Belaunzarán-Zamudio Pablo F, Mosqueda-Gomez Juan L, Macias-Hernandez Alejando, Sierra-Madero Juan G, Ahmed Saifuddin, Beyrer Chris
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutricion Salvador Zubiran, Mexico City, Mexico.
PLoS One. 2017 Jun 27;12(6):e0179931. doi: 10.1371/journal.pone.0179931. eCollection 2017.
To estimate the prevalence of HCV-infection and identify associated factors among inmates in the State Prison System of Guanajuato in Mexico (Sep-2011 to Feb-2012).
Cross-sectional, observational study in 10 prisons in the State of Guanajuato in Mexico (2011-2012). We offered HCV-testing and applied audio computer-assisted self-interviews to all adults imprisoned in the State Prison System. We used a complex survey analysis to estimate the distribution of variables and its corresponding 95% confidence intervals, taking into consideration the expected cluster effect by common characteristics within prisons. Inverse probability weights were applied to correct potential biased estimates arising from non-participation in accrual activities and non-response rates. We fitted multivariate logistic regression models to identify risk-behaviors associated to HCV-infection.
We included data of 2,519 participating inmates. Prevalence of HCV-infection was 4.9 (95%CI = 3.6-5.9). Most HCV-infected inmates were male (99%). Before being incarcerated, inmates with HCV-infection were more frequently tattooed, used and injected drugs more frequently, and were more likely to share materials for injecting, when compared with those non-infected. During incarceration, HCV-infected inmates got tattoos and used drugs more often than non-infected, including injecting-drugs and sharing materials. Injecting-drug use (OR = 7.6, 95%CI, 2.5-23.4), sharing materials for injecting-drugs (OR = 19.6, 95%CI, 4.7-81.7) and being tattooed at least once before incarceration (OR = 2.1, 95%CI, 1.1-3.9), but not during incarceration, were independently associated to HCV-infection.
The prevalence of HCV-infection among inmates in the State of Guanajuato in Mexico is considerably higher than in the general population. The most important risk factors for HCV in this inmate population were injecting-drugs and sharing materials for injections before incarceration. High-risk behaviors during imprisonment are very high particularly among those already infected. HCV diagnostic and treatment services, and harm-reduction programs for incarcerated injecting-drug users in Mexico should be integrated to control the HCV epidemic in Mexico.
评估墨西哥瓜纳华托州监狱系统内囚犯丙型肝炎病毒（HCV）感染率，并确定相关因素（2011年9月至2012年2月）。
对墨西哥瓜纳华托州的10所监狱进行横断面观察性研究（2011 - 2012年）。我们为该州监狱系统内所有成年囚犯提供HCV检测，并采用音频计算机辅助自我访谈。我们使用复杂的调查分析方法来估计变量分布及其相应的95%置信区间，同时考虑到监狱内共同特征所产生的预期聚类效应。应用逆概率权重来校正因未参与应计活动和无应答率而产生的潜在偏差估计。我们拟合多变量逻辑回归模型以确定与HCV感染相关的风险行为。
我们纳入了2519名参与研究的囚犯的数据。HCV感染率为4.9%（95%置信区间 = 3.6 - 5.9）。大多数HCV感染囚犯为男性（99%）。与未感染的囚犯相比，感染HCV的囚犯在入狱前纹身、使用和注射毒品的频率更高，且更有可能共用注射材料。在监禁期间，感染HCV的囚犯纹身和使用毒品（包括注射毒品和共用材料）的频率高于未感染的囚犯。注射毒品（比值比[OR] = 7.6，95%置信区间，2.5 - 23.4）、共用注射毒品材料（OR = 19.6，95%置信区间，4.7 - 81.7）以及入狱前至少纹身一次（OR = 2.1，95%置信区间，1.1 - 3.9），但不包括监禁期间纹身，均与HCV感染独立相关。
墨西哥瓜纳华托州囚犯中HCV感染率显著高于一般人群。该囚犯群体中HCV最重要的危险因素是入狱前注射毒品和共用注射材料。监禁期间的高危行为非常普遍，尤其是在那些已经感染的人群中。墨西哥应整合HCV诊断和治疗服务以及针对被监禁注射毒品者的减少伤害项目，以控制墨西哥的HCV流行。
