Prevalence of hepatitis C in prisons: WASH-C surveillance linked to self-reported risk behaviours.
We used cross-sectional willing anonymous salivary hepatitis C (WASH-C) surveillance linked to self-completed risk-factor questionnaires to estimate the prevalence of salivary hepatitis C antibodies (HepCAbS) in five Scottish prisons from 1994 to 1996. Of 2121 available inmates, 1864 (88%) participated and 1532/1864 (82%) stored samples were suitable for testing. Overall 311/1532 (20.3%, prevalence 95% CI 18.3-22.3%) were HepCAbS-positive: 265/536 (49%, 95% CI 45-54%) injector-inmates but only 27/899 (3%, 95% CI 2-4%) non-injector-inmates. Among injectors, HepCAbS positivity was only slightly higher (p = 0.03) in those who had injected inside prison (53%, 162/305) than in those who had not (44%, 98/224). Those who began injecting in 1992-96 were much less likely to be HepCAbS-positive than those who started pre-1992 (31%, 35/114 vs. 55%, 230/422; p < 0.001). Even with injectors who began in 1992-96 but had never injected inside prison, the prevalence of hepatitis C carriage was 17/63 (95% CI 16-38%). The prevalence and potential transmissibility of hepatitis C in injector-inmates are both high. Promoting 'off injecting' before 'off drugs' (both inside and outside prison), methadone prescription during short incarcerations, alternatives to prison, and support of HepCAbS-positive inmates in becoming eligible for treatment, all warrant urgent consideration.
Gore
S M
SM
MRC Biostatistics Unit, Cambridge, UK.
Bird
A G
AG
Cameron
S O
SO
Hutchinson
S J
SJ
Burns
S M
SM
Goldberg
D J
DJ
D000328:Adult; D003430:Cross-Sectional Studies; D006526:Hepatitis C / Q000453:epidemiology* / Q000821:virology; D018937:Hepatitis C Antibodies / Q000032:analysis; D006801:Humans; D015995:Prevalence; D011329:Prisoners / Q000706:statistics & numerical data*; D012309:Risk-Taking; D012463:Saliva / Q000821:virology; D012606:Scotland / Q000453:epidemiology; D012650:Self Disclosure; D015819:Substance Abuse, Intravenous / Q000453:epidemiology
D018937:Hepatitis C Antibodies