title: Incidence and prevalence of hepatitis C in prisons and other closed settings: results of a systematic review and meta-analysis.
abstract: People detained in prisons and other closed settings are at elevated risk of infection with hepatitis C virus (HCV). We undertook a systematic review and meta-analysis with the aim of determining the rate of incident HCV infection and the prevalence of anti-HCV among detainees in closed settings. We systematically searched databases of peer-reviewed literature and widely distributed a call for unpublished data. We calculated summary estimates of incidence and prevalence among general population detainees and detainees with a history of injection drug use (IDU), and explored heterogeneity through stratification and meta-regression. The summary prevalence estimates were used to estimate the number of anti-HCV positive prisoners globally. HCV incidence among general detainees was 1.4 per 100 person-years (py; 95% confidence interval [CI]: 0.1, 2.7; k = 4), and 16.4 per 100 py (95% CI: 0.8, 32.1; k = 3) among detainees with a history of IDU. The summary prevalence estimate of anti-HCV in general detainees was 26% (95% CI: 23%, 29%; k = 93), and in detainees with a history of IDU, 64% (95% CI: 58%, 70%; k = 51). The regions of highest prevalence were Central Asia (38%; 95% CI 32%, 43%; k = 1) and Australasia (35%; 95% CI: 28%, 43%; k = 9). We estimate that 2.2 million (range: 1.4-2.9 million) detainees globally are anti-HCV positive, with the largest populations in North America (668,500; range: 553,500-784,000) and East and Southeast Asia (638,000; range: 332,000-970,000).
  
  
  CONCLUSIONS
  HCV is a significant concern in detained populations, with one in four detainees anti-HCV-positive. Epidemiological data on the extent of HCV infection in detained populations is lacking in many countries. Greater attention towards prevention, diagnosis, and treatment of HCV infection among detained populations is urgently required.
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia; Alpert Medical School, Brown University, Providence, RI, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Larney
authors.forename: Hannah
authors.initials: H
authors.lastname: Kopinski
authors.forename: Curt G
authors.initials: CG
authors.lastname: Beckwith
authors.forename: Nickolas D
authors.initials: ND
authors.lastname: Zaller
authors.forename: Don Des
authors.initials: DD
authors.lastname: Jarlais
authors.forename: Holly
authors.initials: H
authors.lastname: Hagan
authors.forename: Josiah D
authors.initials: JD
authors.lastname: Rich
authors.forename: Brenda J
authors.initials: BJ
authors.lastname: van den Bergh
authors.forename: Louisa
authors.initials: L
authors.lastname: Degenhardt
mesh_terms: D000914:Antibodies, Viral / Q000097:blood; D020378:Confined Spaces; D005260:Female; D014943:Global Health; D016174:Hepacivirus / Q000276:immunology; D006526:Hepatitis C / Q000097:blood / Q000453:epidemiology* / Q000276:immunology; D006801:Humans; D015994:Incidence; D008297:Male; D015995:Prevalence; D011330:Prisons / Q000706:statistics & numerical data*; D012189:Retrospective Studies
chemical_list: D000914:Antibodies, Viral