Prevalence of antibodies to hepatitis B, hepatitis C, and HIV and risk factors in entrants to Irish prisons: a national cross sectional survey

Increased prevalence of transfusion-transmitted diseases among people with tattoos: A systematic review and meta-analysis

Whether having a tattoo increases the risk of transfusion-transmitted diseases (TTDs) is controversial. Although a few studies have suggested a strong association between having tattoos and TTDs, other studies have not shown the significance of the association. In addition, previous studies mainly focused only on hepatitis C viral infections. The objective of our study was to identify the prevalence and risk of TTDs in people with tattoos as compared with the non-tattooed population. A systematic review of the studies published before January 22, 2021, was performed using the Pubmed, Embase, and Web of Science databases. Observational studies on hepatitis C virus (HCV), hepatitis B virus (HBV), human immunodeficiency virus (HIV), and syphilis infections in people with and without tattoos were included. Studies that reported disease status without serological confirmation were excluded. A total of 121 studies were quantitatively analyzed. HCV (odds ratio [OR], 2.37; 95% confidence interval [CI], 2.04–2.76), HBV (OR, 1.55; 95% CI, 1.31–1.83), and HIV infections (OR, 3.55; 95% CI, 2.34–5.39) were more prevalent in the tattooed population. In subgroup analyses, the prevalence of HCV infection was significantly elevated in the general population, hospital patient, blood donor, intravenous (IV) drug user, and prisoner groups. IV drug users and prisoners showed high prevalence rates of HBV infection. The prevalence of HIV infection was significantly increased in the general population and prisoner groups. Having a tattoo is associated with an increased prevalence of TTDs. Our approach clarifies in-depth and supports a guideline for TTD screening in the tattooed population.

The state of harm reduction in prisons in 30 European countries with a focus on people who inject drugs and infectious diseases

BACKGROUND

People who inject drugs are often imprisoned, which is associated with increased levels of health risks including overdose and infectious diseases transmission, affecting not only people in prison but also the communities to which they return. This paper aims to give an up-to-date overview on availability, coverage and policy framework of prison-based harm reduction interventions in Europe.

METHODS

Available data on selected harm reduction responses in prisons were compiled from international standardised data sources and combined with a questionnaire survey among 30 National Focal Points of the European Monitoring Centre for Drugs and Drug Addiction to determine the level of availability, estimated coverage and policy framework of the interventions.

RESULTS

Information about responses to health harms in prisons is limited and heterogeneous. Cross-country comparability is hampered by diverging national data collection methods. Opioid substitution treatment (OST) is available in 29 countries, but coverage remains low (below 30% of people in need) in half of the responding countries. Needle and syringe programmes, lubricant distribution, counselling on safer injecting and tattooing/piercing are scarcely available. Testing for infectious diseases is offered but mostly upon prison entry, and uptake remains low in about half of the countries. While treatment of infections is mostly available and coverage is high for human immunodeficiency virus (HIV) and tuberculosis, hepatitis B and C treatment are less often provided. Health education as well as condom distribution is usually available, but provision remains low in nearly half of the countries. Post-release linkage to addiction care as well as to treatment of infections is available in a majority of countries, but implementation is often partial. Interventions recommended to be provided upon release, such as OST initiation, take-home naloxone and testing of infections, are rarely provided. While 21 countries address harm reduction in prison in national strategic documents, upon-release interventions appear only in 12.

CONCLUSIONS

Availability and coverage of harm reduction interventions in European prisons are limited, compared to the community. There is a gap between international recommendations and 'on-paper' availability of interventions and their actual implementation. Scaling up harm reduction in prison and throughcare can achieve important individual and public-health benefits.

Hepatitis C virus infection in Irish drug users and prisoners - a scoping review

BACKGROUND

Hepatitis C infection is a major public health concern globally. In Ireland, like other European countries, people who use drugs (PWUD) and prisoners carry a larger HCV disease burden than the general population. Recent advances in HCV management have made HCV elimination across Europe a realistic goal. Engaging these two marginalised and underserved populations remains a challenge. The aim of this review was to map key findings and identify gaps in the literature (published and unpublished) on HCV infection in Irish PWUD and prisoners.

METHODS

A scoping review guided by the methodological framework set out by Levac and colleagues (based on previous work by Arksey & O'Malley).

RESULTS

A total of 58 studies were identified and divided into the following categories; Epidemiology, Guidelines and Policy, Treatment Outcomes, HCV-related Health Issues and qualitative research reporting on Patients' and Health Providers' Experiences. This review identified significantly higher rates of HCV infection among Irish prisoners and PWUD than the general population. There are high levels of undiagnosed and untreated HCV infection in both groups. There is poor engagement by Irish PWUD with HCV services and barriers have been identified. Prison hepatology nurse services have a positive impact on treatment uptake and outcomes. Identified gaps in the literature include; lack of accurate epidemiological data on incident infection, untreated chronic HCV infection particularly in PWUD living outside Dublin and those not engaged with OST.

CONCLUSION

Ireland like other European countries has high levels of undiagnosed and untreated HCV infection. Collecting, synthesising and identifying gaps in the available literature is timely and will inform national HCV screening, treatment and prevention strategies.

Hepatitis C virus screening and treatment in Irish prisons from nurse managers' perspectives - a qualitative exploration

Background

Prisoners carry a greater burden of physical, communicable and psychiatric disease compared to the general population. Prison health care structures are complex and provide challenges and opportunities to engage a marginalised and poorly served group with health care including Hepatitis C Virus (HCV) screening, assessment and treatment. Optimising HCV management in prisons is a public health priority. Nurses are the primary healthcare providers in most prisons globally. Understanding the barriers and facilitators to prisoners engaging in HCV care from the perspectives of nurses is the first step in implementing effective strategies to eliminate HCV from prison settings. The aim of this study was to identify the barriers and facilitators to HCV screening and treatment in Irish prisons from a nurse perspective and inform the implementation of a national prison-based HCV screening program.

Methods

A qualitative study using focus group methodology underpinned by grounded theory for analysis in a national group of nurse managers (n = 12).

Results

The following themes emerged from the analysis; security and safety requirements impacting patient access, staffing and rostering issues, prison nurses’ skill set and concerns around phlebotomy, conflict between maintaining confidentiality and concerns for personal safety, peer workers, prisoners’ lack of knowledge, fear of treatment and stigma, inter-prison variations in prisoner health needs and health service delivery and priority, linkage to care, timing of screening and stability of prison life.

Conclusions

Prison nurses are uniquely placed to identify barriers and facilitators to HCV screening and treatment in prisoners and inform changes to health care practice and policy that will optimise the public health opportunity that incarceration provides.

Hepatitis C virus screening and treatment in Irish prisons from a governor and prison officer perspective - a qualitative exploration

BACKGROUND

Prisons are a key location to access Hepatitis C Virus (HCV) infected people who inject drugs (PWID). Prison health care structures are complex and optimising health care delivery to this high need, marginalised and underserved population remains challenging. Despite international guidelines recommending that prisons are a priority location for HCV screening and treatment levels of prisoner engagement in HCV care remain low. Competing priorities between security and healthcare is a key feature of prison health care. A collaborative approach to health care delivery in prisons can maximise the benefits for prisoners, staff and the wider community.

AIM

To identify the barriers and enablers to HCV screening and treatment in Irish prisons and inform the implementation of a HCV screening program within the Irish Prison Services (IPS).

METHODS

Qualitative study using focus group methodology underpinned by grounded theory.

RESULTS

The following themes emerged from the analysis: priority of safety and security, staffing and resources, concerns about personal risk, lack of knowledge, concerns around confidentiality, prisoners' fear of treatment and stigma, timing of screening, use of peer workers, in-reach hepatology and fibroscanning services. The primary role of prison security is to ensure the safety of staff and prisoners with a secondary but important supporting role in health care delivery. Maintaining adequate staffing levels and the provision of training and education were seen as priorities and impacted on prison officers' fear for personal safety and risk of HCV transmission. Opt-out screening and peer support workers had high levels of support among participants.

CONCLUSION

Upscaling HCV management in prisons requires an in-depth understanding of all barriers and facilitators to HCV screening and treatment. Engaging prison officers in the planning and delivery of health care initiatives is a key strategy to optimising the public health opportunity that prisons provides.

Exploring Patient Characteristics and Barriers to Hepatitis C Treatment in Patients on Opioid Substitution Treatment Attending a Community Based Fibro-scanning Clinic

BACKGROUND AND OBJECTIVES

Hepatitis C virus (HCV) infection is a major public health issue. There is substandard uptake in HCV assessment and treatment among people who inject drugs (PWID). Community fibroscanning is used to assess disease severity and target treatment.

METHODS

A survey was administered to a cohort of chronically HCV infected patients attending a community fibroscanning clinic. Questions targeted diagnosis of HCV, suitability, willingness and barriers to engagement in treatment. Descriptive and regression analysis, with thematic analysis of open-ended data was conducted.

RESULTS

There was high acceptance of community fibroscanning among this cohort with over 90% (68) attending. High levels of unemployment (90%) and homelessness (40%) were identified. Most patients were on methadone treatment and had been HCV infected for greater than 10 years with length of time since HCV diagnosis being significantly longer in patients with fibroscan scores > 8.5 kPa (P = 0.016). With each unit increase in methadone dose, the odds of the >8.5 fibroscan group increased by 5.2%. Patient identified barriers to engagement were alcohol and drug use, fear of HCV treatment and liver biopsy, imprisonment, distance to hospital and early morning appointments.

CONCLUSION

The study highlights the usefulness of community fibroscanning. Identifying barriers to treatment in this cohort affords an opportunity to increase the treatment uptake. The availability of afternoon clinics and enhanced prison linkage are warranted.

Prevalence of HIV/AIDS among Iranian Prisoners: A Review Article

BACKGROUND

Worldwide, prisoners are more at risk of being infected by human immunodeficiency virus (HIV) as well as hepatitis C and B in comparison with other risk groups. The combination of acquired immune deficiency syndrome (AIDS), addiction and prison are factors that threaten the health of our society. Influence of risky behaviors is so common on transmission of AIDS into prisoners' bodies. This study used available information and reports to investigate the prevalence of HIV in Iranian prisons.

METHODS

The following review of documents available in national and foreign databases, a total of 26 studies were investigated and required information was extracted from both the full papers and abstracts.

FINDINGS

The selected studies differed methodologically in their sampling method and data collection tools. Within the 26 studies analyzed, there was a combined study cohort of 39707 people in whom HIV prevalence varied between 0% and 24.40%.

CONCLUSION

In this study, HIV prevalence ranged widely among the prisoners, and in most of these studies, the rate in Iran was higher than that of other countries. The prevalence of disease was highest among intravenous drug users. Unless proper preventive and control plans among risk groups such as prisoners are not implemented in a timely and suitable manner, the risk of infection in the broader society will increase.

Point-of-care testing for HIV in an Irish prison setting: results from three major Irish prisons

HIV is more prevalent in the prison population compared to the general population. Prison inmates are at an increased risk of blood-borne infections. Considerable stigma has been documented amongst inmates with HIV infection. In collaboration with the schools, healthcare facilities, prison authorities and inmate Irish Red Cross groups in Wheatfield, Cloverhill and Mountjoy prisons in Dublin, Ireland, the Department of Genito Urinary Medicine and Infectious Diseases at St James' Hospital in Dublin developed a campaign for raising awareness of HIV, educating inmates about HIV and tackling HIV stigma. Following this campaign, large-scale point-of-care testing for HIV was offered over a short period. In total, 741 inmates were screened for HIV. One inmate tested positive for HIV. We experienced a large number of invalid test results, requiring formal laboratory serum testing, and a small number of false positive results. Large-scale point-of-care testing in the Irish prison setting is acceptable and achievable.

Prevalence of hepatitis C virus in Brazil's inmate population: a systematic review

OBJECTIVE

To estimate the prevalence of hepatitis C virus infection in Brazil’s inmate population.

METHODS

Systematic review on hepatitis C virus infection in the inmate population. Brazilian studies published from January 1, 1989 to February 20, 2014 were evaluated. The methodological quality of the studies was assessed using a scale of 0 to 8 points.

RESULTS

Eleven eligible studies were analyzed and provided data on hepatitis C virus infection among 4,375 inmates from seven states of Brazil, with a mean quality classification of 7.4. The overall hepatitis C virus prevalence among Brazilian inmates was 13.6% (ranging from 1.0% to 41.0%, depending on the study). The chances of inmates being seropositive for hepatitis C virus in the states of Minas Gerais (MG), Sergipe (SE), Mato Grosso do Sul (MS), Rio Grande do Sul (RS), Goiás (GO) and Espirito Santo (ES) were 84.0% (95%CI 0.06;0.45), 92.0% (95%CI 0.04;0.13), 88.0% (95%CI 0.09;0.18), 74.0% (95%CI 0.16;0.42), 84.0% (95%CI 0.08;0.31) and 89.0% (95%CI 0.01;0.05) respectively, lower than that observed in the Sao Paulo state (seroprevalence of 29.3%). The four studies conducted in the city of Sao Paulo revealed a lower prevalence in more recent studies compared to older ones.

CONCLUSIONS

The highest prevalence of hepatitis C virus infection in Brazil’s inmate population was found in Sao Paulo, which may reflect the urban diversity of the country. Despite Brazilian studies having good methodological quality to evaluate the prevalence of the hepatitis C virus, they are scarce and lack data on risk factors associated with this infection, which could support decisions on prevention and implementation of public health policies for Brazilian prisons.

Epidemiology of hepatitis C in Europe

The advent of potent and safe direct-acting antivirals against the hepatitis C virus has the potential of fulfilling the dream of eliminating this infection and its impact on global public health. However, even if effective drugs are at hand, most patients remain unaware of their infection, which may be recognized only in late stages when dire complications have occurred. Europe is not spared by this scourge, with its estimated 19,000,000 persons infected, and knowledge of the epidemiology of HCV and its drivers is a critical tool in fighting this virus. A thorough review is provided on the extent of the HCV epidemic across Europe, with a discussion of the most important subgroups affected, and of the risk factors of infection, both traditional and new.

Psychiatric morbidity among women prisoners newly committed and amongst remanded and sentenced women in the Irish prison system

Objectives: To estimate the prevalence of psychiatric morbidity, substance misuse problems and related health and social problems among women prisoners newly committed and a cross-section remanded and sentenced in the Irish prison population. In 2002 women represented 10.7% (1043) of all persons committed to the Irish Prison system, and 3.3% (104) of the daily average number of persons in custody. We surveyed psychiatric morbidity in these two groups to assess the need for psychiatric services for women prisoners, and to compare Irish morbidity with an international average.

Method: We interviewed 94 newly committed women prisoners within 72 hours of committal, representing approximately 9% of female committals per year. We also interviewed a cross sectional sample of 92 women, representing approximately 90% of all women in custody. Mental illness and substance misuse was measured using the SADS-L, SODQ and a structured interview.

Results: Five (5.4%) of the committal and 5 (5.4%) of the cross-sectional sample had a psychotic illness within the previous six months. 8 (8.5%) of the committals and 15 (16.3%) of the women in the cross-sectional sample had a major depressive disorder in the last six months. 8 (8.6%) committals and 14 (15.2%) in the cross-sectional sample had an anxiety disorder within the last six months. 61 (65.6%) of the women interviewed at committal and 61 (65.2%) of the cross-sectional sample had a substance misuse problem in the last six months.

Conclusions: There is a high prevalence of mental illness and substance misuse problems amongst women newly committed to prison and in a cross section of those remanded or sentenced in prison in Ireland. We found evidence of a cycle of deprivation and institutionalisation. These findings highlight the need for the integration of community and forensic psychiatric services, and for ongoing collaboration with drug services.

Irish Travellers and forensic mental health

Objectives: To determine whether Irish Travellers are over-represented amongst transfers from prison to psychiatric hospital. If so, to determine whether this represents an excess over the proportion of Irish Travellers committed to prison.

Method: Irish Travellers admitted to the National Forensic Psychiatry service were identified from a case register over three years 1997-1999. New prison committals were sampled and interviewed as part of the routine committal screening to identify ethnicity.

Results: Irish Travellers accounted for 3.4% of forensic psychiatric admissions compared to 0.38% of the adult population. Travellers transferred from prison to psychiatric hospital had more learning disability and less severe mental illness than other groups, while black and other ethnic minorities had a higher proportion of severe mental illness. Travellers accounted for 6% (95% CI 3-11) of 154 male committals and 4% (95% CI 2-12) of 70 female committals. The estimated annualised prison committal rate was 2.8% (95% CI 2.4-3.3) of all adult male Travellers in Ireland and 1% for female Travellers (95% CI 0.8-1.3). Male Travellers had a relative risk of imprisonment compared to the settled community of 17.4 (95% CI 2.3-131.4), the relative risk for female Travellers was 12.9 (95% CI 1.7-96.7). Imprisoned Travellers had greater rates of drugs and alcohol problems than other prisoners (Relative risk 1.46, 95% C11.11-1.90).

Conclusion: There is gross over-representation of Travellers in forensic psychiatric admissions. This reflects the excess of Travellers amongst prison committals.

Prevalence of HIV and Hepatitis B, C, D Infections and Their Associated Risk Factors among Prisoners in Southern Khorasan Province, Iran

BACKGROUND

Prison inmates are among the high risk population for dangerous infections such HIV, HBV, HCV and other contagious diseases. In spit of many data about the prevalence and risk factors for blood born diseases among prisoners in the world, such data are spares from Iran. The aim of this study was to determine the prevalence and associated risk factors for HIV, HBV, HCV and HDV infections among a large sample of prison inmates in Iran.

METHODS

In a cross-sectional study in 2009-2010, 881 inmates in three prisons of Southern Khorasan Province in Iran were selected based on a systematic, stratified random sampling method. Sera were analyzed for HBV, HDV, HCV and HIV infections by appropriate commercial ELISA kits. An anonymous questionnaire was used to collect the demographic data and information about risk factors.

RESULTS

Overall, 881 prisoners (mean age: 34.7±11.4 years, range: 11-84 years, M/F ratio:4.5/1) were participated in this study. The prevalence of HBV and HCV infection was 6.9% and 7.7%, respectively. Among the HBsAg positive subjects, 6.6% (4/61) and 9.8% (6/61) had HDV and HCV super-infection, respectively. Only one case (0.1%) had HIV infection that was co-infection with HCV. Drug abuse and history of traditional phlebotomy were associated risk factors for HBV infection (P<0.05) and history of drug injection was associated with HCV infection (P<0.05).

CONCLUSIONS

This study show fairly higher prevalence of blood borne infections among prisoners and indicate drug abuse and phlebotomy as the associated risk factor. Implementation of appropriate screening tests and preventive programs is suggested in prisons.

Transmission of hepatitis C virus among intravenous drug users in the Uppsala region of Sweden

Background

Epidemiology and transmission patterns of hepatitis C virus (HCV) are important subjects as we enter a new era of treatment with directly acting antivirals (DAAs). The highest prevalence of HCV in developed countries is found among intravenous drug users (IDUs), where unsafe needle sharing practices provide the main route of infection. Efforts to prohibit the continuous spread of HCV among these groups have been initiated by the community services and health care providers. Our goal was to understand how HCV was transmitted among IDUs within a limited population group. We provide a retrospective study (2005–2007) of the HCV transmission patterns in a population of IDUs in the Uppsala region of Sweden.

Method

Eighty-two serum samples were collected from IDUs in Uppsala County. Our reverse transcription nested polymerase chain reaction (RT-nested PCR) and sequencing method enabled a comprehensive genetic analysis for a broad spectrum of genotypes of two relatively conserved regions, NS5B and NS3, that encodes for the viral polymerase and protease, respectively. HCV RNA in serum samples was amplified and sequenced with in-house primers. Sequence similarities between individuals and subgroups were analyzed with maximum likelihood (ML) phylogenetic trees. Published HCV reference sequences from other geographic regions and countries were also included for clarity.

Results

Phylogenetic analysis was possible for 59 NS5B (72%) and 29 NS3 (35%) sequences from Uppsala patients. Additionally, we also included 15 NS3 sequences from Örebro patients, making a total of 44 NS3 sequences for the analysis. By analyzing the NS3 sequences, two transmission sets were found between the IDUs (>98% sequence identity), with one set consisting of two individuals and another set consisting of three individuals. In addition, the phylogenetic analysis done with our serum samples displayed clusters that distinguished them from the reference sequences.

Conclusion

Our method seems to enable us to trace the HCV transmission between IDUs. Furthermore, the method is fairly independent of the time of infection because the method uses relatively conserved HCV sequence regions (i.e. NS5B and NS3).

Risk prison and hepatitis B virus infection among inmates with history of drug injection in Isfahan, Iran

Objectives. Hepatitis B virus (HBV) is a health problem among injection drug users (IDUs) in prison. The aim of this study is to evaluate the association of factors of incarceration with HBV infection in prisoners with history of drug injection in Isfahan, Iran. Methods. In a cross-sectional study, all IDUs inmates were enrolled. Sociodemographic characteristics and associated risk factors were obtained. Blood samples were collected and serological markers for HBV were analyzed. For data analysis, odds ratio and logistic regression were used. Results. Of the IDUs inmates, 970 subjects participated in the study. History of imprisonment (OR: 1.82, 95% CI: 1.28–2.57), multiple incarceration (OR: 1.43, 95% CI: 1.01–2.02), and total duration of imprisonment (OR: 2.70, 95% CI: 1.94–3.74) were significantly associated with prevalence of HBV among IDUs inmates. Multivariate analysis of associated factors showed that only total duration of incarceration is significantly associated with HBV infection. Conclusion. In conclusion, according to our results, multiple and duration of incarcerations will be considered as important risk factors of HBV infection in IDUs inmates. This fact makes it important to set some screening and prevention programs in prisons to decrease the risk of being infected and prevent the transmission of these diseases.

Assessment of the reproductive health status of adult prison inmates in osun state, Nigeria

Introduction. All over the world, numbers of prisoners have being increasing with majority in the sexually active age group; hence diseases such as HIV, Tuberculosis and Hepatitis are more prevalent in prisons than in the community. This study thus aims to provide an overview of the reproductive health status of adult prison inmates in Osun State. Methodology. This is a cross-sectional study among adult inmates in Osun State prison. Data was obtained from 209 selected respondents using pre-tested semi structured questionnaire. Result. Majority of the respondents were in the age group 20–39 years with mean age of 30.9 + 7.5. 73.2% are aware of STIs, 93.3% HIV/AIDS and 81.3% contraception. 54.6% had multiple sexual partners before incarceration and 23.3% of them used condom always. 89.5% were not involved in any sexual practice inside the prison, 9.1% masturbated and 1.4% had homosexual partners. Less than 6% had access to male condoms gotten from prison staffs and prison clinics. Conclusion and recommendation. No comprehensive reproductive health care system to address reproductive health services in prisons. Respondents' knowledge about STIs, HIV/AIDS and contraception is good, but their condom usage is low compared with the knowledge. Government should put in place specific reproductive health programmes in prisons.

Hepatitis C, hepatitis B and HIV infection among Egyptian prisoners: seroprevalence, risk factors and related chronic liver diseases

BACKGROUND AND AIM

Prisons in Egypt do not currently screen for blood-borne viruses, and there are no statistics concerning the prevalence of hepatitis C virus, hepatitis B virus or human immunodeficiency virus among prisoners. This study was performed to detect the prevalence of antibodies against hepatitis C, hepatitis B core and human immunodeficiency virus among Egyptian prisoners.

METHODS

The study was conducted in an Egyptian prison. The prisoners voluntarily completed a risk factor questionnaire and provided blood specimens for testing for antibodies against hepatitis C virus, hepatitis B virus core antigen and human immunodeficiency virus. Positive results were confirmed by the detecting HCV RNA via polymerase chain reaction. Multivariate regression analysis was performed to determine the factors that were independently associated with positive HCV serology.

RESULTS

Five hundred resident prisoners were screened. The prevalence of hepatitis C virus antibodies was 15.8% (79/500), and viremia was confirmed by PCR in 77.2% (61/79) of the antibody-positive prisoners. The prevalence of antibodies to hepatitis B core antigen was 9.8% (49/500), and 1.2% (6/500) of prisoners were dually infected with HBV and HCV. Antibodies to human immunodeficiency virus were not detected in any of the prisoners. The best predictor for hepatitis C and hepatitis B infection was a history of intravenous drug use (P<0.011 for HBV and P<0.001 for HCV), a period of >10 years spent in prison (P<0.052 for HBV and P<0.021 for HCV) and shared toiletries (P<0.059 for HBV and P<0.002 for HCV).

CONCLUSION

Hepatitis C and hepatitis B virus infections constitute an important public health problem in prisons. Public health strategies to prevent morbidity and mortality from these infections should include hepatitis B vaccination, HCV testing, counseling and medical management of infected prisoners.

Detection of hepatitis C virus RNA in dried blood spots

BACKGROUND

An estimated 130-170 million people worldwide are chronically infected with HCV.(1) In Europe the highest prevalence of HCV infections is in the IDU population.(2) As traditional HCV screening relies on the detection of HCV antibody or HCV RNA in blood, screening in high-risk groups such as IDU is difficult due to poor venous access caused by damaged veins.

OBJECTIVES

In this study DBS was evaluated as an alternative sample type to blood for the detection of HCV RNA.

STUDY DESIGN

The endpoint detection limit, inter-assay and intra-assay variability of the method were determined. The DBS method was compared to our routine frontline assay using a panel of paired DBS and blood samples. The effect of different storage temperatures and length of storage time on the stability of HCV RNA in DBS was also assessed.

RESULTS

The endpoint detection limit of the method based on results from mock DBS was 250 IU/ml. The method was shown to be precise and robust. The sensitivity and specificity of the method was found to be 100% and 95.8%, respectively. No significant variation in the stability of HCV RNA in DBS over a 1 year period at a range of different temperatures was observed.

CONCLUSIONS

A sensitive and stable method was developed for the detection of HCV RNA in DBS. Screening high-risk populations using DBS as a sample type may improve uptake of HCV testing by increasing opportunity for patients to be tested and consequently increasing access to treatment.

Prevalence and correlates of HCV, HVB, and HIV infection among prison inmates and staff, Hungary

The aim of this national, multicenter, cross-sectional study was to assess the prevalence of hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency viruses (HIV) among prisoners, and to identify related risk behaviors including injection drug use. Overall, 4,894 inmates from 20 prisons were enrolled. To have a comparison group, prison staff were also asked to take part. Altogether, 1,553 of the 4,894 inmates from seven prisons completed a questionnaire on risk behaviors. According to the survey, 1.5%, 4.9%, and 0.04% of the prisoners were tested positive for HBsAg, anti-HCV and anti-HIV, respectively. These prevalence data are among the lowest reported from prisons worldwide, although comparable to the Central European data. The prevalence of HBV, HCV, and HIV in the Hungarian prison staff was low (0.38%, 0.47%, and 0%, respectively). The rate of HCV infection was significantly higher among inmates who have ever injected drugs (22.5%) than among inmates who reported they had never injected drugs (1.1%). This first prevalence study of illegal drug injection-related viral infections among Hungarian prisoners points out that ever injecting drugs is the main reason for HCV infection among inmates. The opportunity to reach drug users infected with HCV for treatment underlines the importance of screening programs for blood-borne viruses in prisons.

Factors Correlated With Hepatitis C and B Virus Infections Among Injecting Drug Users in Tehran, IR Iran

BACKGROUND

In Iran, the number of injecting drug users (IDUs) has increased in recent years. The rates of hepatitis C virus (HCV) and hepatitis B virus (HBV) infections among IDUs are reportedly high.

OBJECTIVES

The purpose of this study was to assess factors correlated with HCV and HBV infections among IDUs in Tehran.

PATIENTS AND METHODS

A cross-sectional study included 899 IDUs recruited from the community, drug treatment centers, and drop-in-centers. The study involved interviews conducted using an adapted version of the WHO Drug Injection Study Phase II (Version 2b) questionnaire and blood testing for the HCV antibody, hepatitis B surface antigen, and hepatitis B core antibody. A logistic regression model was used to identify independent factors correlated with HCV and HBV infections.

RESULTS

HCV infection was found to be primarily associated with female gender [odds ratio (OR) 5.0, 95% confidence interval (CI) 2.0-10.0)], unmarried status (OR 2.9, 95% CI 1.9-4.4), drug use for more than 10 years (OR 2.7, 95% CI 1.8-3.9), drug injection frequency of more than once per day (OR 2.6, 95% CI 1.6-4.2), history of imprisonment (OR 2.5, 95% CI 1.6-4.0)], and a history of shared injection needles in prison (OR 2.3, 95% CI 1.5-3.6). HBV infection was mainly correlated with a history of imprisonment (OR 1.9, 95% CI 1.4-2.7) and drug use for more than 10 years (OR 1.4, 95% CI 1.1-1.9).

CONCLUSIONS

Because a considerable number of IDUs in Iran are receiving reduction services, tailoring services for prevention of hepatitis infection are necessary.

Molecular characteristics of HIV type 1 infection among prisoners from Central Western Brazil

Abstract This study among antiretroviral-experienced prisoners from central western Brazil investigated mutations associated with secondary resistance to nucleoside/nonnucleoside reverse transcriptase inhibitors (NRTI/NNRTI), protease inhibitors (Stanford HIV-1 Resistance/International Aids Society Databases), and HIV-1 subtypes (REGA/phylogenetic analyses/SimPlot). Twenty-seven prisoners from three prisons (16 males and four females from Mato Grosso do Sul State and seven males from Goiás State) had HIV-1 protease and reverse transcriptase fragments sequenced after nested PCR. Median age was 35 years. Seven males and two females were intravenous drug users, three males referred homosexual practice. Resistance mutations were present in 37% (10/27): NRTI+NNRTI mutations (n=5), NRTI mutations (n=3), multidrug-resistant mutations (n=2). Subtype B (48%), subtype C (11%), B/F1, B/C, and F1/B/C recombinants (40.7%) were detected. Possible intraprison transmissions were identified: two intravenous drug user females (subtype C); two clusters among homosexual males (subtype B and B/F1). High resistance rate and possible intraprison transmission highlight the need for improved prevention, counseling, and treatment strategies for prisoners.

Determination of the burden of hepatitis C virus infection in Ireland

Information on the burden of hepatitis C virus (HCV) disease is needed to inform policy decisions on primary and secondary prevention. Specimen-based laboratory data (1989–2004) were converted to person-based data and combined with notification data (2004–2009) to describe the burden of HCV infection in Ireland. More than 10 000 people were confirmed as HCV infected in 1989–2004, with the numbers peaking in 2000. The predominant genotypes were 1 (55%) and 3 (39%). Drug use was the most likely risk factor in 80%, with receipt of blood or blood products in 16%. It is estimated that 20 000–50 000 people in Ireland are chronically infected with HCV, a population prevalence of 0·5–1·2%, which is similar to other countries in Northern Europe. This is the first published estimate of the number of chronic HCV infections in Ireland. These data will be of value in health service planning and will contribute to the understanding of HCV infection in Europe.

HIV and hepatitis C virus testing and seropositivity rates in Canadian federal penitentiaries: A critical opportunity for care and prevention

BACKGROUND

Incarcerated persons experience high rates of HIV and hepatitis C virus (HCV) infection, but little is known about the burden of these bloodborne viruses among federal penitentiary inmates in Canada.

OBJECTIVE

The present study investigates rates of testing and seropositivity for HIV and HCV among inmates in all 53 Canadian federal penitentiaries.

METHODS

A cross-sectional design using surveillance data on voluntary HIV and HCV antibody testing in 2002 were applied to estimate the rate of testing uptake and the rate of incident seropositive tests among new admissions to federal penitentiaries and resident inmates. Rates of testing and infection were further examined by sex and region. Seroprevalence of HIV and HCV was estimated from the number of cumulative positive tests to year-end.

RESULTS

Of 7670 new admissions during 2002, 30% were tested for HIV and HCV. Test seropositivity rates in this group were 0.7% for HIV and 10% for HCV. Of the 12,426 resident inmates, 28% were tested for HIV and 27% for HCV. Seropositivity rates in this group were 0.3% for HIV and 7% for HCV. Seroprevalence rates at yearend for 2002 were 2.0% for HIV and 26% for HCV and were substantially higher among women offenders (HIV: 3.7% of women, 1.9% of men; HCV: 34% of women, 26% of men). Variations in testing uptake and test seropositivity were observed across regions.

CONCLUSIONS

The present study underscores the value of continued monitoring and evaluation of trends in HIV and HCV infection, which remain prevalent in federal penitentiaries. Higher rates of testing are warranted for at-risk inmates to improve early detection of infection and provide infected inmates with timely care and treatment. For those who remain free of infection, testing can provide the additional benefits of exposing inmates to health counselling and for the reinforcement of prevention messages. The period of incarceration is also a critical opportunity to link inmates with outside resources in preparation for release to the community.

Hepatitis C and B testing in English prisons is low but increasing

BACKGROUND

Prisons are important settings for blood-borne virus control because of the high prevalence of hepatitis C and B viral infections (HCV and HBV), and behaviours associated with transmission among prisoners.

METHODS

Data from sentinel laboratories in England were used to identify testing for hepatitis C (anti-HCV) and hepatitis B [hepatitis B surface antigen (HBsAg) and anti-hepatitis B core antigen (HBc)] among male and female prisoners between 2005 and 2008.

RESULTS

Between 2005 and 2008, 10 723 prisoners from 39 prisons in England were tested for anti-HCV, anti-HBc and/or HBsAg. Overall, 24.2% prisoners tested positive for anti-HCV. Anti-HCV testing increased 47% over 4 years (P < 0.001), whilst the proportion testing positive decreased significantly from 26% in 2005 to 23% in 2008 (χ(2)= 10.0, df = 3, P = 0.030). In total, 13.9% people tested positive for anti-HBc. Of 5151 people tested for anti-HBc, 4433 were also tested for HBsAg; of these 2.4% were HBsAg positive. HBsAg testing increased 35% between 2005 and 2008, with no significant change in the proportion testing positive. Between 2005 and 2008, 2.4% (CI: 2.32-2.43%) of the prison population (24 prisons) were estimated to have been tested for anti-HCV.

CONCLUSIONS

Although hepatitis testing has increased, only a small proportion of the prison population were tested. More testing is required to identify infected prisoners and refer them for appropriate treatment.

Prevalence of HIV among injection drug users in Georgia

Background

Injection drug use remains a major risk factor for HIV transmission in Georgia. The study aims to characterize the prevalence of HIV among injection drug users in Georgia.

Methods

A cross-sectional, anonymous bio-behavioural survey to assess knowledge and behaviour in injection drug users in combination with laboratory testing on HIV status was conducted in five Georgian cities (Tbilisi, Gori, Telavi, Zugdidi and Batumi) in 2009. A snowball sample of 1127 eligible injection drug user participants was investigated.

Results

Odds of HIV exposure were increased for injection drug users of greater age, with greater duration of drug use and with a history of imprisonment or detainment (p < 0.05).

Conclusions

More research is required to analyze the determinants of HIV risk in Georgian injection drug users. The imprisoned population and young injection drug users may be appropriate target groups for programmes aimed at preventing HIV transmission.

HIV and hepatitis B and C incidence rates in US correctional populations and high risk groups: a systematic review and meta-analysis

BACKGROUND

High Human Immunodeficiency Virus (HIV) prevalence and high risk behaviors have been well documented within United States (US) correctional systems. However, uncertainty remains regarding the extent to which placing people in prison or jail increases their risk of HIV infection, and regarding which inmate populations experience an increased incidence of HIV. Describing these dynamics more clearly is essential to understanding how inmates and former detainees may be a source for further spread of HIV to the general US population.

METHODS

The authors conducted a systematic review and meta-analysis of studies describing HIV incidence in US correctional facility residents and, for comparison, in high risk groups for HIV infection, such as non-incarcerated intravenous drug users (IVDU) and men who have sex with men (MSM) in the US. HIV incidence rates were further compared with Hepatitis B and Hepatitis C Virus rates in these same populations.

RESULTS

Thirty-six predominantly prospective cohort studies were included. Across all infection outcomes, continuously incarcerated inmates and treatment recruited IVDU showed the lowest incidence, while MSM and street recruited IVDU showed the highest. HIV incidence was highest among inmates released and re-incarcerated. Possible sources of heterogeneity identified among HIV studies were risk population and race.

CONCLUSIONS

Although important literature gaps were found, current evidence suggests that policies and interventions for HIV prevention in correctional populations should prioritize curtailing risk of infection during the post-release period. Future research should evaluate HIV incidence rates in inmate populations, accounting for proportion of high risk sub-groups.

People who use drugs, HIV, and human rights

We reviewed evidence from more than 900 studies and reports on the link between human rights abuses experienced by people who use drugs and vulnerability to HIV infection and access to services. Published work documents widespread abuses of human rights, which increase vulnerability to HIV infection and negatively affect delivery of HIV programmes. These abuses include denial of harm-reduction services, discriminatory access to antiretroviral therapy, abusive law enforcement practices, and coercion in the guise of treatment for drug dependence. Protection of the human rights of people who use drugs therefore is important not only because their rights must be respected, protected, and fulfilled, but also because it is an essential precondition to improving the health of people who use drugs. Rights-based responses to HIV and drug use have had good outcomes where they have been implemented, and they should be replicated in other countries.

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.

Predictive markers for hepatitis C virus infection among Brazilian inmates

Hepatitis C virus (HCV) infection has quite high prevalence in the prison system, reaching rates of up to 40%. This survey aimed to estimate the prevalence of HCV infection and evaluate risk factors for this exposure among male inmates at the Ribeirão Preto Prison, State of São Paulo, Brazil, between May and August 2003. A total of 333 participants were interviewed using a standardized questionnaire and underwent immunoenzymatic assaying to investigate anti-HCV. The prevalence of HCV infection among the inmates was 8.7% (95% CI: 5.7-11.7). The participants'mean age was 30.1 years, and the prevalence was predominantly among individuals over 30 years of age. Multivariate analysis showed that the variables that were independently associated with HCV infection were age > 30 years, tattooing, history of previous hepatitis, previous injection drug use and previous needle-sharing.

Soroprevalência da infecção pelo vírus da Hepatite B em uma prisão brasileira

Esta pesquisa objetivou estimar a prevalência do marcador do HBV e seus fatores de risco na população masculina carcerária da Penitenciária de Ribeirão Preto - SP, Brasil. De 1.030 presidiários, foram sorteados 333 participantes, os quais foram submetidos à aplicação de um questionário e à coleta de sangue, no período de maio a agosto de 2003. Para diagnóstico de exposição ao HBV foi utilizado o ensaio imunoabsorvente de ligação de enzimas (ELISA) para detecção dos marcadores HBsAg, anti-HBsAg e anti-HBc total. A prevalência total de infecção pelo HBV nos presidiários foi de 19,5% (IC95%: 15,2 - 23,8). A média de idade dos participantes foi de 30,1 anos. Na análise univariada, a infecção pelo HBV esteve associada à idade acima de 30 anos (p<0,001), uso prévio de drogas injetáveis (p<0,001) e compartilhamento de agulhas prévio (p<0,001). Em um modelo multivariado, de regressão logística, a infecção pelo HBV foi associada à idade acima de 30 anos (OR = 3,3: IC95%: 1,8 - 6.1) e uso prévio de droga injetável (OR = 2,7; IC95%: 1.9 - 6.4). Infecção pelo HBV nas prisões representa grave problema de saúde pública, principalmente relacionado à idade acima de 30 anos e uso prévio de drogas injetáveis.

Prevalence of hepatitis B virus and risk factors in Brazilian non-injecting drug users

Non-injecting drug users are at high-risk for acquiring hepatitis B virus (HBV), although the factors contributing to this increased risk are not known. In the present study, the overall and occult HBV infection prevalence rates were determined in a large population of non-injecting drug users in the Central-West region of Brazil. HBV genotypes and predictors of infection were also identified. A total of 852 individuals in 34 drug treatment centers were interviewed, and their serum samples were tested for the presence of HBV markers by ELISA. HBsAg and anti-HBc-positive samples were tested for HBV DNA by PCR. Samples with HBV DNA were genotyped by restriction fragment length polymorphism (RFLP). The overall prevalence of HBV infection was 14% (95% CI: 11.7-16.5). A multivariate analysis of risk factors showed that age >30 years, non-white race/ethnicity, duration of drug use >10 years, lifetime number of sexual partners >10, non-use of condoms, and HCV and HIV status were associated significantly with HBV infection. Of the 9 (1%) HBsAg-reactive samples, HBV DNA was present in 2/2 of HBeAg-positive and in 5/7 anti-HBe-positive samples. An occult HBV infection rate of 2.7% (3/110) was found among anti-HBc-positive individuals. All HBV DNA-positive samples were genotyped: seven were genotype A, two were genotype D, and one was genotype F. Finally, few individuals (8%) had serological evidence of a previous HBV vaccination. These findings indicate that preventive interventions are needed for both sexual and drug-related high-risk behavior. Additionally, non-injecting drug users should be targeted for HBV vaccination.

[Chronic hepatitis C virus infection and associated liver disease among the inmates of a Spanish prison]

OBJECTIVE

The objective of this study was to determine the prevalence and genotype distribution of chronic hepatitis C virus (HCV) infection in a penitentiary population. The secondary objective was to describe histological findings in liver of the biopsied population, and identify risk factors associated with liver fibrosis and inflammatory activity.

METHODS

Among 800 inmates, 730 accepted HCV antibody screening and PCR confirmation. Sociodemographic, behavioral, and incarceration-related variables were analyzed. Liver biopsy was offered to individuals with chronic HCV infection. Advanced liver disease was defined as fibrosis 3 and/or an inflammatory activity index score 8).

RESULTS

HCV antibodies were found in 279 inmates. PCR confirmed HCV infection in 250 inmates, yielding a prevalence of 34.2% (95% confidence interval [CI]: 30.8-37.8). Intravenous drug use was independently associated with HCV infection, odds ratio (OR) 51.7 (95% CI: 31-86). Genotypes were 1a 32.9%, 3 29.7%, 1b 18.4% and 4 17.1%. Fifty-one liver biopsies were performed; advanced liver disease was found in 7 patients (13.7%) based on fibrosis and in 31 patients (60.7%) based on the inflammatory activity index. High AST and ALT levels were associated with advanced liver disease established on both fibrosis and inflammatory activity (P<.05). Lengthy intravenous drug use was associated with inflammatory activity (P=.02; OR 1.2; 95% CI: 1.03-1.7).

CONCLUSIONS

Persistent HCV infection is highly prevalent among prison inmates and is associated with intravenous drug abuse. HCV genotype diversity is higher in prison inmates than in the general population. Higher transaminase levels are associated with advanced liver disease.

Prevalence and risk factors of the whole spectrum of sexually transmitted diseases in male incoming prisoners in France

Sexually transmitted diseases (STD) are a public health issue in prison. As inmates are eventually released, it is also a community concern. There are very few data on the entire spectrum of STDs, particularly condyloma among prisoners. To determine the prevalence of all STDs: infection with human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), herpes simplex virus (HSV), Chlamydia trachomatis, Neisseria gonorrhoea, syphilis, and condyloma among entering inmates. A cross-sectional study was conducted in France from November 2000 to June 2003. Male adults entering a prison remand center in Caen had a medical consultation and physical examination including external genital organs and perianal area for condyloma and herpes infection, a urethral swab for Chlamydia trachomatis and Neisseria gonorrhoea detection, and a blood sample for HBV, HCV, HIV, and syphilis serology. Five hundred and ninety-seven inmates agreed to participate in the study. Sixteen percent had at least one STD: 4.0% had condyloma, 4.0% chlamydia infection, and 4.9% were positive for HCV antibodies. Two had early syphilis and 1 had acute HBV, but no HIV infection, neither genital herpes nor gonorrhea. The analysis of the STD risk behaviors did not show any difference between the infected and uninfected participants, except that HCV-positive participants were more likely to be intravenous drug users. Results suggest that a systematic screening of all STDs should be at least proposed to every entering inmate since no demographic or sexual characteristics are consistently associated with STDs.

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.

Socio-demographic determinants of coinfections by HIV, hepatitis B and hepatitis C viruses in central Italian prisoners

BACKGROUND

The coinfections HIV/HCV/HBV are an important health issue in penitentiary communities. The aim of the study was to examine HIV, HBV and HCV coinfections determinants amongst prisoners in the jails of Southern Lazio (Central Italy), in the period 1995-2000.

METHODS

Diagnosis of seropositivities for HIV, HBV and HCV was made using ELISA method. A multiple logistic regression analysis was conducted to verify the influence of socio-demographic factors on the HIV/HBV/HCV coinfections.

RESULTS

HIV/HCV, HBV/HCV and HIV/HBV coinfections were detected in 42 (4%), 203 (17.9%) and 31 (2.9%) inmates, respectively. These coinfections are significantly associated with the status of drug addiction (OR = 16.02; p = 0.012; OR = 4.15; p < 0.001; OR = 23.57; p = 0.002), smoking habits (OR = 3.73; p = 0.033; OR = 1.42; p = 0.088; OR = 4.25; p = 0.053) and Italian nationality (OR = 7.05; p = 0.009; OR = 2.31; p < 0.001; OR = 4.61; p = 0.04).

CONCLUSION

The prevalence of HIV, HBV and HCV seropositivity in jails suggests that information and education programs for inmates could be useful to reduce the spread of such infections.

Prevalence of HIV and hepatitis C virus infections among inmates of Quebec provincial prisons

BACKGROUND

To determine the prevalence of HIV and hepatitis C virus (HCV) infections and examine risk factors for these infections among inmates in Quebec provincial prisons.

METHODS

Anonymous cross-sectional data were collected from January to June 2003 for men (n = 1357) and women (n = 250) who agreed to participate in the study and who completed a self-administrated questionnaire and provided saliva samples.

RESULTS

The prevalence of HIV infection was 2.3% among the male participants and 8.8% among the female participants. The corresponding prevalence of HCV infection was 16.6% and 29.2%, respectively. The most important risk factor was injection drug use. The prevalence of HIV infection was 7.2% among the male injection drug users and 0.5% among the male non-users. Among the women, the rate was 20.6% among the injection drug users, whereas none of the non-users was HIV positive. The prevalence of HCV infection was 53.3% among the male injection drug users and 2.6% among the male non-users; the corresponding values among the women were 63.6% and 3.5%.

INTERPRETATION

HIV and HCV infections constitute an important public health problem in prison, where the prevalence is affected mainly by a high percentage of injection drug use among inmates.