Incarceration history and risk of HIV and hepatitis C virus acquisition among people who inject drugs: a systematic review and meta-analysis

Jack Stone,Ellen Heinsbroek,Monica Desai,Peter Vickerman,Daniela Abramovitz,Lisa Maher,Geng Zang,Andrew Mcauley,Hannah Fraser,Julie Bruneau,Lucy Platt,Louis Macgregor,Adam Trickey,Sam Abbott,Matthew Hickman,Campbell Aitken,Tasnim Azim,Viktor Mravčík,Yana Sazonova,Jenny Iversen,Malvina Aladashvili,Tengiz Tsertsvadze,Zoe Ward,Michel Alary,Pavlo Smyrnov,Norah Palmateer ,April M Young ,Sharon J Hutchinson ,Aaron G Lim ,Jennifer R Havens ,Steffanie A Strathdee ,Margaret Hellard ,Paul Dietze ,Rachel Sacks‐Davis ,Natasha K Martin ,Frederick L Altice ,Vivian Hope ,Élise Roy ,Josephine G Walker ,Richard S Garfein ,Yung Fen Yen ,M.‐J Milloy ,Shruti H Mehta

doi:10.1016/s1473-3099(18)30469-9

Abstract

SummaryBackgroundPeople who inject drugs (PWID) experience a high prevalence of incarceration and might be at high risk of HIV and hepatitis C virus (HCV) infection during or after incarceration. We aimed to assess whether incarceration history elevates HIV or HCV acquisition risk among PWID.MethodsIn this systematic review and meta-analysis, we searched MEDLINE, Embase, and PsycINFO databases for studies in any language published from Jan 1, 2000 until June 13, 2017 assessing HIV or HCV incidence among PWID. We included studies that measured HIV or HCV incidence among community-recruited PWID. We included only studies reporting original results and excluded studies that evaluated incident infections by self-report. We contacted authors of cohort studies that met the inclusion or exclusion criteria, but that did not report on the outcomes of interest, to request data. We extracted and pooled data from the included studies using random-effects meta-analyses to quantify the associations between recent (past 3, 6, or 12 months or since last follow-up) or past incarceration and HIV or HCV acquisition (primary infection or reinfection) risk among PWID. We assessed the risk of bias of included studies using the Newcastle-Ottawa Scale. Between-study heterogeneity was evaluated using the I2 statistic and the P-value for heterogeneity.FindingsWe included published results from 20 studies and unpublished results from 21 studies. These studies originated from Australasia, western and eastern Europe, North and Latin America, and east and southeast Asia. Recent incarceration was associated with an 81% (relative risk [RR] 1·81, 95% CI 1·40–2·34) increase in HIV acquisition risk, with moderate heterogeneity between studies (I2=63·5%; p=0·001), and a 62% (RR 1·62, 95% CI 1·28–2·05) increase in HCV acquisition risk, also with moderate heterogeneity between studies (I2=57·3%; p=0·002). Past incarceration was associated with a 25% increase in HIV (RR 1·25, 95% CI 0·94–1·65) and a 21% increase in HCV (1·21, 1·02–1·43) acquisition risk.InterpretationIncarceration is associated with substantial short-term increases in HIV and HCV acquisition risk among PWID and could be a significant driver of HCV and HIV transmission among PWID. These findings support the need for developing novel interventions to minimise the risk of HCV and HIV acquisition, including addressing structural risks associated with drug laws and excessive incarceration of PWID.FundingEngineering and Physical Sciences Research Council, National Institute for Health Research, National Institutes of Health.

Highlights

Hepatitis C virus (HCV) and HIV are leading causes of morbidity and mortality and continue to represent major global public health concerns.[1,2] Injecting drug use is associated with two-fifths of the global hepatitis C virus (HCV) disease burden,[3] while outside sub-Saharan Africa, an estimated one-fifth of new HIV infections occur among people who inject drugs (PWID).[4]PWID have a high prevalence of incarceration (58% have ever been incarcerated5), with a history of incarceration frequently being associated with prevalentHIV and HCV infection.[6]
Injecting drug use is associated with two-fifths of the global HCV disease burden,[3] while outside sub-Saharan Africa, an estimated one-fifth of new HIV infections occur among people who inject drugs (PWID).[4]
We identified a systematic review on the associations between criminalisation of drug use and HIV prevention and treatment-related outcomes among people who inject drugs (PWID), which included only one study measuring the association between incarceration history and HIV acquisition risk among PWID

Summary

Introduction

Hepatitis C virus (HCV) and HIV are leading causes of morbidity and mortality and continue to represent major global public health concerns.[1,2] Injecting drug use is associated with two-fifths of the global HCV disease burden,[3] while outside sub-Saharan Africa, an estimated one-fifth of new HIV infections occur among people who inject drugs (PWID).[4]. HIV and HCV infection.[6] The risk of relapse to illicit drug use is high in the period immediately following release from prison,[7,8] and so individuals are at an increased risk of multiple adverse outcomes during this period—in particular drug-related deaths,[9] and increased injecting risk behaviours and homelessness,[10,11,12,13] and reduced access to interventions such as opioid substitution therapy and HIV antiretroviral therapy.[12,14].

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