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

Authors

  • Sarah Larney,

    Corresponding author
    1. Alpert Medical School, Brown University, Providence, RI, USA
    • National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
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  • Hannah Kopinski,

    1. Center for Prisoner Health and Human Rights, Miriam Hospital, Providence, RI, USA
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  • Curt G. Beckwith,

    1. Alpert Medical School, Brown University, Providence, RI, USA
    2. Division of Infectious Diseases, Miriam Hospital, Providence, RI, USA
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  • Nickolas D. Zaller,

    1. Alpert Medical School, Brown University, Providence, RI, USA
    2. Division of Infectious Diseases, Miriam Hospital, Providence, RI, USA
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  • Don Des Jarlais,

    1. Beth Israel Medical Center, New York, NY, USA
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  • Holly Hagan,

    1. College of Nursing, New York University, New York, NY, USA
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  • Josiah D. Rich,

    1. Alpert Medical School, Brown University, Providence, RI, USA
    2. Center for Prisoner Health and Human Rights, Miriam Hospital, Providence, RI, USA
    3. Division of Infectious Diseases, Miriam Hospital, Providence, RI, USA
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  • Brenda J. van den Bergh,

    1. World Health Organization Regional Office for Europe HIV/AIDS, Sexually Transmitted Infections and Viral Hepatitis Programme, Copenhagen, Denmark
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  • Louisa Degenhardt

    1. National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
    2. Centre for Health Policy, Programs and Economics, School of Population Health, University of Melbourne, Melbourne, Vic, Australia
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  • See Editorial on Page 1197

  • Financial support for this study was provided by the HIV/AIDS Department of the World Health Organization. S.L. is supported by an Australian National Health and Medical Research Council Early Career (NHMRC) Research Fellowship (1035149). C.G.B. is supported by a US National Institutes of Health (NIH) Career Development Award (NIDA K23DA021095). J.D.R. is supported by an NIH Midcareer Investigator Award in Patient Oriented Research (NIDA K24DA022112). L.D. is supported by an NHMRC Senior Research Fellowship (10417142). The National Drug and Alcohol Research Centre receives core funding from the Australian Government Department of Health and Ageing. The Lifespan/Tufts/Brown Center for AIDS Research is funded by the NIH (NIAID P30AI042853).

  • Potential conflict of interest: Nothing to report.

Address reprint requests to: Sarah Larney, Miriam Hospital, CFAR Bldg., Rm. 115, 164 Summit Ave., Providence RI 02904. E-mail: s.larney@unsw.edu.au

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. (Hepatology 2013;58:1215–1224)

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