A prospective study of hepatitis C incidence in Australian prisoners. (15th July 2014)

• Record Type: Journal Article
• Authors: Luciani, Fabio; Bretaña, Neil Arvin; Teutsch, Suzy; Amin, Janaki; Topp, Libby; Dore, Gregory J.; Maher, Lisa; Dolan, Kate; Lloyd, Andrew R.; HITS‐p investigators
• Is Part Of: Addiction. Volume 109:Number 10(2014:Oct.)
• Page Start: 1695
• Page End: 1706
• Publication Date: 2014-07-15
• Subjects: Alcoholism -- Periodicals; Drug addiction -- Periodicals; 616.86
• DOI: 10.1111/add.12643
• Languages: English
• ISSNs: 0965-2140

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="add12643-sec-0001" sec-type="section"> <title>Aims</title> <p>To document the relationships between injecting drug use, imprisonment and hepatitis C virus (HCV) infection.</p> </sec> <sec id="add12643-sec-0002" sec-type="section"> <title>Design</title> <p>Prospective cohort study.</p> </sec> <sec id="add12643-sec-0003" sec-type="section"> <title>Setting</title> <p>Multiple prisons in New South Wales, Australia.</p> </sec> <sec id="add12643-sec-0004" sec-type="section"> <title>Participants</title> <p>HCV seronegative prisoners with a life‐time history of injecting drug use (IDU) were enrolled and followed prospectively (<italic>n</italic> = 210) by interview and HCV antibody and RNA testing 6–12‐monthly for up to 4 years when in prison.</p> </sec> <sec id="add12643-sec-0005" sec-type="section"> <title>Measurements</title> <p>HCV incidence was calculated using the person‐years method. Cox regression was used to identify predictors of incident infection using time‐dependent covariates.</p> </sec> <sec id="add12643-sec-0006" sec-type="section"> <title>Results</title> <p>Almost half the cohort reported IDU during follow‐up (103 subjects; 49.1%) and 65 (31%) also reported sharing of the injecting apparatus. There were 38 HCV incident cases in 269.94 person‐years (py) of follow‐up with an estimated incidence of 14.08 per 100 py [confidence interval (CI) = 9.96–19.32]. Incident infection was associated independently with Indigenous background, injecting daily or more and injecting heroin. Three subjects were RNA‐positive and antibody‐negative at the incident time‐point, indicating early infection, which provided a second incidence estimate of 9.4%. Analysis of continuously incarcerated subjects (<italic>n</italic> = 114) followed over 126.73 py, identified 13 new HCV infections (10.26 per 100 py, CI = 5.46–17.54), one of which was an early infection case. Bleach‐cleansing of injecting equipment and opioid substitution treatment were not associated with a significant reduction in incidence.</p> </sec> <sec id="add12643-sec-0007" sec-type="section"> <title>Conclusions</title> <p>In New South Wales, Australia, imprisonment is associated with high rates of hepatitis C virus transmission. More effective harm reduction interventions are needed to control HCV in prison settings.</p> </sec> </abstract>