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Meta-Analysis
. 2013 Oct;58(4):1215-24.
doi: 10.1002/hep.26387. Epub 2013 Aug 6.

Incidence and prevalence of hepatitis C in prisons and other closed settings: results of a systematic review and meta-analysis

Sarah Larney  1 , Hannah Kopinski, Curt G Beckwith, Nickolas D Zaller, Don Des Jarlais, Holly Hagan, Josiah D Rich, Brenda J van den Bergh, Louisa Degenhardt
Affiliations
Meta-Analysis

Incidence and prevalence of hepatitis C in prisons and other closed settings: results of a systematic review and meta-analysis

Sarah Larney et al. Hepatology. 2013 Oct.

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 We systematically searched databases of peer-reviewed literature and widely distributed a call for unpublished data.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).

Conclusion: 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.

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Figures

Figure 1
Figure 1
Selection of studies for inclusion in systematic review of hepatitis C virus prevalence and incidence in prisons and other closed settings
Figure 2
Figure 2. Hepatitis C virus antibody incidence in general population detainees and detainees with a history of injecting drug use
Notes: ES; effect size
Figure 3
Figure 3. HCV antibody prevalence estimates for adult general population detainees, by region and in total
Notes: Based on 93 sources. No sources were identified for the Pacific Islands or the Caribbean. Details of included sources available in supplementary materials. ES; effect size
Figure 4
Figure 4. Pooled HCV antibody prevalence estimates for adult detainees with a history of injecting drug use, by region and in total
Notes: Based on 51 sources. No sources were identified for countries of Central Asia, the Middle East and North Africa, the Pacific Islands or the Caribbean. Details of included sources available in supplementary materials. ES; effect size
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