper assesses the oral health status in a prison population and identifies risk factors associated with oral health.

METHODS

Cross-sectional stratified random sample of 789 prisoners (657 males and 132 females) from 27 correctional centres across New South Wales, stratified by sex, age and aboriginality. A face to face interview was used to collect information on health status and behavioural risk factors. A subset of participants (312 males and 22 females) received an oral examination which enabled the decayed, missing or filled permanent teeth (DMFT) score to be calculated.

RESULTS

In the last 12 months 391 (50 per cent) inmates had visited a dentist. Reports on treatment received at this last visit were mainly for dental examinations, (62 per cent), dental fillings, (38 per cent), and dental extractions (28 per cent). Self-reported dental needs indicated that 42 per cent perceived the need for a check-up; the perceived need for dental fillings was highest in females compared with males. The mean DMFT for the population was 20.4 and 3.4 for decayed teeth.

CONCLUSIONS

This survey demonstrates that the standard of past oral health care for prison inmates is low. There is a need to be more attentive to oral health promotion as eventually respondents will be returning to the community.

Measuring health service satisfaction: female inmates

This study examines female inmates’ utilisation of and satisfaction with provision of health services, based on data from the 1996 New South Wales (Australia) Inmate Health Survey. Particular variables – indigenous status, mean age, age range, and education level – were analysed for factors associated with satisfaction with provision of health services. Further analysis indicated that for nine outcomes, correctional centre location was the only statistically significant indicator of satisfaction with various aspects of health‐care provision. Three factors – correctional centre location, indigenous status, and age group – were associated with being satisfied with health care received during a woman’s last prison doctor consultation. This study’s most important finding – that correctional centre location was associated with inmates’ satisfaction with health care services in gaol – has implications for governments regarding physical access to health services, and for ensuring services meet inmates’ needs at each correctional centre location.

GB virus C epidemiology in Denmark: different routes of transmission in children and low- and high-risk adults

With the demonstration of an effect of GBV-C infection on the outcome of HIV infection, it has become important to understand the epidemiology of GBV-C. The purpose of this study was to determine the prevalence in high- and low-risk populations. The following populations were tested: school children, 9 and 15 years of age (n = 901), blood donors (n = 5,203), hospital employees (n = 1,432), and prisoners and injecting drug users (n = 447). In-house RT-PCR for GBV-CRNA was used together with a commercial ELISA for anti-E2 (Boehringer, Germany). In addition, questionnaires for risk factors for transmission and serological tests for HIV and hepatitis were applied. The overall prevalence of GBV-CRNA was 1.4% among children, 2.2% among blood donors, 2.2% among hospital employees, 12.5% among non-injecting prisoners, and 34.9% among drug injectors. Correspondingly anti-E2 was found in 0.3%, 12.3%, 25.0%, and 42.7%. Among hospital employees, independent risk factors for GBV-C were professions with blood exposure and sexual risk partners. Among prisoners and drug users, injecting and a sexual risk index were associated independently with GBV-C. Based on these results, the following hypothesis is suggested: GBV-C is transmitted frequently at birth or early childhood and this leads to chronic infection in most cases. Sexual transmission is the most important route of transmission in the adult population but this infection is usually transient. Blood borne transmission plays a role among health care workers and injecting drug users and GBV-C should be further evaluated as a surrogate marker for professional blood exposure.

Cost-effectiveness of hepatitis B vaccination of prison inmates

The purpose of this paper is to determine the cost-effectiveness of vaccinating inmates against hepatitis B. From the prison perspective, vaccinating inmates at intake is not cost-saving. It could be economically beneficial when the cost of a vaccine dose is <US dollars 30 per dose, or there is no prevalence of infection upon intake, or the costs of treating acute or chronic disease are about 70% higher than baseline costs, or the incidence of infection during and after custody were >1.6 and 50%, respectively. The health care system realizes net savings even when there is no incidence in prison, or there is no cost of chronic liver disease, or when only one dose of vaccine is administered. Thus, while prisons might not have economic incentives to implement hepatitis B vaccination programs, the health care system would benefit from allocating resources to them.