A multicentre interventional study to assess blood-borne viral infections in Belgian prisons

Dana Busschots,Rob Bielen,Geert Robaeys,Luk Van Baelen,Geert Hellemans,Gaetan Muyldermans,Niel Hens,Özgür M Koc,Hans Orlent,Christian Brixko,Francis De Smet,Hans Van Vlierberghe,Leen Heyens,Cécile Kremer,Pierre Laukens,Pascal Bilaey

doi:10.1186/s12879-021-06405-z

Abstract

BackgroundPrevalence data on viral hepatitis B (HBV), hepatitis C (HCV), and HIV infection in prison are often scarce or outdated. There is currently no systematic screening for these blood-borne viral infections (BBV) in Belgian prisons. There is an urgency to assess the prevalence of these BBV to inform policymakers and public healthcare.MethodsThis was a multicentre, interventional study to assess the prevalence of BBV using opt-in screening in prisons across Belgium, April 2019 – March 2020. Prisoners were tested using a finger prick and BBV risk factors were assessed using a questionnaire. A generalized linear mixed model was used to investigate the association between the various risk factors and HCV.ResultsIn total, 886 prisoners from 11 Belgian prisons were screened. Study uptake ranged from 16.9 to 35.4% in long-term facilities. The prevalence of HCV antibodies (Ab), hepatitis B surface antigen (Ag) and HIV Ab/Ag was 5.0% (44/886), 0.8% (7/886), and 0.2% (2/886). The adjusted odds for HCV Ab were highest in prisoners who ever injected (p < 0.001; AOR 24.6 CI 95% (5.5–215.2). The prevalence of detectable HCV RNA in the total cohort was 2.1% (19/886). Thirteen (68.4%) prisoners were redirected for follow-up of their HCV infection.ConclusionsOpt-in testing for viral hepatitis B, C and HIV was relatively well-accepted in prisons. Compared with the general population, prisoners have a higher prevalence of infection with BBV, especially for HCV. Systematic screening for these BBV should be recommended in all prisons, preferably using opt-out to optimize screening uptake.Trial registrationRetrospectively registered at clinical trials NCT04366492 April 29, 2020.

Highlights

Prevalence data on viral hepatitis B (HBV), hepatitis C (HCV), and HIV infection in prison are often scarce or outdated
Between April 2019 and March 2020, 886 prisoners from 11 Belgium prison sites were screened for hepatitis C virus (HCV) Ab, hepatitis B surface antigen (HBsAg), and HIV using a finger prick
As our study shows, injecting drug use (IDU) and sharing of associated paraphernalia are the main risk factors for HCV

Summary

Introduction

Prevalence data on viral hepatitis B (HBV), hepatitis C (HCV), and HIV infection in prison are often scarce or outdated. In Europe, the prevalence of HCV Ab in the general population ranges from 0.5% in Western Europe to 6% in Eastern Europe [8]. The estimated prevalence is 15.5% in Western Europe and 20.2% in Eastern Europe [5]. These high rates of HCV infection in prisoners and the substantial risks associated (e.g., cirrhosis) with untreated HCV infection emphasizes the importance of HCV screening and access to treatment in prisons [9]. The WHO advises testing all prisoners for HCV infection [10]

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