Incidence of primary hepatitis C infection and risk factors for transmission in an Australian prisoner cohort.
BACKGROUND
Hepatitis C virus (HCV) infection is common in prisoner populations, particularly those with a history of injecting drug use (IDU). Previous studies of HCV incidence have been based on small case numbers and have not distinguished risk events in prison from those in the community.


METHODS
HCV incidence was examined in a longitudinal cohort of 488 Australian prisoners with a history of IDU and documented to be seronegative within 12 months prior to enrollment. Inmates were tested for anti-HCV antibodies and viremia, and interviewed about demographic and behavioral risk factors for transmission.


RESULTS
The cohort was predominantly male (65%) with high rates of prior imprisonment (72%) and tattooing (73%), as well as longstanding IDU (mean 8.5 years). Ninety-four incident HCV cases were identified (incidence 31.6 per 100 person years). Independent associations were observed between incident infection and prior imprisonment (p = 0.02) and tattooing (p = 0.03), and surprisingly also with methadone maintenance treatment (MMT) (p < 0.001).


CONCLUSIONS
High rates of new HCV infection were found in this prisoner cohort reflecting their substantive risk behavior profile, despite having remained uninfected for many years. The association with MMT is challenging and highlights the need for better understanding of prison-specific HCV transmission risks, as well as the uptake and effectiveness of prevention programs.
School of Medical Sciences, The University of New South Wales, Sydney, New South Wales, Australia. s.teutsch@unsw.edu.au
Suzy
S
Teutsch
Fabio
F
Luciani
Nicolas
N
Scheuer
Luke
L
McCredie
Parastu
P
Hosseiny
William
W
Rawlinson
John
J
Kaldor
Gregory J
GJ
Dore
Kate
K
Dolan
Rosemary
R
Ffrench
Andrew
A
Lloyd
Paul
P
Haber
Michael
M
Levy
D000328:Adult; D015331:Cohort Studies; D005260:Female; D016174:Hepacivirus; D006526:Hepatitis C / Q000453:epidemiology* / Q000635:transmission*; D006801:Humans; D007407:Interviews as Topic; D008137:Longitudinal Studies; D008297:Male; D009517:New South Wales / Q000453:epidemiology; D011322:Primary Prevention; D011329:Prisoners; D012307:Risk Factors; D055815:Young Adult