Rapid assessment of tuberculosis in a large prison system--Botswana, 2002

Prisons are settings in which tuberculosis (TB) transmission occurs, and TB rates in prisons are often five to 10 times higher than national rates. Data on the prevalence of TB in prisons in Africa are limited; however, studies from Malawi, Ivory Coast, and Tanzania that used active screening found TB rates > or = 10 times higher than national rates. During 1989-2001, TB rates in Botswana increased threefold, from 199 cases per 100,000 population to 620 (Botswana National TB Program, unpublished data, 2002). This increase has been associated with the human immunodeficiency virus (HIV) epidemic. In Botswana, prisoners are not screened routinely for TB. To determine the prevalence of TB and drug-resistant TB in the Botswana prison system and to improve future screening for TB among prisoners and guards, CDC, in collaboration with the Botswana Ministry of Health and the Division of Prisons and Rehabilitation, screened prisoners and guards at four prisons during April-May 2002. This report summarizes the results of the survey, which indicate a high point prevalence of TB among prisoners in Botswana of 3,797 cases per 100,000 population and support the need for improved screening.     

Prevalence of HIV,syphilis, hepatitis B,and hepatitis C among entrants to Maryland correctional facilities

Although high prevalence of hepatitis C virus (HCV) in correctional institutions has been established, data are sparse regarding the comorbidities of hepatitis B virus (HBV), HCV, and human immunodeficiency virus (HIV), all of which may complicate the management of HCV. This study sought to estimate the prevalence and correlates associated with HCV prevalence among entrants into the Maryland Division of Correction and the Baltimore City Detention Center. Participants included all newly incarcerated entrants between January 28 and March 28, 2002. Excess sera with identifiers removed from samples drawn for routine syphilis testing were assayed for antibodies to HIV and HCV and for HBV surface antigen and surface and total core antibodies. Separately, all HIV-positive specimens were tested using the serological testing algorithm for recent HIV seroconversion. Of the 1,081 immates and 2,833 detainees, reactive syphilis serology was noted in 0.6% of the combined population; HIV seroprevalence was 6.6%; HCV prevalence was 29.7%; and 25.2% of detainees and prisoners had antigen or core or surface antibodies to HBV. A multivariate analysis of predictors of HCV positivity indicated that detainees, women, whites, older age groups, those who were HIV seropositive, and individuals with past or present infection with HBV were significantly more likely to be positive for HCV. These data indicate that hepatitis C remains an important public health concern among entrants to jail and prison and is complicated with coinfections that need to be addressed for effective treatment.     

Prevalence and incidence of bloodborne viral infections among Danish prisoners

In order to determine the prevalence and incidence of bloodborne viral infections among prisoners, we conducted a prospective study in a Danish medium security prison for males. The prisoners were offered an interview and blood test for hepatitis and human immunodeficiency virus HIV at inclusion as well as at release from prison or end of study. Of 403 prisoners available 325 (79%) participated in the initial survey and for 142 (44%) a follow-up test was available. 43% (140/325) of the participants were injecting drug users (IDUs) of whom 64% were positive for hepatitis B (HBV) and 87% for hepatitis C (HCV) markers. No cases of HIV or human T lymphotropic virus (HTLV) were found. 32% of all prisoners could transmit HBV and/or HCV by blood contact. 70% of IDUs had shared injecting equipment, and 60% had injected inside prison. Only 2% of IDUs were vaccinated against HBV. Duration of injecting drug use, numbers of imprisonments, and injecting in prison were independently and positively associated with the presence of HBV antibodies among IDUs by logistic regression analysis. The HBV incidence was 16/100 PY (95% CI: 2–56/100 PY) and the HCV incidence 25/100 PY (1–140) among injecting drug users (IDUs). We conclude that IDUs in prison have an incidence of hepatitis B and C 100 times higher than reported in the general Danish population. They should be vaccinated against hepatitis B and new initiatives to stop sharing of injecting equipment in and outside prison is urgently needed.     

AIDS deaths, HIV infections declining among prisoners

The Justice Department has announced that the overall prevalence rate of HIV among the nation's prisoners has stabilized, and the number of deaths attributed to AIDS has declined. Although there have been substantial improvements in health care in prisons, much work remains to be done in preventing and treating infections. The report states there is a strong link between HIV infection and inmate's substance abuse before imprisonment. Women in prison have a higher HIV infection rate than men, and African-Americans and Hispanics continue to have higher rates than whites. The Justice Department report outlines concerns facing correctional facilities including prevention programs, discharge planning, and testing in the federal and state prison systems to control the spread of HIV. Charts profile HIV in the nation's prisons, including trends, geographic prevalence, and infection rate by race, ethnicity, and gender.     

HIV prevention in prisons and jails: obstacles and opportunities.

High rates of human immunodeficiency virus (HIV) infection among jail and prison inmates suggest that HIV prevention efforts should focus on incarcerated populations. Overcrowding, the high prevalence of injection drug use, and other high-risk behaviors among inmates create a prime opportunity for public health officials to affect the course of the HIV epidemic if they can remedy these problems. Yet, along with the opportunity, there are certain obstacles that correctional institutions present to public health efforts. The various jurisdictions have differing approaches to HIV prevention and control. Whether testing should be mandatory or voluntary, whether housing should be integrated or segregated by HIV serostatus, and whether condoms, bleach, or clean needles should be made available to the prisoners, are questions hotly debated by public health and correctional officials. Even accurate assessment of risk-taking within the institutions leads to controversy, as asking questions could imply acceptance of the very behaviors correctional officials are trying to prevent. Education and risk-reduction counseling are the least controversial and most widely employed modes of prevention, but the effectiveness of current prevention efforts in reducing HIV transmission in this high-risk population is largely undetermined.     

HIV infection among male prisoners in South Australia, 1989 to 1994

Abstract: The prevalence of human immunodeficiency virus (HIV) in male prisoners in South Australia from July 1989 to June 1994 was ascertained from a repeated cross–sectional study. We also compared the criminological and demographic characteristics and histories of drug use of 39 HIV–infected prisoners and a randomly selected sample of 86 uninfected prisoners admitted at the same time. The numbers of HIV–infected prisoners in prison in any month ranged from 4 to 12. Prevalence among the total prison population ranged from 0.4 per cent to 1.4 per cent, and among the subpopulation of injecting drug users from 1.25 per cent to 4.36 per cent. Many HIV–infected prisoners continued after their diagnosis to have lifestyles that resulted in imprisonment. Infected prisoners were significantly older, had spent longer in prison and were more likely to be users of heroin (OR = 13.1) and methadone (OR = 25.4) than controls. Infection with HIV among South Australian prisoners has been continuous since at least the mid–1980s. The recidivism among many of the infected prisoners contributes to the variation in prevalence but also raises concerns about their management. Greater effort to minimise the recidivism of the HIV–infected prisoners could reduce the prevalence of HIV in the prison population. (Aust N Z J Public Health 1997; 21: 572–6)     

Transmission of Hepatitis C Virus among Prisoners,Australia, 2005–2012

Hepatitis C virus (HCV) is predominantly transmitted between persons who inject drugs. For this population, global prevalence of HCV infection is high and incarceration is common and an independent risk factor for HCV acquisition. To explore HCV transmission dynamics in incarcerated populations, we integrated virus sequences with risk behavior and spatiotemporal data and analyzed transmission clusters among prisoners in Australia. We detected 3 clusters of recent HCV transmission consisting of 4 likely in-custody transmission events involving source/recipient pairs located in the same prison at the same time. Of these 4 events, 3 were associated with drug injecting and equipment sharing. Despite a large population of prisoners with chronic HCV, recent transmission events were identified in the prison setting. This ongoing HCV transmission among high-risk prisoners argues for expansion of prevention programs to reduce HCV transmission in prisons.     

The prevalence and the risk behaviours associated with the transmission of hepatitis C virus in Australian correctional facilities

This study measured the prevalence and the risk factors associated with HCV antibody-positive prisoners. A total of 630 prisoners completed a questionnaire about risk behaviours associated with HCV transmission and were tested for HCV antibody from a blood test. Of these 362 (57.5%) prisoners were HCV antibody positive. A total of 436 (68.8%) prisoners reported ever injecting drugs and 332 reported injecting drugs in prison. HCV-positive prisoners were more likely to have injected drugs (OR 29.9) and to have injected drugs in prison during their current incarceration (OR 3.0). Tattooing was an independent risk factor for being HCV positive (OR 2.7). This is the first study conducted on prisoners that has identified having a tattoo in prison as a risk factor for HCV. Injecting drugs whilst in prison during this incarceration was also a risk factor for HCV. Our results show prisoners who injected drugs outside of prison continue to inject in prison but in a less safe manner.     

深圳市监狱服刑人群艾滋病、肝炎和性病的监测

目的:了解深圳市监狱服刑人员艾滋病、肝炎(甲、乙、丙、丁、戊型)和性病(以梅毒为代表)的感染情况,为制定防治策略提供科学依据。方法:2005年初对深圳市某监狱四个监区的1402名男性服刑人员进行血清采集,在采样血清中随机抽取550份,进行HIV、肝炎(包括HAV、HBV、HCV、HDV、HEV)以及梅毒抗体的检测。结果:检出HIV抗体阳性4例,检出率为0.73%,监区之间无差别(P>0.05);HAV、HBsAg、HCV抗体阳性率分别为18.36%、24.73%、6.90%;HDV、HEV无感染者,检出率为零;梅毒抗体阳性17例,检出率为3.09%。4例HIV感染者中,HIV/HBV双重感染2例,HIV/TP双重感染1例,HIV/HBV/TP三重感染1例。结论:监狱服刑人群具有较高的HIV、甲肝、乙肝和梅毒感染率,应加强对监狱人群的疾病监测及行为干预,降低其重返社会后扩散和传播传染病的危险性。     

Prevalence and Correlates of HCV,HVB, and HIV Infection among Prison Inmates and Staff,Hungary

The aim of this national, multicenter, cross-sectional study was to assess the prevalence of hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency viruses (HIV) among prisoners, and to identify related risk behaviors including injection drug use. Overall, 4,894 inmates from 20 prisons were enrolled. To have a comparison group, prison staff were also asked to take part. Altogether, 1,553 of the 4,894 inmates from seven prisons completed a questionnaire on risk behaviors. According to the survey, 1.5%, 4.9%, and 0.04% of the prisoners were tested positive for HBsAg, anti-HCV and anti-HIV, respectively. These prevalence data are among the lowest reported from prisons worldwide, although comparable to the Central European data. The prevalence of HBV, HCV, and HIV in the Hungarian prison staff was low (0.38%, 0.47%, and 0%, respectively). The rate of HCV infection was significantly higher among inmates who have ever injected drugs (22.5%) than among inmates who reported they had never injected drugs (1.1%). This first prevalence study of illegal drug injection-related viral infections among Hungarian prisoners points out that ever injecting drugs is the main reason for HCV infection among inmates. The opportunity to reach drug users infected with HCV for treatment underlines the importance of screening programs for blood-borne viruses in prisons.     

Seroprevalence of HIV, HCV and syphilis in Brazilian prisoners: Preponderance of parenteral transmission

Between November 1993 and April 1994, our physicians' team interviewed and took blood samples of 631 prisoners randomly drawn from the largest prison of South America, which counted about 4700 inmates at that time. The interview consisted of questions related to risk behaviour for HIV infection, and the subjects were asked to provide blood for serological tests for HIV, hepatitis C and syphilis. Our main purpose was to investigate the relationship between HCV and injecting drug use as related to HIV seropositivity. Participation in the study was voluntary and confidentiality was guaranteed. Overall prevalences found were as follows: HIV: 16% (95% confidence interval (CI): 13–19%); HCV: 34% (95% CI: 30–38%), and syphilis: 18% (95% CI: 15–21%). Acknowledged use of ever injecting drug was 22% and no other parenteral risk was reported. Our results, as compared with other studies in the same prison, suggest that HIV prevalence has been stable in recent years, and that the major risk factor for HIV infection in this population is parenteral exposure by injecting drug use.     

Tattoos, incarceration and hepatitis B and C among street-recruited injection drug users in New Mexico, USA: update

To the Editor:In a previous report [1], we described significant risks for hepatitis B (HBV) and hepatitis C (HCV) positivity associated with receipt of tattoos, particularly while incarcerated, among a street-recruited population of injection drug users (IDUs) in New Mexico, United States from 1995 to 1997. Another recent report in this Journal, based on a study conducted on prisoners in Australia, found tattooing in prison to be an independent risk for HCV [2]. Another report also described a strong association between tattoos and HCV, but found the strongest association to be with commercial tattooing venues [3]. That study found the risk associated with receipt of tattoos in prison elevated, but not statistically significant. That same report reviewed other articles and found a significant risk for HCV infection associated with tattoos in six out of eight studies that had data available. Further, a recent U.S. Centers for Disease Control and Prevention (CDC) document summarized the literature on risks for hepatitis infections in correctional settings and developed extensive control guidelines [4].     

Prisoner healthcare co-payment policy

Cost-effective provision of adequate healthcare to prisoners is a core problematic issue in contemporary correctional healthcare settings. An increasingly popular policy for reducing prison healthcare costs is prisoner co-payment systems for health services. Advocates of this policy assert that it facilitates efficient healthcare delivery in prison settings. This article examines the appropriateness and consequences of prisoner healthcare co-payment systems in US prisons. In conclusion, the policy has a strong potential to compromise prisoners' access to healthcare, while not significantly reducing prison healthcare costs. Alternative approaches for improving the efficiency of prison healthcare services are suggested, and implications for Australia are considered.     

Prevalence and incidence of HIV, hepatitis B virus, and hepatitis C virus infections among males in Rhode Island prisons

OBJECTIVES: We evaluated prevalence and intraprison incidence of HIV, hepatitis B virus, and hepatitis C virus infections among male prison inmates. METHODS: We observed intake prevalence for 4269 sentenced inmates at the Rhode Island Adult Correctional Institute between 1998 and 2000 and incidence among 446 continuously incarcerated inmates (incarcerated for 12 months or more). RESULTS: HIV, hepatitis B virus, and hepatitis C virus prevalences were 1.8%, 20.2%, and 23.1%, respectively. Infections were significantly associated with injection drug use (odds ratio = 10.1, 7.9, and 32.4). Incidence per 100 person-years was 0 for HIV, 2.7 for HBV, and 0.4 for HCV. CONCLUSIONS: High infection prevalence among inmates represents a significant community health issue. General disease prevention efforts must include prevention within correctional facilities. The high observed intraprison incidence of HBV underscores the need to vaccinate prison populations.     

The association of psychiatric disorders and HIV infection in the correctional setting

PURPOSE: Psychiatric disorders, such as bipolar disorder, schizophrenia, and depression, have been associated with both HIV-associated risk behaviors and HIV infection. While the US prison population is reported to exhibit elevated rates of HIV/AIDS and most psychiatric disorders, scarce information currently exists on the association of these conditions in the prison setting. The present study examined the association of six major psychiatric disorders with HIV infection in one of the nation's largest prison populations. METHODS: The study population consisted of 336,668 Texas Department of Criminal Justice inmates who were incarcerated for any duration between January 1, 1999 and December 31, 2001. Information on medical conditions and sociodemographic factors was obtained from an institution-wide medical information system. RESULTS: Inmates diagnosed with HIV infection exhibited elevated rates of major depression, dysthymia, bipolar disorder, schizophrenia, schizoaffective disorder, and non-schizophrenic psychotic disorder. These rates persisted in stratified analyses and in a multivariate analysis that statistically adjusted for gender, race, and age category. CONCLUSION: The present cross-sectional study's finding of a positive association between HIV infection and psychiatric diagnoses among inmates holds both clinical and public health relevance. It will be important for future investigations to prospectively assess the underlying mechanisms of these associations in the correctional setting.     

Seroprevalence of markers for hepatitis B, C and G in male and female prisoners - NSW, 1996

OBJECTIVES: 1. Establish the prevalence of markers for hepatitis B (HBV), C (HCV) and G (HGV) in a sample of male and female inmates. 2. Examine exposure to multiple viruses. 3. Compare risk factors for HGV infection with known risk factors for HBV and HCV. DESIGN: Cross-sectional random sample stratified by sex, age and Aboriginality. Inmates were screened for three hepatitis markers. Participants were 789 inmates (657 male, 132 female) in 27 correctional centres in New South Wales, 1996. RESULTS: Overall detection of each of the three screening markers was 35% for HBV, 39% for HCV and 10% for HGV. Exposure rates were higher in female prisoners than males. Increased rates of anti-HBc were observed in Aboriginal inmates compared with non-Aboriginals (54% cf. 27%); anti-HCV and HGV-RNA were comparable between the two groups (36% cf. 41% and 9% cf. 10%). Markers were significantly higher in female injecting drug users (IDU), particularly HCV (90% cf. 66%). Thirty-five per cent of inmates were unaware of their HCV status. For HBV, 72% did not self-report past or present exposure despite serological evidence to the contrary. The multivariate analysis identified Aboriginality, long-term injecting and injecting while in prison as risk factors for HBV. HCV risk factors were female sex, non-Aboriginality, institutionalisation and IDU-associated behaviours. For HGV, female sex and previous imprisonment were significant risk factors but IDU was not. CONCLUSIONS: Blood-borne hepatitis viruses are common in prison inmates, particularly females (HBV, HCV and HGV), Aboriginals (HBV) and IDU (HBV and HCV). Infection can be related to a number of risk factors, which appear similar for HBV and HCV, but distinct from HGV.     

Correlation between HIV and HCV in Brazilian prisoners: evidence for parenteral transmission inside prison

OBJECTIVE: It is an accepted fact that confinement conditions increase the risk of some infections related to sexual and/or injecting drugs practices. Mathematical techniques were applied to estimate time-dependent incidence densities of HIV infection among inmates. METHODS: A total of 631 prisoners from a Brazilian prison with 4,900 inmates at that time were interviewed and their blood drawn. Risky behavior for HIV infection was analyzed, and serological tests for HIV, hepatitis C and syphilis were performed, intended as surrogates for parenteral and sexual HIV transmission, respectively. Mathematical techniques were used to estimate the incidence density ratio, as related to the time of imprisonment. RESULTS: Prevalence were: HIV - 16%; HCV - 34%; and syphilis - 18%. The main risk behaviors related to HIV infection were HCV prevalence (OR=10.49) and the acknowledged use of injecting drugs (OR=3.36). Incidence density ratio derivation showed that the risk of acquiring HIV infection increases with the time of imprisonment, peaking around three years after incarceration. CONCLUSIONS: The correlation between HIV and HCV seroprevalence and the results of the mathematical analysis suggest that HIV transmission in this population is predominantly due to parenteral exposure by injecting drug, and that it increases with time of imprisonment.     

Infection epidemiological data among blood donors in Germany 2003-2004. Report of the Robert Koch Institute in accordance with Article 22 of the Transfusion Act

The Robert Koch Institute collects and evaluates data on the prevalence and incidence of HIV, hepatitis C (HCV), hepatitis B (HBV) and syphilis infections among blood and plasma donors in Germany in accordance with Article 22 of the Transfusion Act. This surveillance permits an assessment of the occurrence of infections in the blood donor population and consequently the safety of the collected donations. This report includes data from all blood donation services in Germany for 2003 and 2004. Altogether 7.09 million and 6.37 million donations or blood samples from prospective donors were screened in 2003 and 2004, respectively. In 2003 the prevalence rates of the relevant infections (per 100,000 donations) were 8.2 for HIV, 99.3 for HCV, 158.9 for HBV and 34.4 for syphilis. In 2003 the rates of seroconversion (per 100,000 donations) were 0.8 for HIV, 1.2 for HCV, 1.0 for HBV and 1.5 for syphilis in 2003. In 2004 the prevalence rates (per 100,000 donations) were 4.8 for HIV, 85.3 for HCV, 156.3 for HBV and 36.8 for syphilis. In 2004 the rates of seroconversion (per 100,000 donations) were 0.9 for HIV, 1.3 for HCV, 0.6 for HBV and 2.0 for syphilis. The analysis showed a very low incidence of infections with a decreasing trend for HCV infections and an increase in HIV and syphilis infections. The latter needs to be monitored carefully and possible causes evaluated. The quality of the reported data has improved compared to previous years. Still, some problems remain with the differentiation of the data according to sex, age and interdonation interval as well as reporting by individual blood donation centres as required by the Transfusion Act.     

HCV感染患者肝脏纤维化255例队例研究

目的了解有偿献血者中丙型肝炎病毒(HCV)感染者肝脏纤维化状况和丙肝纤维化危险因素。方法选取河南省王营村有有偿献血史的单纯HCV感染者149例和丙型肝炎病毒/人类免疫缺陷病毒(HCV/HIV)混合感染者106例,进行回顾性队列研究和现场调查,采集血样进行HCV、HIV抗体、CD4、CD8T细胞检测,B超检查肝脏纤维化;采用COX回归分析比较HCV感染者肝脏纤维化的危险因素。结果 255例患者中,肝脏纤维化发生率为25.88%(66/255),不同性别、是否接受高效抗逆转录病毒治疗、CD4T和CD8T细胞计数、病毒感染类型的肝脏纤维化发生率差异均有统计学意义(P<0.05);以肝脏纤维化为结局,HCV混合感染组的中位生存时间比单纯HCV感染者早5.74年进入肝脏纤维化阶段,差异有统计学意义(χ2=47.41,P<0.01)。HCV/HIV混合感染是影响肝脏纤维化的风险因子(χ2=10.453,P<0.01)。结论与单纯HCV感染者比较,HCV/HIV混合感染能够增加肝脏纤维化发生危险性并加快其病程进程。     

Infektionsepidemiologische Daten von Blutspendern 2003–2004

The Robert Koch Institute collects and evaluates data on the prevalence and incidence of HIV, hepatitis C (HCV), hepatitis B (HBV) and syphilis infections among blood and plasma donors in Germany in accordance with Article 22 of the Transfusion Act. This surveillance permits an assessment of the occurrence of infections in the blood donor population and consequently the safety of the collected donations. This report includes data from all blood donation services in Germany for 2003 and 2004. Altogether 7.09 million and 6.37 million donations or blood samples from prospective donors were screened in 2003 and 2004, respectively. In 2003 the prevalence rates of the relevant infections (per 100,000 donations) were 8.2 for HIV, 99.3 for HCV, 158.9 for HBV and 34.4 for syphilis. In 2003 the rates of seroconversion (per 100,000 donations) were 0.8 for HIV, 1.2 for HCV, 1.0 for HBV and 1.5 for syphilis in 2003. In 2004 the prevalence rates (per 100,000 donations) were 4.8 for HIV, 85.3 for HCV, 156.3 for HBV and 36.8 for syphilis. In 2004 the rates of seroconversion (per 100,000 donations) were 0.9 for HIV, 1.3 for HCV, 0.6 for HBV and 2.0 for syphilis. The analysis showed a very low incidence of infections with a decreasing trend for HCV infections and an increase in HIV and syphilis infections. The latter needs to be monitored carefully and possible causes evaluated. The quality of the reported data has improved compared to previous years. Still, some problems remain with the differentiation of the data according to sex, age and interdonation interval as well as reporting by individual blood donation centres as required by the Transfusion Act