Incidence and risk for acute hepatitis C infection during imprisonment in Australia

Eur J Epidemiol (2010) 25:143148 DOI 10.1007/s10654-009-9421-0

INFECTIOUS DISEASES

Incidence and risk for acute hepatitis C infection during imprisonment in Australia

Kate Dolan Suzy Teutsch Nicolas Scheuer

Michael Levy William Rawlinson

John Kaldor Andrew Lloyd Paul Haber

Received: 25 May 2009 / Accepted: 31 December 2009 / Published online: 19 January 2010 Springer Science+Business Media B.V. 2010

Abstract To determine hepatitis C incidence and the demographic and behavioural predictors in seronegative drug injecting prisoners. Prisoners in New South Wales, Australia who: were aged 18 years and over; reported IDU; had been continuously imprisoned; had a documented negative HCV antibody test result in prison in the last 12 months; provided written informed consent. Subjects were interviewed about their demographic characteristics and detailed risk factors for transmission prior to, and since, imprisonment. A blood sample was collected to screen for HCV antibodies by ELISA and RNA by PCR. Of 253 inmates recruited, 120 were continuously

imprisoned and included in this analysis. Sixteen acquired HCV infection indicating an incidence of 34.2 per 100 person years (CI: 19.655.6). Risk factors for transmission included prior imprisonment, methadone treatment and greater than 10 years of education. Although the frequency of injecting was reduced in prison, 33.6% continued to inject drugs, most commonly methamphetamine, and 90% of these reported sharing injecting equipment. Prison inmates were at high risk of HCV infection, despite some reduction in high-risk behaviours and access to prevention services. To prevent HCV transmission in prisons, better prevention strategies are required.

Keywords Prisoners Hepatitis C Injecting drug use

Incidence

AbbreviationsHCV Hepatitis C virus IDU Injecting drug use(rs) NSW New South Wales

Introduction

Approximately 2.2% of worlds population is infected with hepatitis C (HCV; [1]). As HCV is a blood borne viral infection, injecting drug users (IDUs) are the primary group of interest, with imprisoned IDUs requiring special attention. IDUs are imprisoned at alarming rates, with over half and up to 90% having been imprisoned at some time [2]. Estimates of IDUs engaging in injecting in prison range from 11 [3] to 53% [4]. Evidence of intraprison HCV transmission comes from case reports linked to IDU [5], tattooing [6], bloody ghts [7], reuse of barbers shears [8]

K. Dolan (&) N. Scheuer

National Drug and Alcohol Research Centre, University of New...