New hepatitis C virus infection, re-infection and associated risk behaviour in male Irish prisoners: a cohort study, 2019

Des Crowley,Walter Cullen,Sarah Jayne Miggin,Gordana Avramovic,Susan Mckiernan,Eamon Laird,Marie O’Meara,Tina Mchugh,Collette Farrell,Eileen O Connor,Deirdre O Reilly,Anne Halpin,Mary Keevans,John S Lambert,Ross Murtagh

doi:10.1186/s13690-021-00623-2

Abstract

BackgroundPrisoners are recognised as a high-risk population and prisons as high-risk locations for the transmission of hepatitis c virus (HCV) infection. Injecting drug use (IDU) is the main driver of HCV infection in prisoners and harm reduction services are often suboptimal in prison settings. HCV prevalence and incident data in prisoners is incomplete which impacts the public health opportunity that incarceration provides in identifying, treating and preventing HCV infection. The aim of this study is to identify new HCV infection and associated risk factors in an Irish male prison.MethodsWe conducted a follow up (18-month) cohort study on prisoners who had previously tested negative, self-cleared or had been successfully treated for HCV infection. We conducted the study in a male medium security prison located in Dublin Ireland (Mountjoy Prison) using HCV serology, a review of medical records and a researcher-administered questionnaire.Results99 prisoners with a mean age of 33.2 yrs. participated in the study and 82(82.8%) completed a research-administered questionnaire. Over half (51%) had a history of drug use from a young age (14.8 yrs.), 49.9% a history of heroin use and 39% a history of IDU. The prevalence of HIV and hepatitis B virus core antibody was 3% and HCV antibody was 22.2%. No new HCV infections were identified in those who had never been infected (n = 77), had self-cleared (n = 9) or achieved sustained virological response (n = 12). Small numbers of prisoners continued to engage in risk-behaviour including, IDU both in the prison (n = 2) and the community (n = 3), sharing syringes (n = 1) and drug taking paraphernalia (n = 6) and receiving non-sterile tattoos (n = 3).ConclusionDespite the high numbers of Irish prisoners with a history of IDU and HCV infection, new HCV infection is low or non-existent in this population. Small numbers of prisoners continue to engage in risk behaviour and larger studies are required to further understand HCV transmission in this cohort in an Irish and international context.

Highlights

Prisoners are recognised as a high-risk population and prisons as high-risk locations for the transmission of hepatitis c virus (HCV) infection
Demographic data A total of 99 prisoners with a mean age of 32.2 years consented to participate in the study. 94% reported Ireland as their country of origin and 21% were homeless prior to incarceration. This cohort were first incarcerated in their late teens, had experienced multiple incarcerations and had spent the majority of their young adult lives in prison
Just over half (51%) of participants had a history of drug use, 43.9% a history of heroin use and 39% a history of Injecting drug use (IDU)

Summary

Introduction

Prisoners are recognised as a high-risk population and prisons as high-risk locations for the transmission of hepatitis c virus (HCV) infection. Injecting drug use (IDU) is the main driver of HCV infection in prisoners and harm reduction services are often suboptimal in prison settings. Hepatitis C (HCV) infection is a major public health concern and a leading cause of liver-related morbidity and mortality worldwide [1]. Injecting drug use (IDU) is the major driver of HCV infection in developed countries [1, 2]. From available data it is estimated that over a quarter of prisoners globally have been infected with HCV increasing to over 60% in prisoners with a history of IDU [3]. Incident infection is estimated at 1.4 per 100 person-year (py) increasing to 16.6 per 100 py in prisoners with a history of IDU [3]

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