Prevalence and Incidence of HCV Infection among Prisoners in Central Brazil

Hepatitis B and hepatitis C virus infections and associated factors among prisoners in Gondar City, Northwest Ethiopia

BACKGROUND

Globally, hepatitis B virus (HBV) and hepatitis C virus (HCV) cause considerable morbidity and mortality from their acute and chronic infections. The transmission of the viruses within the prisons is high due to overcrowding, and other risk behaviors such as drug use, and unsafe sexual practices. This study aimed at determining the prevalence and associated factors of HBV and HCV infections among prisoners in Gondar city, Northwest Ethiopia.

METHODS

A cross-sectional study was conducted in the Gondar City Prison Center from May 1, 2022, to July 30, 2022. A total of 299 prison inmates were selected by using a systematic random sampling technique. A semi-structured questionnaire was used to collect data on sociodemographic, clinical, behavioral and prison related factors. Five milliliters of blood sample were collected, and the serum was separated from the whole blood. The serum was tested for HBV surface antigen (HBsAg) and anti-HCV antibody by using an Enzyme-Linked Immunosorbent Assay (ELISA). Data was entered using EpiData version 4.6.0 and exported to SPSS version 20 for analysis. Logistic regression analysis was done to assess the association between the independent variables and HBV and HCV infections. P-values < 0.05 were considered statistically significant.

RESULTS

The overall seroprevalence of HBV or HCV infections was 10.4%. The seroprevalence of HBV and HCV infections was 7.0% and 4.0%, respectively. It has been demonstrated that having several heterosexual partners, sharing sharp materials in prison, having longer imprisonment, and having a body tattoo are significantly associated with HBV infection. The presence of a body tattoo, a history of surgical procedures, and previous imprisonment are associated risk factors for HCV infection.

CONCLUSION

The prevalence of HBV and HCV were high-intermediate and high, respectively. Therefore, preventative and control initiatives are needed in prisons to decrease the rate of infection and transmission.

Incidence of hepatitis C virus infection in the prison setting: The SToP-C study

People in prison are at high risk of HCV given high injecting drug use prevalence. This study evaluated HCV incidence and associated injecting drug use characteristics in prison. The SToP-C study enrolled people incarcerated in four Australian prisons. Participants were tested for HCV at enrolment and then every 3-6 months (October-2014 to November-2019). Participants eligible for this analysis included those at-risk of HCV primary infection (anti-HCV negative) or re-infection (anti-HCV positive, HCV RNA negative) with follow-up assessment. A total of 1643 eligible participants were included in analyses (82% male; median age 33 years; 30% injected drugs in prison; 1818 person-years of follow-up). Overall HCV incidence was 6.11/100 person-years (95%CI: 5.07-7.35), with higher rate of re-infection (9.34/100 person-years; 95%CI: 7.15-12.19) than primary infection (4.60/100 person-years; 95%CI: 3.56-5.96). In total population (n = 1643), HCV risk was significantly higher among participants injecting drugs in prison [vs. no injecting; adjusted hazard ratio (aHR): 10.55, 95%CI: 5.88-18.92), and those who were released and re-incarcerated during follow-up (vs. remained incarcerated; aHR: 1.60, 95%CI: 1.03-2.49). Among participants who injected recently (during past month, n = 321), HCV risk was reduced among those receiving high-dosage opioid agonist therapy (OAT), i.e. methadone ≥60 mg/day or buprenorphine ≥16 mg/day, (vs. no OAT, aHR: 0.11, 95%CI: 0.02-0.80) and increased among those sharing needles/syringes without consistent use of disinfectant to clean injecting equipment (vs. no sharing, HR: 4.60, 95%CI: 1.35-15.66). This study demonstrated high HCV transmission risk in prison, particularly among people injecting drugs. High-dosage OAT was protective, but improved OAT coverage and needle/syringe programmes to reduce sharing injecting equipment are required.

Differences in HCV Seroprevalence, Clinical Features, and Treatment Outcomes between Female and Male Incarcerated Population: Results from a Matched Cohort Study

BACKGROUND

Women represent less than 5% of the incarcerated population in Italy, with very limited data on HCV infection. Higher HCV seroprevalence and active infection rates have been described among incarcerated females in available studies. Our aim is to compare the prevalence and cascade of care of HCV between male and female populations in Italian penitentiaries.

METHODS

We conducted a multicentre, retrospective study comparing HCV seroprevalence, active infections, treatment, and SVR rates between female (Group A) and male (Group B) populations in Italian prison settings.

RESULTS

No significant differences were found between the two groups regarding PWIDs (p = 0.16), nor in people living with HIV (p = 0.35) or HBV co-infection (p = 0.36). HCV seroprevalence was higher in Group A (p = 0.002). There was no statistically significant difference between the two groups regarding active infections (p = 0.41). Both groups showed a low level of fibrosis, and the dominant genotype was 3a. Almost all patients underwent antiviral treatment. All treated patients achieved SVR12.

CONCLUSIONS

Our findings illuminate the importance of recognizing and addressing gender differences in HCV seroprevalence within penitentiary settings. Moving forward, addressing the unique needs of incarcerated females and optimizing HCV care for all incarcerated individuals are essential steps in the pursuit of achieving HCV micro-elimination goals.

Hepatitis A virus infection in Brazilian correctional facilities

Hepatitis A virus (HAV) infection is transmitted by the fecal-oral route, through interpersonal contact and ingestion of contaminated food or water. Prisoners are at higher risk of acquiring HAV infection mainly due to the environment of closed penal institutions and socioeconomic conditions. This study aims to determine the seroprevalence of anti-HAV and its associated risk factors among inmates from twelve prisons in Central Brazil. A cross-sectional study was conducted between March 2013 and March 2014. A total of 580 prisoners participated in the study. The participant's samples were tested for Total and IgM anti-HAV antibodies by electrochemiluminescence immunoassay (ECLIA). Risk factors associated with anti-HAV seropositivity were also analyzed. The prevalence rate of HAV exposure was 88.1% (95% CI: 85.5-90.7). No sample had a positive reaction to IgM anti-HAV. Increasing age, low level of education, and being imprisoned in Corumbá city were independently associated with HAV exposure among prisoners. To prevent the burden of the disease, vaccination strategies should be considered for susceptible prisoners in Central Brazil.

Hepatitis C prevalence in incarcerated settings between 2013–2021: a systematic review and meta-analysis

Background

The introduction of highly effective direct-acting antiviral therapy has changed the hepatitis C virus (HCV) treatment paradigm. However, a recent update on HCV epidemiology in incarcerated settings is necessary to accurately determine the extent of the problem, provide information to policymakers and public healthcare, and meet the World Health Organization's goals by 2030. This systematic review and meta-analysis were performed to determine the prevalence of HCV Ab and RNA in incarcerated settings.

Methods

For this systematic review and meta-analysis, we searched PubMed, Embase, Scopus, and Web of Science for papers published between January 2013 and August 2021. We included studies with information on the prevalence of HCV Ab or RNA in incarcerated settings. A random-effects meta-analysis was done to calculate the pooled prevalence and meta-regression to explore heterogeneity.

Results

Ninety-two unique sources reporting data for 36 countries were included. The estimated prevalence of HCV Ab ranged from 0.3% to 74.4%. HCV RNA prevalence (available in 46 sources) ranged from 0% to 56.3%. Genotypes (available in 19 sources) 1(a) and 3 were most frequently reported in incarcerated settings. HCV/HIV coinfection (available in 36 sources) was highest in Italy, Estonia, Pakistan, and Spain. Statistical analysis revealed that almost all observed heterogeneity reflects real differences in prevalence between studies, considering I² was very high in the meta-analysis.

Conclusions

HCV in incarcerated settings is still a significant problem with a higher prevalence than in the general population. It is of utmost importance to start screening for HCV (Ab and RNA) in incarcerated settings to give clear, reliable and recent figures to plan further treatment. This is all in the context of meeting the 2030 WHO targets which are only less than a decade away.

Trial registration

PROSPERO: CRD42020162616

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14623-6.

Human T-Lymphotropic Virus-1/2 Infection in Central Brazil Prisons: A Multicenter Study

Human T-lymphotropic virus (HTLV) infection is endemic in some group populations. Prisoners are at high risk of acquiring HTLV infection mainly due to the environment of closed penal institutions, socioeconomic conditions, and risk behaviors. This study aimed to investigate the prevalence, the occurrence of new cases of HTLV infection after a 1-year follow-up, and circulating subtypes of HTLV-1 among prisoners from twelve closed prisons in Mato Grosso do Sul state, Central Brazil. A total of 1,507 prisoners were randomly enrolled in the cross-sectional study. Out of the 1,507 participants, 1,000 prisoners, susceptible to HTLV infection, were included in the prospective cohort study. In the cross-sectional study, serological evidence of HTLV infection was 0.4% (CI 95%: 0.1-0.7), tested for anti-HTLV antibodies by enzyme-linked immunosorbent assay (ELISA). Three samples were positive for HTLV-1, two samples were positive for HTLV-2, and 1 sample was indeterminate by the Western blot method. The presence of HTLV proviral DNA was detected in all positive samples by amplification of the HTLV tax gene through nested-PCR. Phylogenetic analysis showed that HTLV-1 samples belonged to the Cosmopolitan subtype Transcontinental subgroup. From a cohort of 1,000 individuals, no new case of HTLV infection was detected. Although the prevalence rate of HTLV infection found in this study was similar to that observed in the Brazilian general population, the lack of access to preventive interventions and harm reduction measures all contribute to increasing the risk of HTLV transmission and acquisition among this key and vulnerable population.

Seroprevalence and Spatial Distribution of Hepatitis C Virus in Bahia, Brazil

In Salvador, which is the capital of the Brazilian state of Bahia, it has been estimated that 1.5% of the general population is infected with hepatitis C virus (HCV); however, the circulation of HCV throughout the state remains unknown. The present retrospective study aimed to determine anti-HCV seroprevalence and describe the geographic distribution of hepatitis C in Bahia. Data from HCV serological tests submitted to the Bahia Central Laboratory of Public Health between 2004 and 2013 were analyzed. Serology for HCV was performed using the AxSYM anti-HCV enzymatic microparticle immunoassay and chemiluminescence immunoassay. A subgroup of samples with detectable HCV-RNA was genotyped using the linear array hepatitis C virus genotyping assay. A total of 247,837 samples were analyzed. The median age of the studied population was 31 years (interquartile range, 25-44 years), and the female:male ratio was 3.9:1. The global seroprevalence of HCV in Bahia was estimated to be 1.3% (3,230/247,837), corresponding to an infection rate of 21.2/100,000 inhabitants. The seroprevalence of HCV was higher among males and increased with age. The presence of anti-HCV antibodies was detected throughout all mesoregions of Bahia, and the municipality with the highest infection rate was Ipiaú (112.04 cases/100,000 inhabitants). Genotypes 1 and 3 were found to be the most prevalent, followed by genotypes 2, 4, and 5. Our results provide evidence of the widespread distribution of previous HCV infection throughout the state of Bahia.

Seroprevalence and associated factors of HIV and Hepatitis C in Brazilian high-security prisons: A state-wide epidemiological study

The prevalence of hepatitis C virus (HCV) and the acquired immunodeficiency virus (HIV) is much higher in prisons than in community settings. Some explanatory factors for this burden include putative aspects of the prison environment, such as unprotected sexual relations and sexual violence, use of injectable drugs and syringe sharing. Nonetheless, efforts in better understanding the dynamics of both HCV and HIV are scarce in developing countries such as Brazil, which poses a risk not only to the inmates but to the community as well. In this investigation, we sought to determine the seroprevalence and sociodemographic and behavioral risk factors associated with HIV and anti-HCV antibodies among men detained at high-security institutions. This is an epidemiological, proportionally stratified observational study including 1,132 inmates aged 18 to 79 years-old (M_age = 32.58±10.18) from eleven high-security prisons located in the State of Paraná, Brazil. We found that HIV and anti-HCV prevalence were 1.6% (95% CI: 1.0–2.5) and 2.7% (95% CI: 1.0–2.5), respectively. Risk factors associated with HIV included not receiving intimate visits (OR = 8.80, 95% CI: 1.15–66.88), already having another sexually transmitted infection (OR = 3.89, 95% CI: 1.47–10.29), and reporting attendance in HIV preventive campaigns (OR = 4.24, 95% CI: 1.58–11.36). Moreover, anti-HCV seroprevalence was associated with higher age (OR = 4.03, 95% CI: 1.61–10.07), criminal recidivism (OR = 2.58, 95% CI 1.02–6.52), and the use of injectable drugs (OR = 7.32, 95% CI 3.36–15.92). Although prisons might increase the risk for acquiring and transmitting HIV and HCV, the adoption of permanent epidemiological surveillance programs could help reducing the circulation of viruses, involving strategies focusing on screening, treating, and preventing infections to assure proper prisoner health. Moreover, these policies need to take place inside and outside the prison environment to offer continued assistance to former prisoners once they leave the institution.

Hepatitis B and Hepatitis C Viral Infections and Associated Factors Among Prisoners in Northeast Ethiopia

BACKGROUND

Hepatitis is an inflammation of the liver and often caused by viruses. Hepatitis viruses are the leading causes of liver-related morbidity and mortality worldwide, with Hepatitis B and C viruses share the great majority. Studies have shown that prison settings are one of the high-risk environments for the transmission of these viruses. However, there is limited information on the seroprevalence and associated factors of hepatitis B and C viral infection among Ethiopian prisoners.

METHODS

A facility-based cross-sectional study was conducted among 339 prisoners in Dessie town, Ethiopia from February to April 2020. Hepatitis B surface antigen and antibody against hepatitis C virus in serum were determined using Enzyme-Linked Immunosorbent Assay. We imputed the data using "EpiData 3.1" software and exported it to Statistical Package for Social Sciences version 20.0 for analysis, and a p-value of <0.05 was considered statistically significant.

RESULTS

The overall seroprevalence of hepatitis B surface antigen and anti-hepatitis C virus among prisoners was 22/339 (6.5%) (95% CI = 3.8-9.4), and 4/339 (1.2%) (95% CI = 0.0-2.4), respectively. Multiple sexual partners, previous imprisonment, body tattooing, and contact with the jaundiced patient were independently associated with hepatitis B virus infection. Prisoners who had a history of blood transfusion, and dental extraction were independently associated with hepatitis C virus infection.

CONCLUSION

The seroprevalence of hepatitis B and hepatitis C viral infection among Dessie town prisoners was intermediate and low, respectively. The finding of a significant association between the presence of Hepatitis B surface antigen and hepatitis C virus antibodies among prisoners and factors calls for the need of serological testing for both Hepatitis B and C viruses to high-risk individuals. Strengthening screening strategies and prevention programs in prison settings is advisable to prevent disease transmission.

The global and regional prevalence of hepatitis C and B co-infections among prisoners living with HIV: a systematic review and meta-analysis

BACKGROUND

Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are common among individuals with human immune deficiency virus (HIV) infection worldwide. In this study, we did a systematic review and meta-analysis of the published literature to estimate the global and regional prevalence of HCV, HBV and HIV coinfections among HIV-positive prisoners.

METHODS

We searched PubMed via MEDLINE, Embase, the Cochrane Library, SCOPUS, and Web of science (ISI) to identify studies that reported the prevalence of HBV and HCV among prisoners living with HIV. We used an eight-item checklist for critically appraisal studies of prevalence/incidence of a health problem to assess the quality of publications in the included 48 cross-sectional and 4 cohort studies. We used random-effect models and meta-regression for the meta-analysis of the results of the included studies.

RESULTS

The number of the included studies were 50 for HCV-HIV, and 23 for HBV-HIV co-infections. The pooled prevalence rates of the coinfections were 12% [95% confidence interval (CI) 9.0-16.0] for HBV-HIV and 62% (95% CI 53.0-71.0) for HCV-HIV. Among HIV-positive prisoners who reported drug injection, the prevalence of HBV increased to 15% (95% CI 5.0-23.0), and the HCV prevalence increased to 78% (95% CI 51.0-100). The prevalence of HBV-HIV coinfection among prisoners ranged from 3% in the East Mediterranean region to 27% in the American region. Also, the prevalence of HCV-HIV coinfections among prisoners ranged from 6% in Europe to 98% in the East Mediterranean regions.

CONCLUSIONS

Our findings suggested that the high prevalence of HBV and HCV co-infection among HIV-positive prisoners, particularly among those with a history of drug injection, varies significantly across the globe. The results of Meta-regression analysis showed a sliding increase in the prevalence of the studied co-infections among prisoners over the past decades, rising a call for better screening and treatment programs targeting this high-risk population. To prevent the above coinfections among prisoners, aimed public health services (e.g. harm reduction via access to clean needles), human rights, equity, and ethics are to be seriously delivered or practiced in prisons. Protocol registration number: CRD42018115707 (in the PROSPERO international).

Hepatitis C virus infection and its associated factors among prisoners in a Nigerian prison

Background

The prison population is considered at high risk of acquiring infectious diseases due to confined conditions, behavioral factors, injection drug use, unprotected sexual activity, non-professional tattooing and scarification, and needle sharing. Hepatitis C virus (HCV) is a blood borne pathogen mostly transmitted via percutaneous exposure that results in inflammation of the liver. It is one of the public health problem worldwide and is the principal cause of parenterally transmitted non-A, non-B hepatitis. The study was aimed at evaluating the prevalence of HCV among prison inmates in Calabar, Cross River State, Nigeria and the associated factors.

Methods

The study took a descriptive cross sectional approach using multi-stage sampling technique. One hundred and forty-two (142) prison inmates within the age range of 18–50 years and above were recruited for this study.

Result

Forty two (42); [29.6%] of the participating prison inmates were seropositive for HCV. Gender stratification showed that 31.0% of the males were seropositive for HCV while 15.4% of the females were seropositive for HCV. Fisher exact test showed that gender, age, marital status, occupation and level of education had no association in distribution of seroprevalence of HCV (p > 0.05) but the duration in prison was significantly associated with distribution of seropositivity of HCV in the studied population (p < 0.05). Bivariate logistic regression showed that tattoo/scarification, injection drug use, history of blood transfusion, sexual experience, shaving equipment sharing and multiple sexual partners were not risk factor for distribution of HCV prevalence in the studied population (p > 0.05). However, 23.5% who had tattoo/scarification, 29.6% who used injection drug, 33.3% who had history of blood transfusion, 29.8% who had sexual experience, 21.2% who shared shaving equipment, and 28.3% who had multiple sex partners were seropositive for HCV.

Conclusion

Approximately 29.6% prevalence of Hepatitis C virus infection observed among inmates studied is high and calls for concern. Attitude and behaviors by inmates such as tattooing/scarification, injection drugs use, sharing of shaving equipment, multiple sexual partners should be discouraged.

The seroprevalence of untreated chronic hepatitis C virus (HCV) infection and associated risk factors in male Irish prisoners: a cross-sectional study, 2017

IntroductionData on chronic hepatitis C (HCV) infection prevalence in European prisons are incomplete and impact the public health opportunity that incarceration provides.AimsWe aimed to estimate the seroprevalence of untreated chronic HCV infection and to identify associated risk factors in an Irish male prison.MethodsWe conducted a cross-sectional study involving a researcher-administered questionnaire, review of medical records and HCV serology.ResultsOf 422 prisoners (78.0% of the study population) who participated in the study, 298 (70.6%) completed the questionnaire and 403 (95.5%) were tested for HCV antibodies. Of those tested, 92 (22.8%) were HCV antibody-positive, and of those, 53 (57.6%) were HCV RNA-positive, 23 (25.0%) had spontaneous clearance, 16 (17.4%) had a sustained viral response, 10 (11.0%) were co-infected with HIV and six (6.0%) with HBV. The untreated chronic HCV seroprevalence estimate was 13.1% and the seroprevalence of HCV among prisoners with a history of injecting drug use (IDU) was 79.7%. Risk factors significantly associated with past HCV infection were IDU (p < 0.0001), having received a prison tattoo (p < 0.0001) or a non-sterile community tattoo (p < 0.0001), sharing needles and other drug-taking paraphernalia (p < 0.0001). Small numbers of prisoners had a history of sharing razors (n=10; 3.4%) and toothbrushes (n=3; 1.0%) while incarcerated. On multivariable analysis, history of receiving a non-sterile community tattoo was the only significant risk factor associated with HCV acquisition (after IDU was removed from the model) (p = 0.005, β = 0.468).ConclusionThe level of untreated chronic HCV infection in Irish prisons is high, with IDU the main associated risk.

Prevalence, incidence and associated factors for HBV infection among male and female prisoners in Central Brazil: A multicenter study

BACKGROUND

Prison populations are at high risk for hepatitis B virus (HBV) infection. The aim of this study was to assess the prevalence, incidence, HBV associated factors and circulating genotypes/subtypes.

METHODS

A total of 3,368 prisoners from 12 closed prisons were randomly recruited for a cross-sectional study. In addition, a cohort study was conducted 12 months later and included 1,656 individuals. Participants underwent an interview and blood collection for the detection of HBV serological markers and HBV-DNA phylogenetic analysis.

RESULTS

HBV exposure (anti-HBc+) was 9.8% (95% CI: 8.8-10.8); 11.2% were female and 9.6% were male. HBsAg+ was 0.6%. Only 31.4% of the participants had HBV vaccination-like profile (anti-HBs+ alone; 30.4% male vs. 36.8% female; p=0.004). Most individuals were susceptible to HBV (60.2% female vs. 52.2% male, p=0.001). HBV isolates were classified as genotypes A (45.4%), D (27.3%) and F (27.3%). In males, HBV exposure was associated with increased age. Male prisoners had more evidence of HCV/HBV co-infection (10.7%) than females (3.4%) and the frequency of Treponema pallidum infection among prisoners who had been exposed to HBV was higher in female prisoners when compared with male (39.7% vs. 19.1%). The incidence of HBV was 0.18/100 person-years (95% CI: 0.12%-0.25%).

CONCLUSIONS

Our results indicate a high prevalence of HBV exposure in prisoners. Despite the low incidence of this infection, the occurrence of new cases indicates the need to implement preventive measures.

Tattooing among Iranian prisoners: results of the two national biobehavioral surveillance surveys in 2015-2016

BACKGROUND

Tattooing is among identified risk factor for blood-borne diseases.

OBJECTIVE

This study aims to determine the prevalence of tattooing during lifetime and in prisons and its related factors among Iranian prisoners.

METHODS

This is a cross-sectional study. The required data was obtained from hepatitis B and C surveillance surveys in prisons in 2015-2016 that was collected through face-to-face interview. 12,800 prisoners were selected by multi-stage random sampling from 55 prisons of 19 provinces in Iran. Weighted prevalence and associated factors (using Chi-Square test and multivariate logistic regression) were determined by Stata/SE 14.0 survey package.

RESULTS

Out of 12,800 prisioners, 11,988 participated in the study (93.6% participation rate). The prevalence of tattooing in lifetime and in prisons was 44.7% and 31.1% respectively. The prevalence of tattooing during lifetime was significantly associated with age<35 years, being single, illiteracy, history of imprisonment, drug use, piercing during lifetime, extramarital sex and history of STI; the prevalence of tattooing in prison had a significant association with history of imprisonment, drug use, piercing in prison, and history of extramarital sex (p<0.05).

STUDY LIMITATIONS

Information and selection bias was one of the study limitations.

CONCLUSION

The results of this study showed that the prevalence of tattooing during lifetime and in prison among prisoners was significantly high especially in high-risk groups such as drug users and sexually active subjects. Given the role of tattooing, drug injection and sex in the transmission of blood-borne diseases, harm reduction programs are recommended to reduce these high-risk behaviors in prisons.

Prevalence of Viremic hepatitis C, hepatitis B, and HIV infection, and vaccination status among prisoners in Stockholm County

BACKGROUND

Identification and knowledge of settings with high prevalence of hepatitis C virus (HCV) infection is important when aiming for elimination of HCV. The primary aim of this study was to estimate the prevalence of viremic HCV infection among Swedish prisoners. Secondary aims were to estimate the prevalence of hepatitis B surface antigen (HBsAg), human immunodeficiency virus (HIV), and the proportion who have received hepatitis B virus (HBV) vaccination.

METHODS

A cross-sectional study of all incarcerated persons (n = 667) at all prisons (n = 9) in Stockholm County was conducted. All prisoners are routinely offered opt-in screening for HCV antibodies (anti-HCV), HCV RNA, HBsAg, anti-HBs, anti-HBc and HIV Ag/Ab at prison in Sweden. Data on the results of these tests and the number of received HBV vaccine doses were collected from the prison medical records. The parameters of HCV RNA, anti-HCV, and occurrence of testing for HCV were analysed in multiple logistic regression models in relation to age, sex and prison security class.

RESULTS

The median age was 35 (IQR 26-44) years, and 93.4% were men. Seventy-one percent (n = 471) had been tested for anti-HCV, 70% (n = 465) for HBsAg and 71% (n = 471) for HIV. The prevalence of anti-HCV, HCV RNA, HBsAg and HIV Ag/Ab was 17.0, 11.5, 1.9, and 0.2%, respectively among tested persons. The proportion of prisoners who had received full HBV vaccination was 40.6% (n = 271) among all study subjects.

CONCLUSIONS

The prevalence of viremic HCV infection among Swedish prisoners in Stockholm County was 11.5%, which is high in comparison to the general population. Therefore, when aiming for the WHO goal of HCV elimination, prisons could suit as a platform for identification and treatment of HCV infection. There is a need to increase testing for blood-borne viruses and to improve vaccination coverage against HBV in Swedish prisons.

Screening for HBV, HCV, HIV and syphilis infections among bacteriologically confirmed tuberculosis prisoners: An urgent action required

Viral hepatitis, syphilis, HIV, and tuberculosis infections in prisons have been identified globally as a public health problem. Tuberculosis (TB) and viral hepatitis co-infection may increase the risk of anti-tuberculosis treatment-induced hepatotoxicity, leading to the frequent cause of discontinuation of the first-line anti-tuberculosis drugs. Therefore, the aim of this cross-sectional study was to investigate the epidemiological features of HCV, HBV, syphilis and HIV infections among bacteriologically confirmed tuberculosis prisoners in Campo Grande (MS), Central Brazil. The participants who agreed to participate (n = 279) were interviewed and tested for the presence of active or current HCV, HBV, syphilis and HIV infections. The prevalence of HCV exposure was 4.7% (13/279; 95% CI 2.2-7.1). HCV RNA was detected in 84.6% (11/13) of anti-HCV positive samples. Out of 279 participants, 19 (6.8%; 95% CI 4.4-10.4) were HIV co-infected, 1.4% (4/279, 95% CI 0.5-3.8) had chronic hepatitis B virus (HBsAg positive) and 9.3% (26/279, 95% CI 6.4-13.4) had serological marker of exposure to hepatitis B virus (total anti-HBc positive). The prevalence of lifetime syphilis infection (anti-T. pallidum positive) was 10% (28/279, 95% CI 7.0-14.2) and active syphilis (VDRL ≥ 1/8 titre) was 5% (14/279, 95% CI 2.9-8.3). The prevalence of TB/HCV co-infection among prisoners with HIV (15.8%) was higher than among HIV-non-infected prisoners (3.8%; P<0.05). These results highlight the importance of hepatitis testing among prisoners with bacteriologically confirmed case of TB who can be more effectively and safely treated in order to reduce the side effects of hepatotoxic anti-TB drugs.

Characteristics associated with anti-HCV serological markers in prisoners in the state of Paraná, Brazil: a case-control study

Background

The prison system in Paraná, Brazil, is experiencing serious problems related to the increasing number of prisoners. Control of hepatitis C virus (HCV) has become more intense because the incarcerated population is considered a high-risk group for contagious diseases due to the favorable conditions found in prisons for the spread of these morbidities. The objective of this study was to identify features associated with hepatitis C infection among male prisoners in correctional institutions of Paraná state, Brazil.

Methods

This was a case-control study (27 cases and 54 controls) of men incarcerated in 11 penitentiaries in Paraná, Brazil. Information was obtained through a questionnaire in a cross-sectional epidemiological survey on HCV infection during the period from May 2015 to December 2016. Eligible men were recruited after testing positive for anti-HCV antibodies. Cases and controls were selected based on serological results of enzyme-linked immunosorbent assays and were matched by age, location of the penitentiary, and time in prison. Logistic regression analysis was used to identify risk factors for HCV seropositivity.

Results

The main significant independent risk factor for the acquisition of HCV infection was the use of injectable drugs (OR = 4.00; 95%CI:1.41–11.35; p < 0.001).

Conclusions

This study provides evidence that HCV infection is associated with drug use by this population. This information is pivotal for tailoring prevention programs and guiding specific socioeducational measures that aim to reduce or prevent HCV transmission within the prison setting.

Hepatitis C disease burden and strategies for elimination by 2030 in Brazil. A mathematical modeling approach

Introduction and aim

Hepatitis C is a key challenge to public health in Brazil. The objective of this paper was to describe the Brazilian strategy for hepatitis C to meet the 2030 elimination goal proposed by World Health Organization (WHO).

Methods

A mathematical modeling approach was used to estimate the current HCV-infected Brazilian population, and to evaluate the relative costs of two different scenarios to address HCV disease burden in Brazil: (1) if no further changes are made to the HCV treatment program in Brazil; (2) where the WHO targets for 2030 elimination are met through diagnosis and treatment efforts peaking before 2024.

Results

An anti-HCV prevalence of 0.53% was calculated for the total population. It was estimated that the number of HCV-RNA+ individuals in Brazil in 2017 was 632,000 (0.31% of the population). Scale-up of treatment and diagnosis over time will be necessary in order to achieve WHO targets beginning in 2018. Direct costs (diagnostic, treatment and healthcare costs) are projected to increase significantly during the scale-up of treatment and diagnosis in the initial years of the intervention scenario, but then fall below the base case on an annual basis by 2025–2036, once HCV is eliminated, due to health sectors savings from the prevention of HCV liver-related morbidity and mortality.

Conclusion

Achieving the WHO targets is technically feasible in Brazil with a scale-up of treatment and diagnosis over time, beginning in 2018. However, elimination of hepatitis C requires policy changes to substantially scale-up prevention, screening and treatment of HCV, together with public health advocacy to raise awareness among affected populations and healthcare providers.

Health morbidity in Brazilian prisons: a time trends study from national databases

OBJECTIVE

The goal of this study was to explore the surveillance data about mandatory reporting diseases, included in the official information systems, and evaluate the historical trend analysis in prisoners in Brazil.

DESIGN

A time trends study was performed using secondary data from prisons' health units.

SETTING

Nationwide representative data of Brazilian prisoners obtained from 2007 to 2014 health and prison information systems database were analysed. These data are carried out by units identified as prison health facilities.

PRIMARY OUTCOME MEASURES

Diseases diagnosis and individual data were available at the National System of Disease Notification (in Portuguese SINAN), Mortality Information System (in Portuguese SIM) and Prison Registration Systems (in Portuguese INFOPEN and GEO prisons). Analyses of the notification data performed in the SINAN at the national level. SINAN was consolidated with SIM, INFOPEN and GEO prison data.

RESULTS

A total of 23 235 cases of compulsory disease notification causing morbidity were reported in prison units in Brazil; of these cases, 20 003 (85.6%) were men and 3362 (14.4%) were women. Over time, the proportion of prisoners increased from 1.92 per 1000 inhabitants in 2007 to 2.77 per 1000 inhabitants in 2014 (rising trend). From a total of 27 states, 12 of them presented a growth in disease notifications, 14 were stable and in only one state was there a decrease in notifications. There was an increase in notifications in the country as a whole. Tuberculosis (64.4%), dengue (9.1%), AIDS (9.0%) and viral hepatitis (5.9%) were among the most frequently reported diseases during the study period.

CONCLUSION

Despite showing stable tendencies, our results show high rates of diseases in Brazilian prisons. Prison health services should not be isolated but integrated into regional and national health and justice systems.

Hepatitis B and Hepatitis C in prisons: a prevalence study

PURPOSE

Prisons, which are hazardous places for various contagious diseases, carry additional risks for HBV and HCV because of the communal lifestyle (common use of tools like razor blades, tattoo applications, intravenous drug use and homosexual intercourse). The purpose of this paper is to determine the prevalence of HBV and HCV, and also provide information for prisoners in this respect.

DESIGN/METHODOLOGY/APPROACH

This study included 180 prisoners from the Buca F-Type Closed Prison, and 180 prisoners from the Foça Open Prison in Turkey. After the training seminars, serum levels of HBsAg, anti HBs, anti HBc total and anti HCV in the prisoners were assessed using the MICROELISA method.

FINDINGS

All the prisoners were male. The mean age was 40(21-73) years. According to the results of 360 prisoners from both prisons, 17 (4.7 percent) prisoners were HBsAg positive and were diagnosed as HBV. Isolated anti HBs was positive in 33 (9.1 percent) prisoners who had been previously vaccinated. In 25 (6.9 percent) prisoners isolated Anti HBc total was positive, and in 61 (16.9 percent) prisoners both Anti HBs and Anti HBc total was positive in those who were considered to be recovered from the HBV. Anti HCV was positive in 2 (0.5 percent) prisoners; the process was repeated twice, and found to be repeatedly positive. Coinfection of HBV and HCV was not detected.

RESEARCH LIMITATIONS/IMPLICATIONS

In this study, the prevalence of HBV and HCV was determined to be similar to those in the normal population. However, it is not expedient to generalize this result and apply it to all prisons. For the sake of public health, prisons should be scanned for infectious diseases, and vaccinations must be applied as necessary, in order to provide protection.

ORIGINALITY/VALUE

It is a study to determine the prevalence of HBV and HCV in the prisoner population, which constitute one of the risk groups because of the communal lifestyle (common use of some tools such as the razor blade, tattoo applications, intravenous drug use and homosexual intercourse), and to compare the results with other groups in Turkey and globally.

Prevalence of Drug Injection, Sexual Activity, Tattooing, and Piercing Among Prison Inmates

Prisoners engage in a range of risk behaviors that can lead to the transmission of viral infections, such as HIV, hepatitis B and hepatitis C. In this review, we summarize the epidemiologic literature from 2007 to 2017 on 4 key risk behaviors for human immunodeficiency virus and hepatitis C virus among prisoners globally: drug injection, sexual activity, tattooing, and piercing. Of 9,303 peer-reviewed and 4,150 gray literature publications, 140 and 14, respectively, met inclusion criteria covering 53 countries (28%). Regions with high levels of injection drug use were Asia Pacific (20.2%), Eastern Europe and Central Asia (17.3%), and Latin America and the Caribbean (11.3%), although the confidence interval for Latin America was high. Low levels of injection drug use in prison were found in African regions. The highest levels of sexual activity in prison were in Europe and North America (12.1%) and West and Central Africa (13.6%); low levels were reported from the Middle East and North African regions (1.5%). High levels of tattooing were reported from Europe and North America (14.7%), Asia Pacific (21.4%), and Latin America (45.4%). Prisons are burdened with a high prevalence of infectious diseases and risk behaviors for transmission of these diseases, and, commonly, a striking lack of evidence-based infection control measures, even when such measures are available in the surrounding community. Given that most prisoners return to these communities, failure to implement effective responses has repercussions not only prisoner health but also for public health.

Substance Use During Imprisonment in Low- and Middle-Income Countries

Substance use disorders are among the most common health problems of people involved with the criminal justice system. Scaling up addiction services in prisons is a global public health and human rights challenge, especially in poorly resourced countries. We systematically reviewed the prevalence of substance use in prison populations in low- and middle-income countries. We searched for studies reporting prevalence rates of nicotine, alcohol, illicit drug, and injection drug use during imprisonment in unselected samples of imprisoned people in low- and middle-income countries. Data meta-analysis was conducted and sources of heterogeneity were examined by meta-regression. Prevalence of nicotine use during imprisonment ranged from 5% to 87%, with a random-effects pooled estimate of 56% (95% confidence interval (CI): 45, 66) with significant geographical heterogeneity. Alcohol use varied from 1% to 76% (pooled prevalence, 16%, 95% CI: 9, 25). Approximately one-quarter of people (25%; 95% CI: 17, 33; range, 0–78) used illicit drugs during imprisonment. The prevalence of injection drug use varied from 0% to 26% (pooled estimate, 1.6%, 95% CI: 0.8, 3.0). Lifetime substance use was investigated in secondary analyses. The high prevalence of smoking in prison suggests that policies regarding smoking need careful review. Furthermore, the findings underscore the importance of timely, scalable, and available treatments for alcohol and illegal drug use by people involved with the criminal justice system.

HIV and Viral Hepatitis Among Imprisoned Key Populations

Prisons and other closed facilities create opportunities for transmission of human immunodeficiency virus (HIV) and viral hepatitis during detention and after release. We conducted a systematic review and meta-analysis of peer-reviewed publications (2005-2015) to describe the prevalence of HIV, hepatitis C virus, and hepatitis B virus among key populations in prisons worldwide and to compare estimates of infection with those of other prison populations. Most data were reported for people who inject drugs (PWID; n = 72) and for men who have sex with men (MSM; n = 21); few data were reported on sex workers (SW; n = 6), or transgender women (n = 2). Publications were identified from 29 countries, predominantly middle- and high-income countries. Globally, PWID had 6 times the prevalence of HIV (pooled prevalence ratio (PPR) = 6.0, 95% CI: 3.8, 9.4), 8 times the prevalence of hepatitis C virus (PPR = 8.1, 95% CI: 6.4, 10.4), and 2 times the prevalence of hepatitis B virus (PPR = 2.0, 95% CI: 1.5, 2.7) compared with noninjecting prisoner populations. Among these articles, only those from Iran, Scotland, Spain, and Italy included the availability of methadone therapy; 2 articles included information on access to needle exchange programs by PWID detainees. HIV prevalence was more than 2 times higher among SW (PPR = 2.6, 95% CI: 2.2, 3.1) and 5 times higher among MSM (PPR = 5.3, 95% CI: 3.5, 7.9) compared with other prisoners. None of these articles reported HIV prevention coverage among SW or transgender women; 1 described HIV and sexually transmitted infection screening for MSM in prison. Prevention programs specific to key populations are important, particularly for populations that are criminalized and/or may cycle in and out of prison.

Epidemiology of HIV, syphilis, and hepatitis B and C among manual cane cutters in low-income regions of Brazil

Background

In recent decades the epidemic of asymptomatic sexually transmitted infections has extended deep into Brazil, including small towns and rural areas. The purpose of this study was to investigate the epidemiology of HIV, syphilis, and hepatitis B (HBV) and hepatitis C viruses (HCV), and to evaluate immunization coverage against hepatitis B in a group of rural workers in Brazil.

Methods

In 2016, a cross-sectional study was conducted with 937 manual sugarcane cutters of the Midwest and Northeast Regions of Brazil. All individuals were interviewed and screened for HIV, syphilis, HBV and HCV. Correlating factors with lifetime HBV infection were investigated using logistic regression. Positive Predictive Values, Negative Predictive Values, sensitivity and specificity were also calculated relative to vaccination against Hepatitis B, comparing anti-HBs titers to vaccination reports.

Results

Most reported previous hospitalization (55%), occupational injuries (54%), sharing of personal items (45.8%), alcohol consumption (77.2%), multiple sexual partners in previous 12 months (39.8%), and no condom use during sexual intercourse in last 12 months (46.5%). Only 0.2% reported using injection drugs. Anti-HIV-1 was detected in three individuals (0.3%). Serological markers of lifetime syphilis (treponemal test) were detected in 2.5% (95% CI: 1.6–3.6) of participants, and active syphilis (treponemal test and VDRL) present in 1.2%. No samples were positive for anti-HCV. The prevalence of lifetime HBV infection (current or past infection) was 15.9%, and 0.7% (95% CI 0.4 to 1.5) were HBsAg-positive. Previous hospitalization (OR 1.53, CI 1.05–2.24, p < 0.01) and multiple sexual partners in the last 12 months (OR 1.80, CI 1.25–2.60, p < 0.01) were predictors for lifetime HBV infection. Although 46.7% (95% CI 43.4–49.9) of individuals reported having been vaccinated against hepatitis B, only 20.6% (95% CI 18.1–23.3) showed serological evidence of previous hepatitis B vaccination (positive for anti-HBs alone).

Conclusions

The high prevalence of syphilis and HBV compared to the general population and the high frequency of risk behaviors show the potential for sexual and parenteral dissemination of these agents in this rural population. In addition, the low frequency of hepatitis B vaccinated individuals suggests a need for improved vaccination services.

A liver health hui: hepatitis C knowledge and associated risk factors in New Zealand gang members and their families

Hepatitis C virus (HCV) and B virus (HBV) infections are highly prevalent, with a high percentage of undiagnosed cases. Knowledge of HCV and its modes of transmission are essential for disease prevention and management. We studied a high-risk New Zealand gang population on viral hepatitis prevalence, their level of knowledge and the liver health risk factors in a community setting. Participants completed demographic, risk factor and knowledge questionnaires in three health meetings in New Zealand. Participants' blood samples were tested for HBV, HCV, biochemical indicators of liver disease. Liver fibrosis levels were assessed using a Fibroscan® device. We studied 52 adult Mongrel Mob members, affiliates and whānau (extended family) throughout New Zealand. We identified no HCV and two HBV cases, confirmed high-risk factor levels and poor associated knowledge, with a significant association between lack of knowledge and presence of specific risk factors. We successfully conducted a community-focused, high-risk, hard-to-reach gang population study, and found a link between lack of knowledge and risk factors for HCV infection. This study provided first-of-its-kind data on viral hepatitis in a gang population and demonstrated the need for educational screening programmes to aid early HCV detection, prevention and treatment.

Hepatitis C seropositivity among newly incarcerated prisoners in Estonia: data analysis of electronic health records from 2014 to 2015

Background

Hepatitis C virus (HCV) infection is a widespread problem in prisons. The present study aimed to assess the prevalence of HCV seropositivity, HCV genotypes, factors associated with HCV seropositivity in newly incarcerated prisoners and to report experiences of treatment with pegylated interferon/ribavirin for HCV-positive inmates.

Methods

Patient data were extracted from the Estonian prison medical information system (Vanglate meditsiiniline infosüsteem) databases.

Results

Among 1845 prisoners newly incarcerated from January 2014 to January 2015, the overall prevalence of HCV was 56.3% (95% CI: 54 to 59), and 25.5% (95% CI: 23.5 to 27.6%) had HIV (39.0% had neither). The all-inclusive HCV testing strategy identified 37.7% more HCV infected prisoners than the risk-based (drug use history, HIV status) case finding. Factors associated with HCV seropositivity included history of drug use (aOR 6.51 95%CI 5.12–8.28), HIV co-infection (aOR 2.56 95%CI 1.92–3.43), previous incarceration (aOR 3.61 95%CI 2.48–4.04), and increasing age. The main HCV genotypes were 3a (n = 172, 44.4%) and 1b (n = 135, 35.2%). Twenty-five prisoners received HCV treatment: 60% (n = 15) were cured, 16% (n = 4) relapsed (3 with genotype 3a, one with 1b), and 12% (n = 3) were unresponsive (all with genotype 3a).

Conclusions

HCV seropositivity rate is high and HCV tretment rate is very low in Estonian prisons. Optimizing case finding and scaling up treatment is critical to addressing the health needs of prisoners and meeting public health goals.

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

Background

Hepatitis C virus (HCV) is one of the major public health problems both in developed and developing countries. Prison represents a high-risk environment for prisoners, in that it is characterized by high-risk behaviors such as injecting drug use (IDU), tattooing, unprotected sexual intercourses, or sharing syringes. The aim of this study was to quantitatively evaluate the prevalence of HCV among Iranian prisoners conducting a systematic review and meta-analysis.

Methods

We searched different scholarly databases including Embase, PubMed/MEDLINE, ISI/Web of Sciences, the Cochrane library, Scopus, CINAHL, and PsycINFO as well as Iranian bibliographic thesauri (namely, Barakatns, MagIran, and SID) up to December 2017. The Newcastle Ottawa Scale (NOS) was used to assess the quality of the studies included. HCV prevalence rate with its 95% confidence interval (CI) was estimated using the DerSimonian-Laird random-effects model, with Freeman-Tukey double arcsine transformation. Egger’s regression test was used to evaluate publication bias.

Results

Finally, 17 articles were selected based on inclusion and exclusion criteria. Overall, 18,693 prisoners were tested. Based on the random-effects model, the prevalence of HCV among Iranian prisoners was 28% (CI 95% 21–36) with heterogeneity of I² = 99.3% (p = 0.00). All studies used an ELISA test for the evaluation of HCV antibodies. The findings of this study showed that the highest prevalence rate (53%) was among prisoners who inject drugs.

Conclusion

The findings of our study showed that the prevalence of HCV among Iranian prisoners is dramatically high. Managing this issue in Iran’s prisons requires careful attention to the availability of health facilities and instruments, such as screening, and harm reduction policies, such as giving sterile syringes and needles to prisoners. An integrated program of training for prisoners, prison personnel and medical staff is also needed to improve the level of health condition in prisons.

Tattooing in prison: a risk factor for HCV infection among inmates in the Quebec's provincial correctional system

PURPOSE

To determine the prevalence of hepatitis C virus (HCV) and identify related risk factors among inmates in Quebec provincial prisons.

METHODS

Anonymous cross-sectional data were collected between May 2014 and March 2015 for 1315 men and 250 women who completed a questionnaire and provided oral fluid samples.

RESULTS

The global prevalence of HCV infection was 11.9% in male participants and 19.2% in female participants (P = .003). Among people who inject drugs (PWID), the prevalence was much higher compared to that in persons who does not: 51.0% versus 2.4% in men (P < .001) and 61.4% versus 2.8% in women (P < .001). In the multivariable analysis, lifetime history of injection drug use was the most important risk factor for HCV infection (adjusted odds ratio [AOR]: 14.2; 95% confidence interval [95% CI]: 9.5-21.4), with needle sharing significantly associated with HCV among PWID (AOR: 1.4; 95% CI: 1.1-1.7). Tattooing in prison was frequent, especially among men (37.2%), and independently associated with HCV infection among non-PWID (AOR: 2.8; 95% CI: 1.4-5.6).

CONCLUSION

Inmates are at high risk for HCV infection especially because of a high proportion of active or past PWID among them. In addition, tattooing while in prison seems to contribute to HCV infection among non-PWID.