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

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using the I2 statistic and the P-value for heterogeneity.FindingsWe included published results from 20 studies and unpublished results from 21 studies.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.

A systematic review on models of care effectiveness and barriers to Hepatitis C treatment in prison settings in the EU/EEA

“…Such elevated HCV prevalence among those in prisons reflects a concentration of high‐risk individuals in the prison setting, especially drug users and people who inject drugs (PWID), who form a large part of the imprisoned population . The risk of infection persists further during incarceration, as prison settings amplify adverse health conditions through overcrowding, poor physical infrastructure and often inadequate access to health care services, and due to the common occurrence of high‐risk behaviours, such as sharing of needles and other sharp objects, tattooing and unprotected same‐sex intercourses …”

Sexual behaviour as a risk factor for hepatitis C virus infection among people who inject drugs in Montreal, Canada

“…Women who inject drugs that are unstably housed have demonstrated increased injection risk behaviours and HIV risk, with unstable housing adversely impacting other social instability such as employment and incarceration . Harm reduction interventions for people at risk of HCV acquisition should undoubtedly be integrated in incarceration settings considering the high rate of incarceration of people who inject drugs and the increase in risk behaviour shortly following release . Without greater number of seroconversion events and follow‐up time among female participants, it was not possible to ascertain why women who have sex with women appeared to have greater risk of HCV seroconversion, nor the role of unstable housing and incarceration.…”

History of detention and the risk of hepatitis C among people who inject drugs in Germany

“…The same meta-analysis estimated the incidence rate among prisoners with a history of drug injection to be 16.4 per 100 person-years (Larney et al, 2013). The results of another meta-analysis by Stone et al also suggest that recent incarceration among PWID is associated with a substantial increase in HCV acquisition risk (Stone et al, 2018).…”