Greater attention to hepatitis C virus in detention facilities needed
By Kirsty Oswald, medwireNews Reporter
25 March 2013
Hepatology 2013; Advance online publication

medwireNews: Around 2.2 million prison detainees worldwide are anti-hepatitis C virus (HCV) positive, estimate the authors of a global meta-analysis, who say that more must be done to identify and treat HCV in this population.

The analysis included 128 sources reporting HCV incidence and anti-HCV prevalence in people detained in prisons, jails, juvenile detention facilities, pre-trial detention centers, and extrajudicial detention centers for people who take drugs.

One in four detainees overall, and two in three detainees with a history of intravenous drug use (IDU), are anti-HCV positive, the authors report in Hepatology.

Furthermore, they found evidence for onward transmission within closed settings. Data from four sources showed that there are an estimated 1.4 new HCV infections per 100 person-years in detained settings, which rises to 16.4 per 100 person-years among those with a history of IDU.

Unsurprisingly, the highest overall prevalence of anti-HCV was among detainees with a history of IDU at 64%, compared with 26% among the general detainee population.

The authors also found wide variation between countries, with the highest regional prevalence in Central Asia. However, the greatest numbers are found in North America, and East and South-East Asia who have an estimated 668,500 and 638,000 anti-HCV-positive prisoners, respectively.

Sarah Larney from Brown University in Providence, Rhode Island, USA, and colleagues say that despite awareness of HCV infection in detained populations, little work has been carried out regarding its global epidemiology. What's more, few countries have implemented preventive and treatment strategies in closed settings to tackle the problem.

"Our findings suggest that closed settings are important sites for the diagnosis and treatment of prevalent infection," they write.

The authors say that detainees should have access to sterile needles and syringes, which would also reduce HIV transmission risk, and that all detainees should be tested for HCV upon entrance to the system. They also add that, while costly, HCV treatment in prisons would have substantial benefits.

"Providing treatment in closed settings would not only aid detainees but also generate substantial public health benefits, including reducing the pool of infection (thereby reducing the likelihood of exposure among people engaging in risk behaviours) and reducing the burden of disease associated with chronic HCV infection," they conclude.

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