Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, United Kingdom.
The Kirby Institute, UNSW Sydney, Sydney, 2052, Australia.
Int J Drug Policy. 2021 Oct;96:103419. doi: 10.1016/j.drugpo.2021.103419. Epub 2021 Aug 25.
Little is known about the relationship between short-term incarceration and risk of hepatitis C virus (HCV) infection among people who inject drugs (PWID). We investigated whether varying patterns of recent incarceration lasting less than two years are associated with HCV acquisition risk in this population.
We followed prospectively PWID at risk of acquiring HCV infection in Montréal (2004-2019). At 6-month (up until 2011), then 3-month intervals, participants were tested for HCV antibodies or RNA, and self-reported whether they have been incarcerated in each of the previous 6 or 3 months. If incarcerated, they reported the setting and time spent in incarceration. We fit three separate multivariable time-updated Cox regression models, one for each measure of incarceration: any incarceration lasting less than two years (yes/no), incarceration stratified by setting (local police station/provincial prison/no) and incarceration stratified by time in incarceration (≤1 week/>1 week and ≤1 month/>1 month and <2 years/no).
Among 709 PWID followed over 2315.2 person-years, HCV incidence was 9.9/100 person-years (95% confidence interval (CI): 8.7-11.2)]. During follow-up, 248 PWID (35.0%) reported at least one recent incarceration episode of less than two years. Overall, compared to PWID who did not experience incarceration in the prior 6 or 3 months, PWID who did were 1.56 (95% CI: 1.13, 2.17) times more likely to acquire HCV. We found no statistically significant difference in the magnitude of associations across categories of setting and time in incarceration (likelihood ratio test P= 0.53 and 0.44, respectively).
Any recent incarceration lasting less than two years, regardless of the setting and time in incarceration, was associated with an elevated risk of HCV acquisition among PWID. Findings support the need to expand access to harm-reduction programs in short-term incarceration settings and, in parallel, to prioritise public health-oriented alternatives to incarcerating PWID where possible.
人们对短期监禁与吸毒者（PWID）感染丙型肝炎病毒（HCV）风险之间的关系知之甚少。我们调查了在该人群中，不到两年的近期监禁模式变化是否与 HCV 感染风险相关。
我们前瞻性地随访了蒙特利尔（2004-2019 年）有感染 HCV 风险的 PWID。在 6 个月（直至 2011 年）和 3 个月的间隔期，参与者接受 HCV 抗体或 RNA 检测，并报告他们在前 6 个月或 3 个月内是否被监禁。如果被监禁，他们报告了监禁的地点和时间。我们拟合了三个独立的多变量时间更新 Cox 回归模型，每个模型用于衡量监禁情况：任何不到两年的监禁（是/否）、按监禁地点分层（当地警察局/省级监狱/否）和按监禁时间分层（≤1 周/>1 周和 ≤1 个月/<2 年/否）。
在 709 名随访 2315.2 人年的 PWID 中，HCV 发病率为 9.9/100 人年（95%置信区间（CI）：8.7-11.2）]。在随访期间，248 名 PWID（35.0%）报告了至少一次不到两年的近期监禁经历。总体而言，与在前 6 个月或 3 个月内没有监禁经历的 PWID 相比，有监禁经历的 PWID 感染 HCV 的可能性高 1.56 倍（95%CI：1.13，2.17）。我们发现，在监禁地点和时间的分类中，关联的程度没有统计学上的显著差异（似然比检验 P=0.53 和 0.44）。
任何不到两年的近期监禁，无论监禁地点和时间如何，都与 PWID 感染 HCV 的风险增加有关。研究结果支持在短期监禁环境中扩大获得减少伤害方案的机会，并在可能的情况下，优先考虑以公共卫生为导向的替代监禁 PWID 的方法。
