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. 2024 Jan;31(1):21-34.
doi: 10.1111/jvh.13895. Epub 2023 Nov 7.

Incidence of hepatitis C virus infection in the prison setting: The SToP-C study

Behzad Hajarizadeh  1 , Joanne M Carson  1 , Marianne Byrne  1 , Jason Grebely  1 , Evan Cunningham  1 , Janaki Amin  2 , Peter Vickerman  3 , Natasha K Martin  4 , Carla Treloar  5 , Marianne Martinello  1 , Andrew R Lloyd  1 , Gregory J Dore  1 ; SToP-C study group
Collaborators, Affiliations

Incidence of hepatitis C virus infection in the prison setting: The SToP-C study

Behzad Hajarizadeh et al. J Viral Hepat. 2024 Jan.

Abstract

People in prison are at high risk of HCV given high injecting drug use prevalence. This study evaluated HCV incidence and associated injecting drug use characteristics in prison. The SToP-C study enrolled people incarcerated in four Australian prisons. Participants were tested for HCV at enrolment and then every 3-6 months (October-2014 to November-2019). Participants eligible for this analysis included those at-risk of HCV primary infection (anti-HCV negative) or re-infection (anti-HCV positive, HCV RNA negative) with follow-up assessment. A total of 1643 eligible participants were included in analyses (82% male; median age 33 years; 30% injected drugs in prison; 1818 person-years of follow-up). Overall HCV incidence was 6.11/100 person-years (95%CI: 5.07-7.35), with higher rate of re-infection (9.34/100 person-years; 95%CI: 7.15-12.19) than primary infection (4.60/100 person-years; 95%CI: 3.56-5.96). In total population (n = 1643), HCV risk was significantly higher among participants injecting drugs in prison [vs. no injecting; adjusted hazard ratio (aHR): 10.55, 95%CI: 5.88-18.92), and those who were released and re-incarcerated during follow-up (vs. remained incarcerated; aHR: 1.60, 95%CI: 1.03-2.49). Among participants who injected recently (during past month, n = 321), HCV risk was reduced among those receiving high-dosage opioid agonist therapy (OAT), i.e. methadone ≥60 mg/day or buprenorphine ≥16 mg/day, (vs. no OAT, aHR: 0.11, 95%CI: 0.02-0.80) and increased among those sharing needles/syringes without consistent use of disinfectant to clean injecting equipment (vs. no sharing, HR: 4.60, 95%CI: 1.35-15.66). This study demonstrated high HCV transmission risk in prison, particularly among people injecting drugs. High-dosage OAT was protective, but improved OAT coverage and needle/syringe programmes to reduce sharing injecting equipment are required.

Keywords: HCV; cohort study; correctional facilities; intravenous substance abuse; opiate substitution treatment.

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Conflict of interest statement

GJD is a consultant or adviser for, and has received research grants from, AbbVie, Abbot Diagnostics, Gilead Sciences, Bristol Myers Squibb, Cepheid, GlaxoSmithKline, Merck, Janssen and Roche. ARL is a consultant/adviser and has received investigator‐initiated research grants from Gilead, AbbVie and Bristol‐Myers Squibb. JG is a consultant or adviser for, and has received research grants from AbbVie, bioLytical, Camurus, Cepheid, Gilead Sciences, Hologic and Indivor, and has received honoraria from AbbVie, Cepheid and Gilead Sciences. NM has received research grants from AbbVie and Gilead Sciences. PV has received research grants from Gilead Sciences. Other co‐authors had none to declare.

Figures

FIGURE 1
FIGURE 1
Overview of the study population. * HCV test results at enrolment were not available for seven participants. † Most (n = 104) are participants who were enrolled during late 2019 and were not due for follow‐up or there was no access to the participant by the end of the study. ‡ Five participants had the second incident HCV infection after clearance (total HCV incident events = 111). § Included participants who did not receive treatment, or those who received treatment but did not have any record of post‐treatment follow‐up or clearance.
FIGURE 2
FIGURE 2
Incidence rate of HCV infection (A), primary infection (B), and re‐infection (C) among participants, by injecting drug use status at the beginning of the follow‐up.
FIGURE 3
FIGURE 3
Cumulative incidence of HCV infection (A), primary infection (B) and re‐infection (C) among participants, by injecting drug use status at the beginning of the follow‐up. IDU: injecting drug us.
See this image and copyright information in PMC

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