title: Ongoing incident hepatitis C virus infection among people with a history of injecting drug use in an Australian prison setting, 2005-2014: The HITS-p study.
abstract: Hepatitis C virus (HCV) transmission is high in prisons. This study investigated trends in HCV incidence and associated factors among a cohort of prisoners with a history of injecting drug use in New South Wales, Australia. Data were available from the Hepatitis C Incidence and Transmission Study-prisons (HITS-p) from 2005 to 2014. Temporal trends in HCV incidence were evaluated. Factors associated with time to HCV seroconversion among people with ongoing injecting was assessed using Cox proportional hazards. Among 320 antibody-negative participants with a history of injecting drug use (mean age 26; 72% male), 62% (n=197) reported injecting drug use during follow-up. Overall, 93 infections were observed. HCV incidence was 11.4/100 person-years in the overall population and 6.3/100 person-years among the continually imprisoned population. A stable trend in HCV incidence was observed. Among the overall population with ongoing injecting during follow-up, ≥weekly injecting drug use frequency was independently associated with time to HCV seroconversion. Among continuously imprisoned injectors with ongoing injecting during follow-up, needle/syringe sharing was independently associated with time to HCV seroconversion. This study demonstrates that prison is a high-risk environment for acquisition of HCV infection. Needle and syringe sharing was associated with HCV infection among continually imprisoned participants, irrespective of frequency of injecting or the type of drug injected. These findings highlight the need for the evaluation of improved HCV prevention strategies in prison, including needle/syringe programmes and HCV treatment.
authors.affiliation: The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.
authors.forename: E B
authors.identifier: 0000-0002-8048-3473
authors.initials: EB
authors.lastname: Cunningham
authors.affiliation: The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.
authors.forename: B
authors.initials: B
authors.lastname: Hajarizadeh
authors.affiliation: The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.|Inflammation and Infection Research Centre, School of Medical Sciences, UNSW Sydney, Sydney, NSW, Australia.
authors.forename: N A
authors.initials: NA
authors.lastname: Bretana
authors.affiliation: The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Amin
authors.affiliation: Inflammation and Infection Research Centre, School of Medical Sciences, UNSW Sydney, Sydney, NSW, Australia.
authors.forename: B
authors.initials: B
authors.lastname: Betz-Stablein
authors.affiliation: The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.
authors.forename: G J
authors.initials: GJ
authors.lastname: Dore
authors.affiliation: The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.|Inflammation and Infection Research Centre, School of Medical Sciences, UNSW Sydney, Sydney, NSW, Australia.
authors.forename: F
authors.initials: F
authors.lastname: Luciani
authors.affiliation: Inflammation and Infection Research Centre, School of Medical Sciences, UNSW Sydney, Sydney, NSW, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Teutsch
authors.affiliation: National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia.
authors.forename: K
authors.initials: K
authors.lastname: Dolan
authors.affiliation: The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.|Inflammation and Infection Research Centre, School of Medical Sciences, UNSW Sydney, Sydney, NSW, Australia.
authors.forename: A R
authors.initials: AR
authors.lastname: Lloyd
authors.affiliation: The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Grebely
mesh_terms: D000328:Adult; D005260:Female; D006526:Hepatitis C / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D009517:New South Wales / Q000453:epidemiology; D011330:Prisons; D011446:Prospective Studies; D015819:Substance Abuse, Intravenous / Q000150:complications*; D055815:Young Adult
keywords: 
  PWID
  ; Australia; hepatitis C Virus; incidence; prison