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Data on chronic hepatitis C (HCV) infection prevalence in European prisons are incomplete and impact the public health opportunity that incarceration provides.


We aimed to estimate the seroprevalence of untreated chronic HCV infection and to identify associated risk factors in an Irish male prison.


We conducted a cross-sectional study involving a researcher-administered questionnaire, review of medical records and HCV serology.


Of 422 prisoners (78.0% of the study population) who participated in the study, 298 (70.6%) completed the questionnaire and 403 (95.5%) were tested for HCV antibodies. Of those tested, 92 (22.8%) were HCV antibody-positive, and of those, 53 (57.6%) were HCV RNA-positive, 23 (25.0%) had spontaneous clearance, 16 (17.4%) had a sustained viral response, 10 (11.0%) were co-infected with HIV and six (6.0%) with HBV. The untreated chronic HCV seroprevalence estimate was 13.1% and the seroprevalence of HCV among prisoners with a history of injecting drug use (IDU) was 79.7%. Risk factors significantly associated with past HCV infection were IDU (p < 0.0001), having received a prison tattoo (p < 0.0001) or a non-sterile community tattoo (p < 0.0001), sharing needles and other drug-taking paraphernalia (p < 0.0001). Small numbers of prisoners had a history of sharing razors (n=10; 3.4%) and toothbrushes (n=3; 1.0%) while incarcerated. On multivariable analysis, history of receiving a non-sterile community tattoo was the only significant risk factor associated with HCV acquisition (after IDU was removed from the model) (p = 0.005, β = 0.468).


The level of untreated chronic HCV infection in Irish prisons is high, with IDU the main associated risk.


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  1. Stanaway JD, Flaxman AD, Naghavi M, Fitzmaurice C, Vos T, Abubakar I, et al. The global burden of viral hepatitis from 1990 to 2013: findings from the Global Burden of Disease Study 2013. Lancet. 2016;388(10049):1081-8.  https://doi.org/10.1016/S0140-6736(16)30579-7  PMID: 27394647 
  2. Hope VD, Eramova I, Capurro D, Donoghoe MC. Prevalence and estimation of hepatitis B and C infections in the WHO European Region: a review of data focusing on the countries outside the European Union and the European Free Trade Association. Epidemiol Infect. 2014;142(2):270-86.  https://doi.org/10.1017/S0950268813000940  PMID: 23714072 
  3. European Centre for Disease Prevention and Control (ECDC). Systematic review on hepatitis B and C prevalence in the EU/EEA. Stockholm: ECDC; 2016. Available from: https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/systematic-review-hepatitis-B-C-prevalence.pdf
  4. Degenhardt L, Peacock A, Colledge S, Leung J, Grebely J, Vickerman P, et al. Global prevalence of injecting drug use and sociodemographic characteristics and prevalence of HIV, HBV, and HCV in people who inject drugs: a multistage systematic review. Lancet Glob Health. 2017;5(12):e1192-207.  https://doi.org/10.1016/S2214-109X(17)30375-3  PMID: 29074409 
  5. Thornton L, Murphy N, Jones L, Connell J, Dooley S, Gavin S, et al. Determination of the burden of hepatitis C virus infection in Ireland. Epidemiol Infect. 2012;140(8):1461-8.  https://doi.org/10.1017/S0950268811001920  PMID: 21923968 
  6. Larney S, Kopinski H, Beckwith CG, Zaller ND, Jarlais DD, Hagan H, et al. Incidence and prevalence of hepatitis C in prisons and other closed settings: results of a systematic review and meta-analysis. Hepatology. 2013;58(4):1215-24.  https://doi.org/10.1002/hep.26387  PMID: 23504650 
  7. European Centre for Disease Prevention and Control (ECDC). Public health guidance on active case finding of communicable diseases in prison settings. Prevention and control of communicable diseases in prison settings. Stockholm: ECDC; 2018. Available from: https://ecdc.europa.eu/sites/portal/files/documents/Active-case-finding-communicable-diseases-in-prisons.pdf
  8. Dolan K, Wirtz AL, Moazen B, Ndeffo-Mbah M, Galvani A, Kinner SA, et al. Global burden of HIV, viral hepatitis, and tuberculosis in prisoners and detainees. Lancet. 2016;388(10049):1089-102.  https://doi.org/10.1016/S0140-6736(16)30466-4  PMID: 27427453 
  9. European Centre for Disease Prevention and Control (ECDC)/European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). Systematic review on active case finding of communicable diseases in prison settings. Stockholm/Lisbon: ECDC/EMCDDA 2017. Available from: https://www.ecdc.europa.eu/sites/portal/files/documents/Systematic-review-on-communicable-diseases-in-prison-settings-final-report.pdf
  10. Drummond A, Codd M, Donnelly N, McCausland D, Mehegan J, Daly L, et al. Study on the prevalence of drug use, including intravenous drug use, and blood-borne viruses among the Irish prisoner population. Dublin: BMJ Publishing Group Ltd; 2014.
  11. Blach S, Zeuzem S, Manns M, Altraif I, Duberg AS, Muljono DH, et al. Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study. Lancet Gastroenterol Hepatol. 2017;2(3):161-76.  https://doi.org/10.1016/S2468-1253(16)30181-9  PMID: 28404132 
  12. Mahowald MK, Larney S, Zaller ND, Scharff N, Taylor LE, Beckwith CG, et al. Characterizing the burden of hepatitis c infection among entrants to Pennsylvania state prisons, 2004 to 2012. J Correct Health Care. 2016;22(1):41-5.  https://doi.org/10.1177/1078345815618384  PMID: 26672118 
  13. Irish Penal Reform Trust (IPRT). Facts and figures. Dublin: IPRT. [Accessed: 16 Mar 2018]. Available from: http://www.iprt.ie/prison-facts-2
  14. Allwright S, Bradley F, Long J, Barry J, Thornton L, Parry JV. Prevalence of antibodies to hepatitis B, hepatitis C, and HIV and risk factors in Irish prisoners: results of a national cross sectional survey. BMJ. 2000;321(7253):78-82.  https://doi.org/10.1136/bmj.321.7253.78  PMID: 10884256 
  15. Department of Health. Hepatitis C screening (national clinical guideline No. 15). Dublin: Department of Health; 2017. Available from: https://health.gov.ie/wp-content/uploads/2017/08/HepC-NCG-15_Summary_v8.pdf
  16. World Health Organization (WHO). Guidelines for the screening care and treatment of persons with chronic hepatitis C infection. Geneva: WHO; 2016. Available from: https://apps.who.int/iris/bitstream/handle/10665/205035/9789241549615_eng.pdf?sequence=1
  17. European Association for the Study of the Liver. Electronic address: [email protected]. EASL recommendations on treatment of hepatitis C 2016. J Hepatol. 2017;66(1):153-94.  https://doi.org/10.1016/j.jhep.2016.09.001  PMID: 27667367 
  18. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61(4):344-9.  https://doi.org/10.1016/j.jclinepi.2007.11.008  PMID: 18313558 
  19. Swan D, Cullen W, Macias J, Oprea C, Story A, Surey J, et al. Hepcare Europe - bridging the gap in the treatment of hepatitis C: study protocol. Expert Rev Gastroenterol Hepatol. 2018;12(3):303-14.  https://doi.org/10.1080/17474124.2018.1424541  PMID: 29300496 
  20. Irish Prison Service. Irish prison service annual report 2017. Dublin: Irish Prison Service; 2017. Available from: https://www.irishprisons.ie/wp-content/uploads/documents_pdf/IPS-annualreport-2017.pdf
  21. Garvey P, O’Grady B, Franzoni G, Bolger M, Irwin Crosby K, Connell J, et al. Hepatitis C virus seroprevalence and prevalence of chronic infection in the adult population in Ireland: a study of residual sera, April 2014 to February 2016. Euro Surveill. 2017;22(30):30579.  https://doi.org/10.2807/1560-7917.ES.2017.22.30.30579  PMID: 28797323 
  22. Seeff LB. The history of the "natural history" of hepatitis C (1968-2009). Liver Int. 2009;29(Suppl 1):89-99.  https://doi.org/10.1111/j.1478-3231.2008.01927.x  PMID: 19207971 
  23. Bulteel N, Partha Sarathy P, Forrest E, Stanley AJ, Innes H, Mills PR, et al. Factors associated with spontaneous clearance of chronic hepatitis C virus infection. J Hepatol. 2016;65(2):266-72.  https://doi.org/10.1016/j.jhep.2016.04.030  PMID: 27155531 
  24. Lazarus JV, Sperle I, Maticic M, Wiessing L. A systematic review of Hepatitis C virus treatment uptake among people who inject drugs in the European Region. BMC Infect Dis. 2014;14(S6) Suppl 6;S16.  https://doi.org/10.1186/1471-2334-14-S6-S16  PMID: 25252742 
  25. Martin NK, Vickerman P, Dore GJ, Hickman M. The hepatitis C virus epidemics in key populations (including people who inject drugs, prisoners and MSM): the use of direct-acting antivirals as treatment for prevention. Curr Opin HIV AIDS. 2015;10(5):374-80.  https://doi.org/10.1097/COH.0000000000000179  PMID: 26248124 
  26. Rice JP, Burnett D, Tsotsis H, Lindstrom MJ, Cornett DD, Voermans P, et al. Comparison of hepatitis C virus treatment between incarcerated and community patients. Hepatology. 2012;56(4):1252-60.  https://doi.org/10.1002/hep.25770  PMID: 22505121 
  27. Aspinall EJ, Mitchell W, Schofield J, Cairns A, Lamond S, Bramley P, et al. A matched comparison study of hepatitis C treatment outcomes in the prison and community setting, and an analysis of the impact of prison release or transfer during therapy. J Viral Hepat. 2016;23(12):1009-16.  https://doi.org/10.1111/jvh.12580  PMID: 27509844 
  28. Marco A, Esteban JI, Solé C, da Silva A, Ortiz J, Roget M, et al. Hepatitis C virus reinfection among prisoners with sustained virological response after treatment for chronic hepatitis C. J Hepatol. 2013;59(1):45-51.  https://doi.org/10.1016/j.jhep.2013.03.008  PMID: 23523577 
  29. Taylor A, Munro A, Allen E, Dunleavy K, Cameron S, Miller L, et al. Low incidence of hepatitis C virus among prisoners in Scotland. Addiction. 2013;108(7):1296-304.  https://doi.org/10.1111/add.12107  PMID: 23297816 
  30. Public Health England (PHE). Hepatitis C in the UK 2017 Report. London: PHE; 2017. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/632465/HCV_in_the_uk_report_2017.pdf
  31. Hajarizadeh B, Grebely J, Matthews GV, Martinello M, Dore GJ. The path towards hepatitis C elimination in Australia following universal access to interferon-free treatments. J Hepatol. 2017;66(1):S291-2.  https://doi.org/10.1016/S0168-8278(17)30899-1 
  32. Dore GJ, Altice F, Litwin AH, Dalgard O, Gane EJ, Shibolet O, et al. Elbasvir-grazoprevir to treat hepatitis C virus infection in persons receiving opioid agonist therapy a randomized trial. Ann Intern Med. 2016;165(9):625-34.  https://doi.org/10.7326/M16-0816  PMID: 27537841 
  33. Puga MAM, Bandeira LM, Pompilio MA, Croda J, Rezende GR, Dorisbor LFP, et al. Prevalence and Incidence of HCV Infection among Prisoners in Central Brazil. PLoS One. 2017;12(1):e0169195.  https://doi.org/10.1371/journal.pone.0169195  PMID: 28060860 
  34. Cunningham EB, Hajarizadeh B, Bretana NA, Amin J, Betz-Stablein B, Dore GJ, et al. Ongoing incident hepatitis C virus infection among people with a history of injecting drug use in an Australian prison setting, 2005-2014: The HITS-p study. J Viral Hepat. 2017;24(9):733-41.  https://doi.org/10.1111/jvh.12701  PMID: 28256027 
  35. Vescio MF, Longo B, Babudieri S, Starnini G, Carbonara S, Rezza G, et al. Correlates of hepatitis C virus seropositivity in prison inmates: a meta-analysis. J Epidemiol Community Health. 2008;62(4):305-13.  https://doi.org/10.1136/jech.2006.051599  PMID: 18339822 
  36. Jordan AE, Perlman DC, Neurer J, Smith DJ, Des Jarlais DC, Hagan H. Prevalence of hepatitis C virus infection among HIV+ men who have sex with men: a systematic review and meta-analysis. Int J STD AIDS. 2017;28(2):145-59.  https://doi.org/10.1177/0956462416630910  PMID: 26826159 
  37. Tsang THF, Horowitz E, Vugia DJ. Transmission of hepatitis C through tattooing in a United States prison. Am J Gastroenterol. 2001;96(4):1304-5.  https://doi.org/10.1111/j.1572-0241.2001.03728.x  PMID: 11316197 
  38. Morris MD, Brown B, Allen SA. Universal opt-out screening for hepatitis C virus (HCV) within correctional facilities is an effective intervention to improve public health. Int J Prison Health. 2017;13(3-4):192-9.  https://doi.org/10.1108/IJPH-07-2016-0028  PMID: 28914118 
  39. Rumble C, Pevalin DJ, O’Moore É. Routine testing for blood-borne viruses in prisons: a systematic review. Eur J Public Health. 2015;25(6):1078-88.  https://doi.org/10.1093/eurpub/ckv133  PMID: 26219884 
  40. Kinner SA, Jenkinson R, Gouillou M, Milloy MJ. High-risk drug-use practices among a large sample of Australian prisoners. Drug Alcohol Depend. 2012;126(1-2):156-60.  https://doi.org/10.1016/j.drugalcdep.2012.05.008  PMID: 22658284 

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