Hepatitis C infection and incarcerated populations
Introduction
It is estimated that approximately 170 million people, or 3% of the world’s population, are currently infected with the hepatitis C virus (HCV) (WHO, 1999). Present and past injection drug use (IDU), along with a history of transfusion of unscreened blood products, account for 90% of those individuals with chronic HCV infection. According to the World Health Organization (WHO) IDU, and more specifically, re-use of contaminated syringes, has accounted for between 2.3 and 4.7 million HCV infections worldwide (WHO, 2000). In the United States, HCV is the most common blood-borne infection, infecting an estimated 4 million Americans. It is responsible for most chronic liver disease and 8000–10,000 deaths annually (National Institute on Drug Abuse, 2001). While blood transfusions accounted for 40% of new HCV cases in the United States prior to the mid-1980s, IDU is currently the primary mode of transmission, accounting for at least 60% of new cases of HCV (Williams, 1999).
The incarcerated population is an important group to study HCV for a number of reasons. Prisons have been shown to be a reservoir of infection. Prisoners have a disproportionately higher prevalence of HIV and HBV than the general population, primarily attributed to IDU prior to incarceration (Anda, Perlman, D’Alessio, et al., 1985; Angarano, Pastore, et al., 1986; Decker, Vaughn, Brodie, et al., 1984; Des Jarlais, Friedman, Novick, et al., 1989; Hull, Lyons, Mann, et al., 1985; Rotily, 2000; Turnbull, Stimson, & Dolan, 1992; Vlahov, Brewer, Castro, et al., 1991). The inmate population is also distinct in that it consists of individuals with greater risk factors for contracting these infections compared to the general population. Such characteristics include IDU, multiple sex partners, alcohol abuse, and living in medically underserved and minority communities (Reindollar, 1999). In the United States, according to the Centers for Disease Control and Prevention (CDC), 31% of state prisoners and 60% of federal prisoners are incarcerated for drug-related crimes.
It is estimated that 30–40% of the 1.8 million inmates in the United States are infected with HCV and worldwide estimates follow a similar pattern. Thus, prisons provide a unique setting for disease prevention, surveillance and treatment.
In this paper, we will discuss methodological issues related to studies of HCV among incarcerated populations, evaluate the existing literature regarding prevalence and incidence, make comparisons when possible between the studies, and describe the behavioural risk factors associated with HCV prevalence in prison. Finally, we will discuss the prevention and treatment possibilities that may or may not be relevant to a correctional setting.
Section snippets
Review of published studies
Published studies of HCV within the incarcerated setting were identified through manual and computerised searches of the MEDLINE database using the subject headings of “HCV” and “prisons” and “jails”. Search criteria were limited to those manuscripts published in the English language after the year 1990. Studies relating to HCV spread within both jail and prison settings are included in the prevalence and incidence summaries. Studies that evaluated prevalence of HCV among healthcare workers and
Discussion
This review demonstrates that HCV infection is endemic among prisoners worldwide. It is important to note, however, that differences in HCV seroprevalence between incarcerated populations and the local comparison groups in some studies could be due to selection bias related to the control population. For example, Catalan-Soares et al. (2000) indicate that blood donors with whom inmates were compared, passed a routine pre-donation screening, which may have selectively excluded those individuals
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2018, Journal of Adolescent HealthCitation Excerpt :Furthermore, given evidence that incarceration precipitates increased injecting risk behavior [72] and reduces adherence to ART among those who are HIV positive [73,74], efforts to minimize the incarceration of at-risk young people are important to preventing the further spread of infection [25,75]. Among studies presenting sex-specific estimates, high HIV or HCV seroprevalence was more often observed among young women than young men, consistent with previous findings that incarcerated women have a particularly high prevalence of HIV and HCV infection, driven largely by a higher prevalence of injection drug use and higher rates of unsafe injecting practices, primarily in the context of intimate relationships [76,77]. We found comparatively few studies that reported age-specific prevalence estimates for HBV or TB, and no evidence that the prevalence of these infections was different among incarcerated AYAs and older prisoners.
The politics of harm reduction in federal prisons
2014, International Journal of Drug PolicyRandomised controlled trial of a service brokerage intervention for ex-prisoners in australia
2013, Contemporary Clinical TrialsHigh-risk drug-use practices among a large sample of Australian prisoners
2012, Drug and Alcohol DependenceCitation Excerpt :Internationally, sharing of injecting equipment is a key driver of blood-borne viral (BBV) infections including HIV (Jürgens et al., 2009) and hepatitis C (HCV; Vescio et al., 2008). It is therefore not surprising that the prevalence of these infections is elevated among prisoners, particularly those with a history of IDU (Dolan et al., 2007; Macalino et al., 2004). Despite intensive and costly efforts to restrict the flow of drugs into prison settings (Black et al., 2004), a substantial proportion of IDU continue to inject drugs in prison (Dolan et al., 1996, 2010; Hellard et al., 2004; Milloy et al., 2008).