title: Burden of infectious diseases, substance use disorders, and mental illness among Ukrainian prisoners transitioning to the community.
abstract: BACKGROUND
  The epidemics of incarceration, substance use disorders (SUDs), and infectious diseases are inextricably intertwined, especially in the Former Soviet Union (FSU). Few objective data documenting this relationship regionally are available. We therefore conducted a comprehensive, representative country-wide prison health survey in Ukraine, where one of the world's most volatile HIV epidemics persists, in order to address HIV prevention and treatment needs.
  
  
  METHODS
  A nation-wide, multi-site randomly sampled biobehavioral health survey was conducted in four Ukrainian regions in 13 prisons among individuals being released within six months. After consent, participants underwent standardized health assessment surveys and serological testing for HIV, viral hepatitis, and syphilis.
  
  
  RESULTS
  Of the 402 participants (mean age = 31.9 years), 20.1% were female. Prevalence of HIV, HCV, HBV, and syphilis was 19.4% (95% CI = 15.5%-23.3%), 60.2% (95% CI = 55.1%-65.4%), 5.2% (95% CI = 3.3%-7.2%), and 10% (95% CI = 7.4%-13.2%), respectively, with regional differences observed; HIV prevalence in the south was 28.6%. Among the 78 HIV-infected inmates, 50.7% were unaware of their HIV status and 44 (56.4%) had CD4<350 cells/mL, of which only five (11%) antiretroviral-eligible inmates were receiving it. Nearly half of the participants (48.7%) reported pre-incarcertion drug injection, primarily of opioids, yet multiple substance use (31.6%) and alcohol use disorders (56.6%) were common and 40.3% met screening criteria for depression.
  
  
  CONCLUSIONS
  This is the only such representative health study of prisoners in the FSU. This study has important implications for regional prevention and treatment because, unlike elsewhere, there is no recent evidence for reduction in HIV incidence and mortality in the region. The prevalence of infectious diseases and SUDs is high among this sample of prisoners transitioning to the community. It is critical to address pre- and post-release prevention and treatment needs with the development of linkage programs for the continuity of care in the community after release.
authors.affiliation: Ukrainian Institute on Public Health Policy, Kyiv, Ukraine.
authors.forename: Lyuba
authors.initials: L
authors.lastname: Azbel
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Wickersham
authors.forename: Yevgeny
authors.initials: Y
authors.lastname: Grishaev
authors.forename: Sergey
authors.initials: S
authors.lastname: Dvoryak
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Altice
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006306:Health Surveys; D006525:Hepatitis, Viral, Human / Q000453:epidemiology*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D018962:Phlebotomy; D015995:Prevalence; D011329:Prisoners / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000453:epidemiology*; D013587:Syphilis / Q000453:epidemiology*; D014455:Ukraine / Q000453:epidemiology