Prevalence of blood-borne virus infections and uptake of hepatitis C testing and treatment in Australian prisons: the AusHep study

Rugiatu Bah; Yumi Sheehan; Xiaoying Li; Gregory J Dore; Jason Grebely; Andrew R Lloyd; Behzad Hajarizadeh; AusHep study group

doi:10.1016/j.lanwpc.2024.101240

Prevalence of blood-borne virus infections and uptake of hepatitis C testing and treatment in Australian prisons: the AusHep study

Lancet Reg Health West Pac. 2024 Nov 21:53:101240. doi: 10.1016/j.lanwpc.2024.101240. eCollection 2024 Dec.

Authors

Rugiatu Bah¹, Yumi Sheehan¹, Xiaoying Li¹, Gregory J Dore¹, Jason Grebely¹, Andrew R Lloyd¹, Behzad Hajarizadeh¹; AusHep study group

Collaborators

AusHep study group:
Andrew Lloyd, Behzad Hajarizadeh, Yumi Sheehan, Rugi Bah, Charlotte Li, Marianne Byrne, Tony Butler, Bridget Musarurwa, Elmira Hooshmand, Annabeth Simpson, Meya Alrayyani, Jason Grebely, Greg Dore, Nikki Price, Melissa Groom

Affiliation

¹ The Kirby Institute, University of New South Wales (UNSW), Sydney, New South Wales, Australia.

Abstract

Background: Incarcerated people are at high risk of blood-borne virus infections, particularly HCV, and a priority population for elimination efforts. This national bio-behavioural survey evaluated blood-borne virus prevalence and HCV testing-and-treatment uptake amongst people in Australian prisons.

Methods: Randomly-selected participants from 23 representative prisons nationally were offered point-of-care testing for HIV and HCV (anti-HCV) antibodies, hepatitis B surface antigen (HBsAg), and HCV RNA (if anti-HCV positive). Demographic data and previous HCV testing and treatment were collected by structured interview.

Findings: 1599 individuals participated (98% participation; 89%male; median age 35 years; 49% ever injected drugs). Prevalence estimates were: 31.7% (95% CI:28.8-34.8) for anti-HCV; 8.0%for HCV RNA (95% CI:6.4-9.9); 0.5% (95% CI:0.2-1.1) for HBsAg, and 0.8% (95% CI: 0.4-1.7) for HIV antibody. Among participants who had ever injected drugs (n = 787), HCV RNA prevalence was highest among those injecting and sharing needles/syringes within the past month [27.9%; adjusted odds ratio (aOR):4.54 (95% CI:2.65-7.77). Among participants (n = 1599), 70.4% (95% CI: 67.4-73.2) had ever been tested for HCV (62.6% in prison). The highest likelihood of having had HCV testing was observed among participants who injected drugs in the past month (aOR = 10.37, 95% CI:5.72-0.18.78). Among those eligible (n = 318), 84.6% (95% CI:79.2-88.7) had ever received HCV treatment (75.0% in prison), and 67.8% (95% CI:61.7-73.4) were cured. The likelihood of HCV treatment was higher among those previously imprisoned, (aOR = 2.67, 95% CI:1.20-5.93).

Interpretation: Despite high overall HCV testing and treatment uptake, the lower uptake and substantial ongoing HCV disease burden in some sub-populations highlights the need for continued prison-based elimination efforts with population-specific interventions.

Funding: The AusHep study was funded by the Australian GovernmentDepartment of Health and Aged Care.

Keywords: Epidemiology; HBV; HCV; HIV; Jail; Prison.