Stone Jack, Martin Natasha K, Hickman Matthew, Hutchinson Sharon J, Aspinall Esther, Taylor Avril, Munro Alison, Dunleavy Karen, Peters Erica, Bramley Peter, Hayes Peter C, Goldberg David J, Vickerman Peter
School of Social and Community Medicine, University of Bristol, Bristol, UK.
Division of Global Public Health, University of California San Diego, San Diego, CA, USA.
Addiction. 2017 Jul;112(7):1302-1314. doi: 10.1111/add.13783. Epub 2017 Mar 3.
People who inject drugs (PWID) experience high incarceration rates, and previous incarceration is associated with elevated hepatitis C virus (HCV) transmission risk. In Scotland, national survey data indicate lower HCV incidence in prison than the community (4.3 versus 7.3 per 100 person-years), but a 2.3-fold elevated transmission risk among recently released (< 6 months) PWID. We evaluated the contribution of incarceration to HCV transmission among PWID and the impact of prison-related prevention interventions, including scaling-up direct-acting antivirals (DAAs) in prison.
Dynamic mathematical modelling of incarceration and HCV transmission, using approximate Bayesian computation for model calibration.
Scotland, UK.
A simulated population of PWID.
Population-attributable fraction (PAF) of incarceration to HCV transmission among PWID. Decrease in HCV incidence and chronic prevalence due to current levels of prison opiate substitution therapy (OST; 57% coverage) and HCV treatment, as well as scaling-up DAAs in prison and/or preventing the elevated risk associated with prison release.
Incarceration contributes 27.7% [PAF; 95% credible interval (CrI) -3.1 to 51.1%] of HCV transmission among PWID in Scotland. During the next 15 years, current HCV treatment rates (10.4/6.8 per 1000 incarcerated/community PWID annually), with existing prison OST, could reduce incidence and chronic prevalence among all PWID by a relative 10.7% (95% CrI = 8.4-13.3%) and 9.7% (95% CrI = 7.7-12.1%), respectively. Conversely, without prison OST, HCV incidence and chronic prevalence would decrease by 3.1% (95% CrI = -28.5 to 18.0%) and 4.7% (95% CrI = -11.3 to 14.5%). Additionally, preventing the heightened risk among recently released PWID could reduce incidence and chronic prevalence by 45.0% (95% CrI = 19.7-57.5%) and 33.3% (95% CrI = 15.6-43.6%) or scaling-up prison HCV treatments to 80% of chronic PWID prison entrants with sufficient sentences (>16 weeks) could reduce incidence and prevalence by 45.6% (95% CrI = 38.0-51.3%) and 45.5% (95% CrI = 39.3-51.0%), respectively.
Incarceration and the elevated transmission risk following prison release can contribute significantly to hepatitis C virus transmission among people who inject drugs. Scaling-up hepatitis C virus treatment in prison can provide important prevention benefits.
注射吸毒者（PWID）的监禁率很高，且既往监禁与丙型肝炎病毒（HCV）传播风险升高有关。在苏格兰，全国调查数据显示监狱中的HCV发病率低于社区（每100人年分别为4.3例和7.3例），但近期获释（<6个月）的PWID的传播风险升高了2.3倍。我们评估了监禁对PWID中HCV传播的影响以及与监狱相关的预防干预措施的影响，包括在监狱中扩大直接抗病毒药物（DAA）的使用。
对监禁和HCV传播进行动态数学建模，使用近似贝叶斯计算进行模型校准。
英国苏格兰。
模拟的PWID人群。
监禁对PWID中HCV传播的人群归因分数（PAF）。由于当前监狱阿片类药物替代疗法（OST；覆盖率57%）和HCV治疗水平，以及在监狱中扩大DAA的使用和/或预防与出狱相关的风险升高，HCV发病率和慢性感染率的下降情况。
在苏格兰，监禁占PWID中HCV传播的27.7%[PAF；95%可信区间（CrI）为-3.1%至51.1%]。在接下来的15年中，当前的HCV治疗率（每年每1000名被监禁/社区PWID中分别为10.4/6.8例），结合现有的监狱OST，可使所有PWID的发病率和慢性感染率分别相对降低10.7%（95%CrI=8.4%-13.3%）和9.7%（95%CrI=7.7%-12.1%）。相反，若没有监狱OST，HCV发病率和慢性感染率将分别下降3.1%（95%CrI=-28.5%至18.0%）和4.7%（95%CrI=-11.3%至14.5%）。此外，预防近期获释PWID中升高的风险可使发病率和慢性感染率分别降低45.0%（95%CrI=19.7%-57.5%）和33.3%（95%CrI=15.6%-43.6%）；或者将监狱中HCV治疗扩大到80%有足够刑期（>16周）的慢性PWID入狱者，可使发病率和患病率分别降低45.6%（95%CrI=38.0%-51.3%）和45.5%（95%CrI=39.3%-51.0%）。
监禁以及出狱后升高的传播风险可显著促进丙型肝炎病毒在注射吸毒者中的传播。在监狱中扩大丙型肝炎病毒治疗可带来重要的预防效益。
