Bah Rugiatu, Sheehan Yumi, Li Xiaoying, Dore Gregory J, Grebely Jason, Lloyd Andrew R, Hajarizadeh Behzad
The Kirby Institute, University of New South Wales (UNSW), Sydney, New South Wales, Australia.
Lancet Reg Health West Pac. 2024 Nov 21;53:101240. doi: 10.1016/j.lanwpc.2024.101240. eCollection 2024 Dec.
Incarcerated people are at high risk of blood-borne virus infections, particularly HCV, and a priority population for elimination efforts. This national bio-behavioural survey evaluated blood-borne virus prevalence and HCV testing-and-treatment uptake amongst people in Australian prisons.
Randomly-selected participants from 23 representative prisons nationally were offered point-of-care testing for HIV and HCV (anti-HCV) antibodies, hepatitis B surface antigen (HBsAg), and HCV RNA (if anti-HCV positive). Demographic data and previous HCV testing and treatment were collected by structured interview.
1599 individuals participated (98% participation; 89%male; median age 35 years; 49% ever injected drugs). Prevalence estimates were: 31.7% (95% CI:28.8-34.8) for anti-HCV; 8.0%for HCV RNA (95% CI:6.4-9.9); 0.5% (95% CI:0.2-1.1) for HBsAg, and 0.8% (95% CI: 0.4-1.7) for HIV antibody. Among participants who had ever injected drugs (n = 787), HCV RNA prevalence was highest among those injecting and sharing needles/syringes within the past month [27.9%; adjusted odds ratio (aOR):4.54 (95% CI:2.65-7.77). Among participants (n = 1599), 70.4% (95% CI: 67.4-73.2) had ever been tested for HCV (62.6% in prison). The highest likelihood of having had HCV testing was observed among participants who injected drugs in the past month (aOR = 10.37, 95% CI:5.72-0.18.78). Among those eligible (n = 318), 84.6% (95% CI:79.2-88.7) had ever received HCV treatment (75.0% in prison), and 67.8% (95% CI:61.7-73.4) were cured. The likelihood of HCV treatment was higher among those previously imprisoned, (aOR = 2.67, 95% CI:1.20-5.93).
Despite high overall HCV testing and treatment uptake, the lower uptake and substantial ongoing HCV disease burden in some sub-populations highlights the need for continued prison-based elimination efforts with population-specific interventions.
The AusHep study was funded by the Australian GovernmentDepartment of Health and Aged Care.
被监禁者感染血源性病毒的风险很高，尤其是丙型肝炎病毒（HCV），是消除工作的重点人群。这项全国性的生物行为调查评估了澳大利亚监狱中人群的血源性病毒流行率以及HCV检测和治疗的接受情况。
从全国23所具有代表性的监狱中随机挑选参与者，为其提供针对HIV和HCV（抗-HCV）抗体、乙型肝炎表面抗原（HBsAg）以及HCV RNA（如果抗-HCV呈阳性）的即时检测。通过结构化访谈收集人口统计学数据以及既往HCV检测和治疗情况。
1599人参与（参与率98%；男性占89%；中位年龄35岁；49%曾注射过毒品）。流行率估计如下：抗-HCV为31.7%（95%置信区间：28.8-34.8）；HCV RNA为8.0%（95%置信区间：6.4-9.9）；HBsAg为0.5%（95%置信区间：0.2-1.1）；HIV抗体为0.8%（95%置信区间：0.4-1.7）。在曾注射过毒品的参与者（n = 787）中，过去一个月内注射并共用针头/注射器的人群中HCV RNA流行率最高[27.9%；调整优势比（aOR）：4.54（95%置信区间：2.65-7.77）]。在参与者（n = 1599）中，70.4%（95%置信区间：67.4-73.2）曾接受过HCV检测（监狱内检测率为62.6%）。过去一个月内注射过毒品的参与者接受HCV检测的可能性最高（aOR = 10.37，95%置信区间：5.72-18.78）。在符合条件的人群（n = 318）中，84.6%（95%置信区间：79.2-88.7）曾接受过HCV治疗（监狱内治疗率为75.0%），67.8%（95%置信区间：61.7-73.4）已治愈。既往有入狱经历者接受HCV治疗的可能性更高（aOR = 2.67，95%置信区间：1.20-5.93）。
尽管总体上HCV检测和治疗的接受率较高，但某些亚人群的接受率较低且HCV疾病负担持续较重，这凸显了需要通过针对特定人群的干预措施，继续在监狱中开展消除工作。
澳大利亚肝炎研究（AusHep）由澳大利亚政府卫生与老年护理部资助。
