National Institute for Health Development, 42, 11619, Tallinn, Hiiu, Estonia.
Department of Family Medicine and Public Health, University of Tartu, Ravila 19, 50411, Tartu, Estonia.
BMC Infect Dis. 2018 Jul 21;18(1):339. doi: 10.1186/s12879-018-3242-2.
Hepatitis C virus (HCV) infection is a widespread problem in prisons. The present study aimed to assess the prevalence of HCV seropositivity, HCV genotypes, factors associated with HCV seropositivity in newly incarcerated prisoners and to report experiences of treatment with pegylated interferon/ribavirin for HCV-positive inmates.
Patient data were extracted from the Estonian prison medical information system (Vanglate meditsiiniline infosüsteem) databases.
Among 1845 prisoners newly incarcerated from January 2014 to January 2015, the overall prevalence of HCV was 56.3% (95% CI: 54 to 59), and 25.5% (95% CI: 23.5 to 27.6%) had HIV (39.0% had neither). The all-inclusive HCV testing strategy identified 37.7% more HCV infected prisoners than the risk-based (drug use history, HIV status) case finding. Factors associated with HCV seropositivity included history of drug use (aOR 6.51 95%CI 5.12-8.28), HIV co-infection (aOR 2.56 95%CI 1.92-3.43), previous incarceration (aOR 3.61 95%CI 2.48-4.04), and increasing age. The main HCV genotypes were 3a (n = 172, 44.4%) and 1b (n = 135, 35.2%). Twenty-five prisoners received HCV treatment: 60% (n = 15) were cured, 16% (n = 4) relapsed (3 with genotype 3a, one with 1b), and 12% (n = 3) were unresponsive (all with genotype 3a).
HCV seropositivity rate is high and HCV tretment rate is very low in Estonian prisons. Optimizing case finding and scaling up treatment is critical to addressing the health needs of prisoners and meeting public health goals.
丙型肝炎病毒（HCV）感染在监狱中是一个普遍存在的问题。本研究旨在评估新入狱囚犯中 HCV 血清阳性率、HCV 基因型、与 HCV 血清阳性相关的因素，并报告对 HCV 阳性囚犯使用聚乙二醇干扰素/利巴韦林治疗的经验。
从爱沙尼亚监狱医疗信息系统（Vanglate meditsiiniline infosüsteem）数据库中提取患者数据。
在 2014 年 1 月至 2015 年 1 月期间新入狱的 1845 名囚犯中，HCV 的总体流行率为 56.3%（95%CI：54-59），25.5%（95%CI：23.5-27.6%）患有 HIV（39.0%两者均无）。全面的 HCV 检测策略比基于风险（药物使用史、HIV 状况）的病例发现方法多发现 37.7%的 HCV 感染囚犯。与 HCV 血清阳性相关的因素包括药物使用史（aOR 6.51，95%CI 5.12-8.28）、HIV 合并感染（aOR 2.56，95%CI 1.92-3.43）、既往监禁（aOR 3.61，95%CI 2.48-4.04）和年龄增长。主要的 HCV 基因型为 3a（n=172，44.4%）和 1b（n=135，35.2%）。25 名囚犯接受了 HCV 治疗：60%（n=15）治愈，16%（n=4）复发（3 例基因型 3a，1 例基因型 1b），12%（n=3）无反应（均基因型 3a）。
爱沙尼亚监狱的 HCV 血清阳性率很高，HCV 治疗率很低。优化病例发现并扩大治疗范围对于满足囚犯的健康需求和实现公共卫生目标至关重要。
