Abstract
Introduction: To realize the global goals of eliminating hepatitis B virus (HBV) and hepatitis C virus (HCV) by 2030, it is necessary to monitor the status of disease among target populations and undertake the required interventions. This study is the third round of surveys to determine the prevalence of hepatitis B and C infections among incarcerated individuals in different provinces of Iran. Methods: This study was conducted in five provinces of Iran (including Kurdistan, Ardabil, West Azerbaijan, Markazi, and Semnan) in 2019. The subjects of the study were selected from incarcerated people in prisons of all provinces that had not been studied in the previous two rounds of the surveys (in 2015 and 2016) in Iran. In this study, 15 prisons were selected and 2475 incarcerated individuals were enrolled into the study based on the multistage sampling method; the selected subjects were surveyed and their dried blood spot (DBS) samples were collected to test HBsAg and HCV-Ab. In cases with a reactive result for HCV-Ab, an HCV-RNA test was also performed on their serum samples. The relationships between independent variables and outcomes were evaluated via logistic regression. Results: Of all participants (2475 subjects) enrolled in the study, 54.18% were selected from northern provinces and 45.82% from the central provinces. The prevalence of HCV-Ab and HBsAg among incarcerated individuals was 5.66% (95% CI: 4.81% to 6.64%) and 2.42% (95% CI: 1.89% to 3.11%), respectively. Among HCV-seropositive individuals, 73.68% (95% CI: 64.70% to 81.01%) had current HCV infection (detectable HCV-RNA). The results showed that histories of imprisonment, drug use, unprotected sexual contact, drug injection, tattooing, and younger age in the first-time drug use in incarcerated individuals significantly increased the risk of HCV transmission. Among these behaviors, drug injection was more likely than other behaviors to result in contracting HCV in incarcerated individuals (OR: 22.91; 95% CI: 14.92–35.18; p < 0.001). Conclusion: To achieve international and national strategies targeted to eliminate HCV and HBV by 2030, it is necessary to pay special attention to prisons in Iran. It is recommended to continue HBV vaccination of eligible people in prisons. Developing screening and treatment protocols for individuals with HCV infection in prisons can help the country to achieve HCV elimination goals.
Highlights
Viral hepatitis imposes a significant burden on communities and the health system.As estimated, 71 and 257 million people worldwide are currently infected with hepatitisC virus (HCV) and hepatitis B virus (HBV), respectively, which cause approximately1.4 million deaths per year (687,000 deaths from HBV and 704,000 deaths from hepatitis C virus (HCV)) [1,2].Given the importance of viral hepatitis, in the 69th World Health Assembly in 2016 which was focused on the global strategies and goals for controlling viral hepatitis, the elimination of HBV and HCV by 2030 was set as a global agenda
Various studies around the world indicated the high prevalence of hepatitis C among incarcerated individuals, especially those with drug injection, which increases the probability of transmission of blood-borne infections such as HCV in prison [14]
Logistic regression analysis showed that history of drug use, history of drug injection, history of tattooing, young age at the first experience of drug use, history of imprisonment, and unprotected sex were the main parameters increasing the risk of having the HCV infection among incarcerated individuals
Summary
Given the importance of viral hepatitis, in the 69th World Health Assembly in 2016 which was focused on the global strategies and goals for controlling viral hepatitis, the elimination of HBV and HCV by 2030 was set as a global agenda To achieve this goal, strategies and measures were set, including a 90% reduction in the incidence of chronic infections (i.e., from 6–10 million cases in 2016 to 0.9 million cases in 2030), and a 65% reduction in annual mortality from chronic hepatitis The highest and the lowest prevalence of HBV infection were observed among prisoners in western and central Africa (23.5%) and North America (1.4%), respectively, and in other areas, it varies from 2.3% to 10.4%. The highest and the lowest prevalence of HCV infection were observed among prisoners in Asia and Pacific (20.6%) and Eastern and Southern Africa (1.8%), respectively, and in other areas, it varies from 4.7% to 20.2% [3]
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