Abstract
BackgroundHepatitis C virus (HCV) is among the highest priority diseases in custodial settings; however, the diagnosis remains suboptimal among people in custody. This study aimed to validate a short survey for identifying people with HCV infection in a provincial prison in Iran.MethodsBetween July and December 2018, residents and newly admitted inmates of Gorgan central prison completed a questionnaire, including data on the history of HCV testing, drug use, injecting drug use, sharing injecting equipment, and imprisonment. Participants received rapid HCV antibody testing, followed by venipuncture for RNA testing (antibody-positive only). Each enrollment question (yes/no) was compared with the testing results (positive/negative).ResultsOverall, 1892 people completed the questionnaire, including 621 (34%) who were currently on opioid agonist therapy (OAT); 30% of participants had been tested for HCV previously. About 71% had a history of drug use, of whom 13% had ever injected drugs; 52% had ever shared injecting equipment. The prevalence of HCV antibody and RNA was 6.9% (n = 130) and 4.8% (n = 90), respectively. The antibody prevalence was higher among people on OAT compared to those with no history of OAT (11.4% vs. 4.0%). History of drug use was the most accurate predictor of having a positive HCV antibody (sensitivity: 95.2%, negative predictive value: 98.9%) and RNA testing (sensitivity: 96.7%, negative predictive value: 99.5%). The sensitivity of the drug use question was lowest among people with no OAT history and new inmates (87% and 89%, respectively). Among all participants, sensitivity and negative predictive value of the other questions were low and ranged from 34 to 54% and 94 to 97%, respectively.ConclusionsIn resource-limited settings, HCV screening based on having a history of drug use could replace universal screening in prisons to reduce costs. Developing tailored screening strategies together with further cost studies are crucial to address the current HCV epidemic in low- to middle-income countries.
Highlights
Hepatitis C virus (HCV) is among the highest priority diseases in custodial settings; the diagnosis remains suboptimal among people in custody
The history of drug use was the most accurate predictor of having positive HCV antibody and RNA results, with respectively 95% and 97% sensitivity. This outcome indicates that in low- and middle-income settings, HCV screening for people with no history of drug use could be skipped in correctional facilities
Participants who were currently receiving opioid agonist therapy (OAT) represented a more vulnerable population for HCV infection compared to those with no history of OAT (11.4% vs. 4.0%). These results indicate that future HCV screening efforts should focus on people with a history of drug use, those who are attending or have a history of OAT
Summary
Hepatitis C virus (HCV) is among the highest priority diseases in custodial settings; the diagnosis remains suboptimal among people in custody. This study aimed to validate a short survey for identifying people with HCV infection in a provincial prison in Iran. Hepatitis C virus (HCV) infection is a global health concern with a rising disease burden [1]. HCV diagnosis remains suboptimal in many regions, including Iran [3]. In Iran, the prevalence of HCV infection among the general population is estimated at 0.6% [5]. The existing infrastructure of harm reduction and primary health care could be utilized to increase HCV diagnosis and linkage to care as well, given the development of low-cost methods for active case finding [17]
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