title: Incidence and correlates of hepatitis C virus infection in a large cohort of prisoners who have injected drugs.
abstract: BACKGROUND
  Hepatitis C virus (HCV) infection is common among prisoners, particularly those with a history of injecting drug use (IDU). Incarcerated people who inject drugs frequently report high-risk injecting practices both in prison and in the community. In spite of rising morbidity and mortality, utilisation of HCV-related services in Australia has been persistently low. This study aimed to describe the incidence, prevalence and correlates of HCV seropositivity in a large cohort of prisoners who have injected drugs, and to identify correlates of receiving confirmation of active infection.
  
  
  METHODS
  Data-linkage to a State-wide statutory notifiable diseases surveillance system was used to investigate the incidence of notified HCV seropositivity, seroconversion and confirmed HCV infection in a cohort of 735 prisoners with a history of IDU, over 14 years of follow up. Hepatitis C test results from prison medical records were used to identify correlates of testing positive in prison.
  
  
  RESULTS
  The crude incidence of HCV notification was 5.1 cases per 100 person-years. By the end of follow up, 55.1% of the cohort had been the subject of a HCV-related notification, and 47.4% of those tested in prison were HCV seropositive. In multivariable analyses, injecting in prison was strongly associated with HCV seropositivity, as was opioid use compared to injection of other drugs. The rate of reported diagnostic confirmation among those with notified infections was very low, at 6.6 confirmations per 100 seropositive participants per year.
  
  
  CONCLUSIONS
  Injecting drugs in prison was strongly associated with HCV seropositivity, highlighting the need for increased provision of services to mitigate the risk of transmission within prisons. Once identified as seropositive through screening, people with a history of IDU and incarceration may not be promptly receiving diagnostic services, which are necessary if they are to access treatment. Improving access to HCV-related services will be of particular importance in the coming years, as HCV-related morbidity and mortality is increasing, and next generation therapies are becoming more widely available.
authors.affiliation: Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia. kathryn.snow@unimelb.edu.au.
authors.forename: Kathryn J
authors.initials: KJ
authors.lastname: Snow
authors.forename: Jesse T
authors.initials: JT
authors.lastname: Young
authors.forename: David B
authors.initials: DB
authors.lastname: Preen
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Lennox
authors.forename: Stuart A
authors.initials: SA
authors.lastname: Kinner
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage; D001315:Australia / Q000453:epidemiology; D055030:Drug Users; D005260:Female; D016174:Hepacivirus; D006526:Hepatitis C / Q000453:epidemiology / Q000209:etiology* / Q000821:virology; D006801:Humans; D015994:Incidence; D007267:Injections; D008297:Male; D015995:Prevalence; D011329:Prisoners; D011330:Prisons; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid
references.citation: Med J Aust. 2012 Nov 5;197(9):492-3
references.pmid: 23121582
references.citation: BMJ. 1995 Feb 4;310(6975):285-8
references.pmid: 7866168
references.citation: Addiction. 2005 Jun;100(6):820-8
references.pmid: 15918812
references.citation: Hepatology. 2013 Oct;58(4):1215-24
references.pmid: 23504650
references.citation: Med J Aust. 2010 May 3;192(9):496-500
references.pmid: 20438418
references.citation: Eur J Epidemiol. 2004;19(12):1119-22
references.pmid: 15678792
references.citation: Minerva Gastroenterol Dietol. 2012 Mar;58(1):65-79
references.pmid: 22419005
references.citation: BMC Public Health. 2010 Oct 22;10:633
references.pmid: 20964864
references.citation: Eur J Epidemiol. 2010 Feb;25(2):143-8
references.pmid: 20084429
references.citation: BMJ. 2012 Aug 17;345:e5615
references.pmid: 22904316
references.citation: PLoS One. 2014 Feb 28;9(2):e90560
references.pmid: 24587394
references.citation: J Infect. 2006 Aug;53(2):125-30
references.pmid: 16313963
references.citation: Epidemiol Infect. 2004 Jun;132(3):409-15
references.pmid: 15188710
references.citation: Contemp Clin Trials. 2013 Sep;36(1):198-206
references.pmid: 23850859
references.citation: Semin Liver Dis. 2011 Nov;31(4):331-9
references.pmid: 22189973
references.citation: Best Pract Res Clin Gastroenterol. 2012 Aug;26(4):371-80
references.pmid: 23199497
references.citation: Int J Drug Policy. 2013 Mar;24(2):85-100
references.pmid: 23026541
references.citation: Intern Med J. 2012 May;42(5):497-504
references.pmid: 21299780
references.citation: Aust N Z J Public Health. 1999 Oct;23(5):464-7
references.pmid: 10575765
references.citation: Drug Alcohol Depend. 2012 Nov 1;126(1-2):156-60
references.pmid: 22658284
references.citation: BMC Public Health. 2010 Dec 21;10:777
references.pmid: 21176146
references.citation: Am J Med. 2013 Aug;126(8):718-22
references.pmid: 23786667
references.citation: Drug Alcohol Depend. 2005 Jan 7;77(1):81-6
references.pmid: 15607844
references.citation: Addiction. 2013 Jul;108(7):1296-304
references.pmid: 23297816
references.citation: J Viral Hepat. 2011 Jul;18(7):e232-41
references.pmid: 21692938
references.citation: J Urban Health. 2004 Sep;81(3):448-52
references.pmid: 15273267
references.citation: Int J Infect Dis. 2009 Mar;13(2):201-8
references.pmid: 18790659
references.citation: PLoS One. 2014 Feb 27;9(2):e87564
references.pmid: 24586281
references.citation: J Clin Epidemiol. 2013 May;66(5):575-81
references.pmid: 23384589