1. Am J Med. 2013 Jun 17. pii: S0002-9343(13)00228-3. doi: 10.1016/j.amjmed.2013.01.031.

[Epub ahead of print] Half a Diagnosis: Gap in Confirming Infection among Hepatitis C Antibody-positive Patients. McGibbon E, Bornschlegel K, Balter S. New York City Department of Health and Mental Hygiene, Long Island City, NY. BACKGROUND: Recent guidelines recommend testing all individuals born during 1945-1965 for hepatitis C virus (HCV) antibody. For antibody-positive patients, subsequent RNA testing is necessary to determine current infection status. This study aimed to assess whether clinicians order HCV RNA tests as recommended for antibody-positive patients and to identify barriers to such testing. METHODS: We sampled individuals newly reported to the New York City Department of Health and Mental Hygiene's HCV surveillance system and collected information from clinicians. For patients without RNA test results, we asked the reason an RNA test was not ordered and requested that the clinician order the test. RESULTS: Of 245 antibody-positive patients, 67% were tested for HCV RNA (for 21% of these, the test was ordered only after our request); 33% had no RNA testing despite our request. Patients without RNA testing were seen in medical facilities (47%), detox facilities (30%), and jail/prison (15%). Reasons RNA testing was not done were that the patient did not return for follow-up (35%), the facility does not do RNA testing (22%), and the patient was tested in jail (15%). CONCLUSIONS: In our study, one third of patients did not get complete testing for accurate diagnosis of HCV, which is essential for medical management. Additional education for clinicians about the importance of RNA testing may help. However, with improved antiviral treatments now available for HCV, it is time for reflex HCV RNA testing for positive antibody tests to become routine, just as reflex Western blot testing is standard for human immunodeficiency virus. Copyright 2013 Elsevier Inc. All rights reserved. PMID: 23786667 [PubMed - as supplied by publisher] 2. J Infect Dev Ctries. 2013 Jun 15;7(6):453-67. doi: 10.3855/jidc.2965. Molecular epidemiology of HIV, HBV, HCV, and HTLV-1/2 in drug abuser inmates in central Javan prisons, Indonesia. Prasetyo AA, Dirgahayu P, Sari Y, Hudiyono H, Kageyama S.

Faculty of Medicine, Sebelas Maret University, Jl. Ir. Sutami 36A, Surakarta, Indonesia. afie.agp.la@gmail.com. INTRODUCTION: This study was conducted to determine the current molecular prevalence of human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV), and human T lymphotropic virus-1/2 (HTLV-1/2) circulating among drug abuser inmates incarcerated in prisons located in Central Java, Indonesia. METHODOLOGY: Socio-epidemiological data and blood specimens were collected from 375 drug abuser inmates in four prisons. The blood samples were analyzed with serological and molecular testing for HIV, HBV, HCV, HDV, and HTLV-1/2. RESULTS: The seroprevalence of HIV, HBsAg, HCV, HDV, and HTLV-1/2 in drug abuser inmates was 4.8% (18/375), 3.2% (12/375), 34.1% (128/375), 0% (0/375), and 3.7% (14/375), respectively. No co-infections of HIV and HBV were found. Co-infections of HIV/HCV, HIV/HTLV-1/2, HBV/HCV, HBV/HTLV-1/2, and HCV/HTLV-1/2 were prevalent at rates of 4% (15/375), 1.3% (5/375), 1.1% (4/375), 0.3% (1/375), and 2.1% (8/375), respectively. The HIV/HCV co-infection rate was significantly higher in injection drug users (IDUs) compared to non-IDUs. Triple co-infection of HIV/HCV/HTLV-1/2 was found only in three IDUs (0.8%). HIV CRF01_AE was found to be circulating in the inmates. HBV genotype B3 predominated, followed by C1. Subtypes adw and adr were found. HCV genotype 1a predominated among HCV-infected inmates, followed by 1c, 3k, 3a, 4a, and 1b. All HTLV-1 isolates shared 100% homology with HTLV-1 isolated in Japan, while all of the HTLV-2 isolates were subtype 2a. CONCLUSION: Drug abuser inmates in prisons may offer a unique community to bridge prevention and control of human blood-borne virus infection to the general community. PMID: 23771289 [PubMed - in process] 3. J Infect Public Health. 2013 Jun;6(3):186-95. doi: 10.1016/j.jiph.2012.12.003. Epub 2013 Feb 27. Hepatitis C, hepatitis B and HIV infection among Egyptian prisoners: Seroprevalence, risk factors and related chronic liver diseases. Mohamed HI, Saad ZM, Abd-Elreheem EM, Abd-Elghany WM, Mohamed MS, Abd Elnaeem EA, Seedhom AE. Department of Tropical Medicine, Minia University, Egypt. Electronic address:

halaibrahem@yahoo.com. BACKGROUND AND AIM: Prisons in Egypt do not currently screen for blood-borne viruses, and there are no statistics concerning the prevalence of hepatitis C virus, hepatitis B virus or human immunodeficiency virus among prisoners. This study was performed to detect the prevalence of antibodies against hepatitis C, hepatitis B core and human immunodeficiency virus among Egyptian prisoners. METHODS: The study was conducted in an Egyptian prison. The prisoners voluntarily completed a risk factor questionnaire and provided blood specimens for testing for antibodies against hepatitis C virus, hepatitis B virus core antigen and human immunodeficiency virus. Positive results were confirmed by the detecting HCV RNA via polymerase chain reaction. Multivariate regression analysis was performed to determine the factors that were independently associated with positive HCV serology. RESULTS: Five hundred resident prisoners were screened. The prevalence of hepatitis C virus antibodies was 15.8% (79/500), and viremia was confirmed by PCR in 77.2% (61/79) of the antibody-positive prisoners. The prevalence of antibodies to hepatitis B core antigen was 9.8% (49/500), and 1.2% (6/500) of prisoners were dually infected with HBV and HCV. Antibodies to human immunodeficiency virus were not detected in any of the prisoners. The best predictor for hepatitis C and hepatitis B infection was a history of intravenous drug use (P<0.011 for HBV and P<0.001 for HCV), a period of >10 years spent in prison (P<0.052 for HBV and P<0.021 for HCV) and shared toiletries (P<0.059 for HBV and P<0.002 for HCV). CONCLUSION: Hepatitis C and hepatitis B virus infections constitute an important public health problem in prisons. Public health strategies to prevent morbidity and mortality from these infections should include hepatitis B vaccination, HCV testing, counseling and medical management of infected prisoners. Copyright 2013 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved. PMID: 23668463 [PubMed - in process] 4. Top Antivir Med. 2013 Feb-Mar;21(1):27-35. Impact of new therapeutics for hepatitis C virus infection in incarcerated populations. Spaulding AS, Kim AY, Harzke AJ, Sullivan JC, Linas BP, Brewer A, Dickert J, McGovern BH, Strick LB, Trestman R, Ferguson WJ. Emory University, Atlanta, GA, USA. Inmate populations bear a disproportionate share of the burden of hepatitis C virus (HCV) infection. With more than 90% of prisoners released back to their

communities within a few years of sentencing, incarceration can be viewed as an opportunity to provide HCV screening and therapeutic interventions to benefit the individual, reduce the costs of HCV management to the health care system from a societal perspective, and improve overall public health. Although optimal medical management of HCV within prison settings would increase the current cost of correctional health care, it could decrease transmission within the community, reduce overall disease burden, and lower the future societal health care costs associated with end-stage liver disease. Nonetheless, most prison systems treat only a small fraction of infected inmates. Current and emerging therapeutic agents will cure HCV infection in the vast majority of patients. Mathematical modeling also shows that expanded HCV screening and treatment are cost-effective from the societal perspective. In this article, we will describe appropriate treatment regimens, propose strategies to lessen the burden of these costly HCV therapies on correctional health care systems, and address the challenges of expanded HCV screening in correctional settings. PMID: 23596276 [PubMed - in process] 5. Rev Soc Bras Med Trop. 2013 Jan-Feb;46(1):24-9. Epidemiology of the viral hepatitis B and C in female prisoners of Metropolitan Regional Prison Complex in the State of Gois, Central Brazil. Barros LA, Pessoni GC, Teles SA, de Souza SM, de Matos MA, Martins RM, Del-Rios NH, de Matos MA, Carneiro MA. Instituto de Patologia Tropical e Sade Pblica, Universidade Federal de Gois, Goinia, GO, Brasil. INTRODUCTION: Little information regarding hepatitis B virus (HBV) and hepatitis C virus (HCV) infections among Brazilian female prisoners exists. This study investigated the prevalence and risk factors associated with HBV and HCV infections and identified viral genotypes among female prisoners in Gois, Central Brazil. METHODS: Women incarcerated in the largest prison in the State of Gois were invited to participate in the study. All female prisoners were interviewed and tested for the detection of hepatitis B surface antigen (HBsAg), antibodies against HBsAg (anti-HBs), against hepatitis B core antigen (anti-HBc), and antibody against HCV (anti-HCV) by ELISA. HBsAg and anti-HCV positive samples were tested for HBV DNA and HCV RNA and genotyped, respectively. RESULTS: Participants (n = 148; 98.6%) completed the study with an overall HBV prevalence of 18.9%. Age >30 years, a low education level, sex with a sexually transmitted diseases carrier, and a male sexual partner serving in the same penitentiary were associated with HBV infections. Only 24% of the women were anti-HBs positive suggesting previous HBV vaccination. Nine female prisoners

(6.1%) were anti-HCV positive. Age >40 years, injecting drug use and length of incarceration were statistically associated with anti-HCV antibodies. Five samples were HCV RNA positive and classified as genotypes 1 (subtypes 1a; n = 3 and 1b; n = 1) and 3 (subtype 3a; n = 1). The HBsAg-reactive sample was HBV DNA positive and genotype A. CONCLUSIONS: These findings highlight the necessity of public policies to control hepatitis B and C infections and emphasize the importance of hepatitis B vaccination in prison environments. PMID: 23563821 [PubMed - in process] 6. J Hepatol. 2013 Jul;59(1):45-51. doi: 10.1016/j.jhep.2013.03.008. Epub 2013 Mar 22. Hepatitis C virus reinfection among prisoners with sustained virological response after treatment for chronic hepatitis C. Marco A, Esteban JI, Sol C, da Silva A, Ortiz J, Roget M, Sarriera C, Teixid N, Guerrero RA, Cayl JA. Health Services of Barcelona Men's Penitentiary Centre, Barcelona, Spain. Electronic address: andres.marco.m@gmail.com. BACKGROUND & AIMS: We estimated HCV reinfection rate and its associated risk factors in inmates with chronic hepatitis C who had achieved sustained virological response (SVR) after completing combination therapy while in prison. METHODS: Individuals who had achieved an SVR after treatment provided from January 2003 to December 2009 at four prisons in Catalonia, had been tested annually for HCV RNA and were in prison during 2010, were invited to complete a questionnaire regarding risk factors for reinfection. Incidence rate was calculated as 100 person-years of follow-up. Risk factors potentially associated with reinfection were evaluated by bivariate log-rank test and multivariate Cox regression analysis. RESULTS: One hundred and nineteen subjects who had achieved an SVR agreed to participate. 98% were male, with a median age of 33.36.3years and 81% had a history of injection drug use (IDU). After a mean follow-up of 1.4years, HCV reinfection was identified in nine former IDUs, seven with HCV genotype switch, for an overall reinfection rate of 5.27 cases per 100 person-years. Reinfection incidence was significantly higher among active drug users (HR=12.47; 95% CI: 2.90-53.71), HIV co-infected (HR=9.95; 95% CI: 1.73-57.34), and those engaging in more than one risk behaviors after treatment (HR=7.47; 95% CI: 1.19-46.89). CONCLUSIONS: HCV reinfection among inmates after successful treatment is high especially in those with ongoing IDU. Preventative interventions at diagnosis and during and after HCV treatment should be strongly reinforced.

Copyright 2013 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved. PMID: 23523577 [PubMed - in process] 7. Hepatology. 2013 Mar 15. doi: 10.1002/hep.26387. [Epub ahead of print] The incidence and prevalence of hepatitis C in prisons and other closed settings: Results of a systematic review and meta-analysis. Larney S, Kopinski H, Beckwith CG, Zaller ND, Jarlais DD, Hagan H, Rich JD, van den Bergh BJ, Degenhardt L. National Drug and Alcohol Research Centre, University of New South Wales, Sydney 2052, NSW, Australia; Alpert Medical School, Brown University, Providence 02906, RI, USA. s.larney@unsw.edu.au. People detained in prisons and other closed settings are at elevated risk of infection with hepatitis C virus (HCV). We undertook a systematic review and meta-analysis with the aim of determining the rate of incident HCV infection and the prevalence of anti-HCV among detainees of closed settings. We systematically searched databases of peer-reviewed literature and widely distributed a call for unpublished data. We calculated summary estimates of incidence and prevalence among general population detainees and detainees with a history of injecting drug use (IDU), and explored heterogeneity through stratification and meta-regression. The summary prevalence estimates were used to estimate the number of anti-HCV positive prisoners globally. HCV incidence among general detainees was 14 per 100 person-years (py; 95% CI: 01, 27; k=4), and 164 per 100py (95% CI: 08, 321; k=3) among detainees with a history of IDU. The summary prevalence estimate of anti-HCV in general detainees was 26% (95% CI: 23%, 29%; k=93), and in detainees with a history of IDU, 64% (95% CI: 58%, 70%; k=51). The regions of highest prevalence were Central Asia (38%; 95% CI 32%, 43%; k=1) and Australasia (35%; 95% CI: 28%, 43%; k=9). We estimate that 22 million (range: 14 million 29 million) detainees globally are anti-HCV positive, with the largest populations in North America (668,500; range: 553,500-784,000) and East and Southeast Asia (638,000; range: 332,000-970,000). Conclusion: HCV is a significant concern in detained populations, with one in four detainees anti-HCV positive. Epidemiological data on the extent of HCV infection in detained populations is lacking in many countries. Greater attention towards prevention, diagnosis and treatment of HCV infection among detained populations is urgently required. (HEPATOLOGY 2013.). Copyright 2013 American Association for the Study of Liver Diseases. PMID: 23504650 [PubMed - as supplied by publisher]

8. J Viral Hepat. 2013 Apr;20(4):e96-106. doi: 10.1111/jvh.12016. Epub 2012 Oct 15. Correlates and characteristics of hepatitis C virus-specific T-cell immunity in exposed uninfected high-risk prison inmates. Cameron B, Galbraith S, Li H, Lloyd A; HITS investigators. Collaborators: Lloyd A, Dolan K, White P, Haber P, Treloar C, Dore G, Maher L. Inflammation and Infection Research Centre, School of Medical Sciences, Sydney, NSW, Australia. barbcameron55@gmail.com Some hepatitis C (HCV)-uninfected, high-risk individuals have HCV-specific cellular immunity without viraemia or seroconversion. The characteristics of these responses and the risk behavioural associations were studied in 94 subjects in a prospective cohort of recently seronegative prisoners reporting injecting drug use (IDU). Detailed behavioural data were collected. HCV antibody and PCR testing were performed. ELISpot assays for HCV-induced interferon (IFN)- and interleukin (IL)-2 production by T lymphocytes, as well as multiplex in vitro cytokine production assays, were performed. Seventy-eight subjects remained antibody and PCR negative and 16 seroconverted. Of the seronegative group, 22 (28%) had IFN- ELISpot responses in comparison with 13 of the 16 seroconverters (82%). This seronegative immune status was associated positively with injecting anabolic steroids and negatively with a recent break from IDU. The IFN- ELISpot responses involved both CD4 and CD8 T lymphocytes and were comparable in magnitude, but narrower in specificity, in uninfected subjects than in seroconverters. A subset of seronegative subjects had HCV-induced cytokine production patterns comparable with the seroconverters with increased production of IFN-, IL-2 and tumour necrosis factor (TNF)- and reduced IL-10 in response to nonstructural peptides. In conclusion, comparable patterns of HCV-specific cellular immunity are found in recently infected subjects and in a minority of high-risk, uninfected subjects. Further characterization of these responses and their protective efficacy will inform HCV vaccine development. 2012 Blackwell Publishing Ltd. PMID: 23490396 [PubMed - in process] 9. Tuberc Res Treat. 2012;2012:132406. doi: 10.1155/2012/132406. Epub 2012 Dec 23. Can social history variables predict prison inmates' risk for latent tuberculosis infection?

Weant TE, Turner AN, Murphy-Weiss M, Murray DM, Wang SH. Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH 43210, USA. Improved screening and treatment of latent tuberculosis infection (LTBI) in correctional facilities may improve TB control. The Ohio Department of Rehabilitation and Correction (ODRC) consists of 32 prisons. Inmates are screened upon entry to ODRC and yearly thereafter. The objective of the study was to determine if social history factors such as tobacco, alcohol, and drug use are significant predictors of LTBI and treatment outcomes. We reviewed the medical charts of inmates and randomly selected age-matched controls at one ODRC facility for 2009. We used a conditional logistic regression to assess associations between selected social history variables and LTBI diagnosis. Eighty-nine inmates with a history of LTBI and 88 controls were identified. No social history variable was a significant predictor of LTBI. Medical comorbidities such as asthma, rheumatoid arthritis, and hepatitis C were significantly higher in inmates with LTBI. 84% of inmates diagnosed with LTBI had either completed or were on treatment. Annual TB screening may not be cost-effective in all inmate populations. Identification of factors to help target screening populations at risk for TB is critical. Social history variables did not predict LTBI in our inmate population. Additional studies are needed to identify inmates for the targeted TB testing. PMCID: PMC3540758 PMID: 23320160 [PubMed] 10. Liver Int. 2013 Feb;33 Suppl 1:68-79. doi: 10.1111/liv.12063. Best strategies for global HCV eradication. Hagan LM, Schinazi RF. Center for AIDS Research, Emory University School of Medicine and Veterans Affairs Medical Center, Decatur, GA 30033, USA. lhagan2@emory.edu Worldwide eradication of hepatitis C virus (HCV) is possible through a combination of prevention education, universal clinical and targeted community screening, effective linkage to care and treatment with promising new direct-acting antiviral drug regimens. Universal screening should be offered in all healthcare visits, and parallel community screening efforts should prioritize high-prevalence, high-transmission populations including injection drug users, prison inmates and those with HIV/HCV co-infection. Increasing awareness of HCV infection through screening, improving treatment uptake and cure rates by providing linkage to care and more effective treatment, and ultimately combining

education efforts with vaccination campaigns to prevent transmission and reinfection can slow and eventually stop the 'silent epidemic'. 2012 John Wiley & Sons A/S. PMID: 23286849 [PubMed - indexed for MEDLINE] 11. Addiction. 2013 Jul;108(7):1296-304. doi: 10.1111/add.12107. Epub 2013 Mar 1. Low incidence of hepatitis C virus among prisoners in Scotland. Taylor A, Munro A, Allen E, Dunleavy K, Cameron S, Miller L, Hickman M. School of Social Sciences, University of the West of Scotland, Paisley, Scotland. AIMS: To estimate hepatitis C virus (HCV) incidence and HCV risk among Scottish prisoners. DESIGN: National sero-behavioural survey; dried blood spots were collected in order to identify recent HCV infections (i.e. HCV antibody-negative and HCV polymerase chain reaction (PCR)-positive). SETTING: All 14 closed prisons in Scotland. PARTICIPANTS: A total of 5187 prisoners responded to the survey (79% of available prisoners on survey days) comprising 5076 individuals (after removing incomplete returns and participants surveyed in more than one prison); 95% men, 32% (1625) reported an injecting history (PWID) and median sentence of 9.5 months. HCV antibody samples were available for 4904 participants; there was sufficient sera for HCV PCR for 2446 prisoners who had been in prison for at least 75 days. MEASUREMENTS: The estimate of in-prison recent infections is based on prisoners incarcerated for a sufficient period, i.e. at least 75 days, so that recent infections could be attributed to prison. FINDINGS: Overall HCV prevalence was 19%; 53% among people who reported an injecting history and 3% among other prisoners. Three recent infections probably acquired in prison were detected. None of the cases reported injecting during their current sentence or any other potential exposure. Estimated incidence was 0.6-0.9% overall and 3.0-4.3% among PWID (assuming all infections acquired through injecting). Fifty-seven per cent (929) of PWID were receiving opiate substitution treatment (OST) at the time of the survey. Of all prisoners, 2.5% and 8% of PWID reported injecting during their current period of incarceration. CONCLUSION: The low incidence of HCV infections in Scottish prisons is due most probably to the low occurrence of in-prison injecting and high coverage of OST. Low HCV risk can be achieved in prisons without necessarily introducing needle exchange programmes, but close monitoring of risk behaviours is essential. If risk increases, provision of needle exchange should be considered. 2013 The Authors, Addiction 2013 Society for the Study of Addiction.

PMID: 23297816 [PubMed - in process] 12. Eur Rev Med Pharmacol Sci. 2012 Dec;16(15):2142-6. Blood born viral infections, sexually transmitted diseases and latent tuberculosis in italian prisons: a preliminary report of a large multicenter study. Sagnelli E, Starnini G, Sagnelli C, Monarca R, Zumbo G, Pontali E, Gabbuti A, Carbonara S, Iardino R, Armignacco O, Babudieri S; Simspe Group. Department of Mental Health and Public Medicine, Second University of Naples, Naples, Italy. evangelista.sagnelli@unina2.it BACKGROUND: Recent screenings of inmates for Hepatitis C virus (HCV), Hepatitis B virus (HBV), human immunodeficiency virus (HIV), Syphilis and Latent Tuberculosis (LTB) did not provide sufficient information to improve healthcare strategies. AIM: To obtain valuable information on the endemicity of the above mentioned Infections in prisons of Italy. MATERIALS AND METHODS: A screening based on a peer-to-peer communication, followed by a month of blood sampling on a voluntary basis was performed to detect antibody to 4 of the 5 above mentioned infections and detect LTB by PPD (purified protein derivative) Skin Test. The present analysis regards data obtained in 9 of the 20 prisons. RESULTS: The percentage of patients who accepted the screening varied between jails (37.3-95.2%, median 62.2), but it was higher than 10.0-20.5% obtained in the same 9 prisons using traditional methods before our intervention. The participation to the screening reached 65.3% for HBV, 64.6% for HCV, 67.4%for HIV, 55.7% for TPHA (Treponema Pallidum Hemagglutination Assay) and 42.8% for LTB. HBsAg was detected in 4.4% of 2265 subjects, anti-HCV in 22.8% of 2241, anti-HIV in 3.8% of 2339 and TPHA in 2.1% of 1932; PPD Skin Test was positive in 17.2% of 1486 subjects. The screening identified 183 subjects with an unknown infection, 56 italian and 127 foreigners to be evaluated for clinical decisions: 35 with HBV chronic infection, 34 with HCV chronic infection, 3 anti-HIV positive, 14 with syphilis and 97 with LTB. CONCLUSIONS: The new approach to the screening, based on a peer-to-peer communication followed by blood sampling on a voluntary basis provided valuable information to improve the healthcare system in each single prison. PMID: 23280032 [PubMed - indexed for MEDLINE] 13. J Gastroenterol Hepatol. 2013 Feb;28(2):314-22. doi: 10.1111/jgh.12063.

Hepatitis B virus exposure and vaccination in a cohort of people who inject drugs: what has been the impact of targeted free vaccination? Winter RJ, Dietze PM, Gouillou M, Hellard ME, Robinson P, Aitken CK. Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, Victoria, Australia. rwinter@burnet.edu.au BACKGROUND AND AIM: Forty percent of new hepatitis B virus (HBV) infections in Australia occur in people who inject drugs (PWID); long-term infection carries the risk of serious liver disease. HBV incidence among Australian PWID has not been measured since the advent of targeted (2001) and adolescent school-based "catch-up" (1998) vaccination programs. We measured HBV incidence and prevalence in a cohort of PWID in Melbourne, Australia and examined demographic and behavioral correlates of exposure and vaccination. METHODS: Community-recruited PWID were surveyed about blood-borne virus risk behaviors and their sera tested for HBV markers approximately three-monthly over three years. Incidence was assessed using prospectively collected data. A cross-sectional design was used to examine prevalence of HBV exposure and vaccination at baseline. Poisson regression was used to identify correlates of HBV exposure and vaccination. RESULTS: At baseline, 33.1% of participants (114/344) had been vaccinated against HBV, 40.4% (139/344) had been exposed (previously or currently infected), and 26.5% (91/344) were susceptible. HBV incidence was 15.7 per 100 person-years. Independent associations with HBV exposure included female gender, South-East Asian ethnicity, drug treatment in the past three months, injecting in prison, and prior exposure to hepatitis C virus. Independent associations with vaccination included being 25 years old, reporting HBV vaccination, and never having been to prison. CONCLUSIONS: HBV infection continues at high incidence among Australian PWID despite the introduction of free vaccination programs. Innovative methods are needed to encourage PWID to complete HBV vaccination. 2012 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd. PMID: 23190264 [PubMed - in process] 14. BMC Infect Dis. 2012 Nov 12;12:294. doi: 10.1186/1471-2334-12-294. Case control study to identify risk factors for acute hepatitis C virus infection in Egypt. Kandeel AM, Talaat M, Afifi SA, El-Sayed NM, Abdel Fadeel MA, Hajjeh RA, Mahoney

FJ. Global Disease Detection and Response, U.S. Naval Medical Research Unit No. 3 (NAMRU-3), Naval, PSC 452 Box 5000 FPO, AE 09835, USA. BACKGROUND: Identification of risk factors of acute hepatitis C virus (HCV) infection in Egypt is crucial to develop appropriate prevention strategies. METHODS: We conducted a case-control study, June 2007-September 2008, to investigate risk factors for acute HCV infection in Egypt among 86 patients and 287 age and gender matched controls identified in two infectious disease hospitals in Cairo and Alexandria. Case-patients were defined as: any patient with symptoms of acute hepatitis; lab tested positive for HCV antibodies and negative for HBsAg, HBc IgM, HAV IgM; and 7-fold increase in the upper limit of transaminase levels. Controls were selected from patients' visitors with negative viral hepatitis markers. Subjects were interviewed about previous exposures within six months, including community-acquired and health-care associated practices. RESULTS: Case-patients were more likely than controls to have received injection with a reused syringe (OR=23.1, CI 4.7-153), to have been in prison (OR=21.5, CI 2.5-479.6), to have received IV fluids in a hospital (OR=13.8, CI 5.3-37.2), to have been an IV drug user (OR=12.1, CI 4.6-33.1), to have had minimal surgical procedures (OR=9.7, CI 4.2-22.4), to have received IV fluid as an outpatient (OR=8, CI 4-16.2), or to have been admitted to hospital (OR=7.9, CI 4.2-15) within the last 6 months. Multivariate analysis indicated that unsafe health facility practices are the main risk factors associated with transmission of HCV infection in Egypt. CONCLUSION: In Egypt, focusing acute HCV prevention measures on health-care settings would have a beneficial impact. PMCID: PMC3515403 PMID: 23145873 [PubMed - indexed for MEDLINE] 15. Hepatology. 2013 Mar;57(3):944-52. doi: 10.1002/hep.26113. Epub 2013 Feb 15. A simple strategy to identify acute hepatitis C virus infection among newly incarcerated injection drug users. Kim AY, Nagami EH, Birch CE, Bowen MJ, Lauer GM, McGovern BH. Division of Infectious Diseases, Gastrointestinal Unit, Massachusetts General Hospital and Harvard Medical School, Harvard University Center for AIDS Research, Boston, MA 02114, USA. akim1@partners.org Acute hepatitis C virus (HCV) infection is underdiagnosed because most patients are asymptomatic. The majority of new infections occur among people who inject

drugs (PWID), many of whom have a history of incarceration. In a previous pilot study, we identified symptomatic HCV cases, mainly among Caucasian inmates. We designed a cross-sectional study to evaluate whether risk factor-based screening of newly incarcerated inmates would enhance identification of asymptomatic acute HCV infection and elucidate any demographic shifts in HCV acquisition. From October 2006 to March 2008, 6,342 inmates underwent health assessments and 3,470 inmates (55%) were screened. The racial distribution was as follows: African American, 24.0%; Caucasian, 49.5%; Hispanic, 22.2%. One hundred seventy-one inmates (4.9%) were classified as high-risk. After further evaluation, 35 (20.5%) inmates were diagnosed with acute HCV with a mean age of 29 years; 62.9% were female and 91% were Caucasian. No African Americans were diagnosed with acute HCV. Our case-finding rate was 1.9 patients/month nearly a three-fold increase compared with our historical control period with a higher proportion of asymptomatic cases. We estimate a prevalence of 1.0% (95% confidence interval, 0.7%-1.4%) of acute HCV infections among newly incarcerated inmates.CONCLUSION: Within the correctional system, systematic screening based on risk factors successfully identifies acute HCV infection among PWID, including asymptomatic patients. Our data also reflect changing nationwide patterns of injection drug use that vary by age, ethnicity, and race, leading to a marked reduction of acute HCV infections among African Americans compared with non-Hispanic whites. The nationwide implementation of this simple low-cost strategy in prison-based settings could identify more than 7,000 acute HCV infections among PWID, provide insight into changing epidemiologic trends, and facilitate appropriate therapeutic and preventive interventions. Copyright 2012 American Association for the Study of Liver Diseases. PMID: 23111904 [PubMed - indexed for MEDLINE] 16. Rev Assoc Med Bras. 2012 Sep-Oct;58(5):557-60. Prevalence of anti-HCV in an inmate population. [Article in English, Portuguese] Rosa Fd, Carneiro M, Duro LN, Valim AR, Reuter CP, Burgos MS, Possuelo L. Pharmacy Course, Universidade de Santa Cruz do Sul (UNISC), Santa Cruz do Sul, RS, Brazil. OBJECTIVE: To estimate the prevalence of hepatitis C using a rapid hepatitis C virus (HCV) test in an inmate population from the countryside of Rio Grande do Sul, Brazil. METHODS: Through a descriptive study, 195 inmates were evaluated by random sampling.

RESULTS: A total of 9.7% of the inmates were positive. In this analysis, the variable injectable drug use was predictive of HCV infection. CONCLUSION: The high prevalence of positive serology for HCV observed among the inmates is of particular concern, as it is much higher than in the general population. Therefore, it is necessary to conduct specific approach campaigns to gather more information on infectious diseases in prison settings, as well as to provide appropriate treatment to prevent viral dissemination. PMID: 23090226 [PubMed - indexed for MEDLINE] 17. Int J Drug Policy. 2013 Mar;24(2):85-100. doi: 10.1016/j.drugpo.2012.08.006. Epub 2012 Sep 29. Review and meta-analysis of the association between self-reported sharing of needles/syringes and hepatitis C virus prevalence and incidence among people who inject drugs in Europe. Palmateer NE, Hutchinson SJ, Innes H, Schnier C, Wu O, Goldberg DJ, Hickman M. Health Protection Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, United Kingdom. norah.palmateer@nhs.net BACKGROUND: Although sharing needles/syringes (N/S) is a recognised risk factor for the hepatitis C virus (HCV), epidemiological studies have shown inconsistent associations between self-reported N/S sharing and biological markers of HCV infection. This review aims to summarise, and explore factors that may explain the variation in, the measure of association between self-reported sharing of N/S and HCV prevalence/incidence among people who inject drugs (PWID). METHODS: Studies undertaken in Europe during 1990-2011 were identified through an electronic literature search. Eligible studies reported HCV prevalence (or incidence) among those who reported ever/never (or recent/non-recent) sharing of N/S. Meta-analysis was undertaken to generate a pooled estimate of the association and heterogeneity was explored using stratified analyses. RESULTS: Sixteen cross-sectional studies and four longitudinal studies were included. Pooled prevalence and incidence of HCV was 59% and 11% among PWID who reported never and not recently sharing N/S, respectively. Random effects meta-analysis generated a pooled odds ratio (OR) of 3.3 (95% CI 2.4-4.6), comparing HCV infection among those who ever (or recently) shared N/S relative to those who reported never (or not recently) sharing. There was substantial heterogeneity between the study effect sizes (I(2)=72.8%). Differences in pooled ORs were found when studies were stratified by recruitment setting (prison vs. drug treatment sites), recruitment method (outreach vs. non-outreach), sample HCV prevalence and sample mean/median time since onset of injecting. CONCLUSION: We found high incidence/prevalence rates among those who did not report sharing N/S during the risk period, which may be due to a combination of

unmeasured risk factors and reporting bias. Study design and population are likely to be important modifiers of the size and strength of association between HCV and N/S sharing. Copyright 2012 Elsevier B.V. All rights reserved. PMID: 23026541 [PubMed - in process] 18. Hepat Mon. 2012 Jul;12(7):442-7. Epub 2012 Jul 30. Prevalence and Risk Factors of HIV, Syphilis, Hepatitis B and C Among Female Prisoners in Isfahan, Iran. Nokhodian Z, Yazdani MR, Yaran M, Shoaei P, Mirian M, Ataei B, Babak A, Ataie M. Infectious Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, IR Iran. BACKGROUND: Female prisoners are at risk of acquiring sexually transmitted infections (STIs). There has been no previous study regarding the epidemiological status of STIs among female prisoners in Isfahan, central Iran. OBJECTIVES: The aim of this study was to investigate the prevalence and risk factors of the aforementioned infections among women incarcerated in the central prison, Isfahan, to determine appropriate prevention measures. PATIENTS AND METHODS: In a cross-sectional study, all of the 163 women incarcerated in the central prison, Isfahan in 2009, were voluntarily enrolled by the census method. After completing a checklist consisting of demographic, social, and risk factors, a 5ml blood sample was taken from each individual. The sera were analyzed for markers of the hepatitis B virus (HBV; HBsAg, HBsAb, HBcAb), hepatitis C virus (HCV; HCV antibodies), human immunodeficiency virus (HIV; HIV antibodies), and syphilis (RPR). Confirmatory tests were performed on HCV antibody-positive cases. RESULTS: The mean age of the participants in the study was 34.54 11.2 years old, 94.3% of these women were Iranian, and many of them had only a primary level of education. The prevalence of HBsAg, HBcAb, HBsAb, and HCV antibodies were; 1.2%, 7.4%, 12.9% and 7.4% respectively. No positive RPR or HIV antibodies were detected. CONCLUSIONS: A significant relationship was seen between the HCV antibody, drug injection and illegal sex in the women, and also between HBc-Ab and drug injection. Regular screening, educational programs, and facilitation of access to suitable treatment care should be widely implemented in the prison population. Testing for immunity against HBV should be considered on admission, and afterwards vaccination of all prisoners and an appropriate preventative approach should be applied.

PMCID: PMC3437455 PMID: 23008724 [PubMed] 19. Int J Prev Med. 2012 Mar;3(Suppl 1):S156-61. Hepatitis C Virus and Associated Risk Factors among Prison Inmates with History of Drug Injection in Isfahan, Iran. Kassaian N, Adibi P, Kafashaian A, Yaran M, Nokhodian Z, Shoaei P, Hassannejad R, Babak A, Ataei B. Infectious Diseases and Tropical Medicine Research Center, Isfahan University of medical Sciences, Isfahan, Iran. OBJECTIVES: Hepatitis C virus (HCV) infection is a major public health problem worldwide with serious complications. According to the importance of intravenous drug use (IDU) as the main risk factor for HCV infection and transmission and prison as the main source of risky behaviors, this study conducted to define HCV infection and related risk factors in prison inmates with history of IDU in Isfahan province, Iran. METHODS: This is a cross -sectional study which the prison inmates with IDU history in voluntary basis were enrolled. A validated questionnaire was asked and blood sample was obtained from each subject for the presence of HCV antibody. Odds ratio and logistic regression were used for data analysis and P-value < 0.05 considered significant. RESULTS: I943 inmates with history of IDU participated in the study. The overall prevalence of HCV antibody was 41.6%. The main independent risk factors were number of injection in the month [OR: 1.006 (1.002- 1.011)], Length of drug addiction [OR: 1.05 (1.004-1.098)], multiple incarceration [OR: 1.15 (1.05-1.23)] and use of needle/syringe share inside prison [OR: 4.19 (2.22-7.9)]. In our study, marriage was a protective factor for HCV infection [OR: 0.34 (0.18-0.64)] as well. CONCLUSIONS: According to relatively high prevalence of HCV infection and associated risk factors which observed in this study it is important to primary prevention in prisons through syringe/needle exchange and counsel with imprisoned IDUs. PMCID: PMC3399300 PMID: 22826759 [PubMed] 20. Rev Esp Sanid Penit. 2012;14(2):67-77. doi: 10.1590/S1575-06202012000200005. [Evolution of the need and coverage of opioid substitution treatments and needle exchange programmes in Spanish prisons, 1992-2009].

[Article in Spanish] de la Fuente L, Bravo MJ, Jimnez-Mejas E, Sordo L, Pulido J, Barrio G. Centro Nacional de Epidemiologa, Instituto de Salud Carlos III, Madrid, Espaa. Comment in Rev Esp Sanid Penit. 2012 Feb;14(3):116; author reply 117-9. Rev Esp Sanid Penit. 2012 Feb;14(3):114-5; author reply 117-9. INTRODUCTION: Spain is one of the few countries to have widely implemented opioid substitution treatments (OST) and needle exchange programmes (NEP) for drug users in prison. We analyze the evolution of the need, coverage and the timeliness of these interventions in Spain between 1992 and 2009. METHODS: Data on the provision of interventions is taken from official publications. The need was calculated by applying multiplicative methods to secondary data from several sources. Coverage was estimated as the quotient between provision and need. Temporal opportunity was estimated by observing the gap between the acme of the incidence of consumption, of HIV infection or need and the curve of provision. RESULTS: OST's began to be implemented in 1992. In 2002 they reached their maximum coverage (63.8%) and subsequently stabilized. NEP's started in 1997. Their maximum coverage reached 20.7% in 2006, but halved in a period of two years. The delay between the epidemic acme and the need and maximum intervention coverage was of 8-25 years. CONCLUSIONS: OST and NEP introduction in Spanish prisons was a great advance, but the delay in their implementation and the low level of NEP coverage could have limited their potential impact on the improvement of the health of incarcerated drug users. The decline of NEP coverage in recent years is a cause of major concern for the evolution of HIV and Hepatitis C epidemics. PMID: 22801652 [PubMed - indexed for MEDLINE] 21. Am J Drug Alcohol Abuse. 2012 Nov;38(6):544-50. doi: 10.3109/00952990.2012.702171. Epub 2012 Jul 11. HIV infection risk among injection drug users in a methadone maintenance treatment program, Taipei, Taiwan 2007-2010. Yen YF, Rodwell TC, Yen MY, Hsu YH, Chuang P, Li LH, Su LW, Yang YH, Jiang XR, Fang YC, Garfein RS.

Section of Infectious Diseases, Taipei City Hospital, Taipei City Government, No.145 Zhengzhou Rd., Taipei, Taiwan. dam37@tpech.gov.tw BACKGROUND: Taiwan has a growing HIV/AIDS epidemic that has recently shifted to an increase among injection drug users (IDUs). This study aimed to measure the prevalence and incidence and identify the correlates of HIV infection among IDUs in a large methadone maintenance treatment program (MMTP) in Taipei, Taiwan. METHODS: Data from intake interviews and HIV testing completed by IDUs upon admission to the Taipei City Hospital MMTP in 2007-2010 were included in this analysis. HIV testing was repeated semi-annually among maintained clients who were HIV-negative during MMTP admission. RESULTS: Of 1444 IDUs admitted, 85.9% were male, median age was 40 years, and mean years of injecting was 14.3 (range: 1-64). The prevalence of HIV, HCV, and HIV/HCV co-infection was 13.4%, 91.1%, and 13.2%, respectively. In multivariable analysis, HIV infection was associated with sharing syringes during the 6 months prior to admission (OR = 14.76, 95% CI 10.31-21.13), homelessness (OR = 6.46, 95% CI 1.49-28.00), and lifetime number of MMTP admissions (OR = 1.76, 95% CI 1.30-2.38) and times incarcerated (OR = 1.10, 95% CI 1.03-1.18). HIV seroincidence was 1.15/100 person-years at risk (95% CI .62-8.77/100 PY) among IDUs who were HIV-negative at first admission. CONCLUSIONS: Taiwanese IDUs in MMTP have a high HIV prevalence, which was associated with syringe sharing and other factors related to social marginalization. Our findings highlight the importance of harm reduction programs, including syringe exchange, along with HIV-prevention education. PMID: 22783806 [PubMed - indexed for MEDLINE] 22. Sex Transm Infect. 2012 Nov;88(7):538. doi: 10.1136/sextrans-2012-050534. Epub 2012 Jul 6. The prevalence of HIV and hepatitis C in individuals leaving prison and entering drug and alcohol treatment services. Williams H, Axten D, Makia F, Naylor E, Leonard O, Teague A, Kelleher M, Fox J. PMID: 22773327 [PubMed - indexed for MEDLINE] 23. Public Health Rep. 2012 Jul-Aug;127(4):407-21. Prevalence, distribution, and correlates of hepatitis C virus infection among homeless adults in Los Angeles. Gelberg L, Robertson MJ, Arangua L, Leake BD, Sumner G, Moe A, Andersen RM, Morgenstern H, Nyamathi A.

University of California at Los Angeles, David Geffen School of Medicine, Department of Family Medicine, Los Angeles, CA 90024, USA. lgelberg@mednet.ucla.edu OBJECTIVE: We documented the prevalence, distribution, and correlates of hepatitis C virus (HCV) infection among urban homeless adults. METHODS: We sampled a community-based probability sample of 534 homeless adults from 41 shelters and meal programs in the Skid Row area of downtown Los Angeles, California. Participants were interviewed and tested for HCV, hepatitis B, and HIV. Outcomes included prevalence, distribution, and correlates of HCV infection; awareness of HCV positivity; and HCV counseling and treatment history. RESULTS: Overall, 26.7% of the sample tested HCV-positive and 4.0% tested HIV-positive. In logistic regression analysis, independent predictors of HCV infection for the total sample included older age, less education, prison history, and single- and multiple-drug injection. Among lifetime drug injectors, independent predictors of HCV infection included older age, prison history, and no history of intranasal cocaine use. Among reported non-injectors, predictors of HCV infection included older age, less education, use of non-injection drugs, and three or more tattoos. Sexual behaviors and snorting or smoking drugs had no independent relationship with HCV infection. Among HCV-infected adults, nearly half (46.1%) were unaware of their infection. CONCLUSIONS: Despite the high prevalence of HCV infection, nearly half of the cases were hidden and few had ever received any HCV-related treatment. While injection drug use was the strongest independent predictor, patterns of injection drug use, non-injection drug use, prison stays, and multiple tattoos were also independent predictors of HCV. Findings suggest that urgent interventions are needed to screen, counsel, and treat urban homeless adults for HCV infection. PMCID: PMC3366378 [Available on 2013/7/1] PMID: 22753984 [PubMed - indexed for MEDLINE] 24. Curr Opin HIV AIDS. 2012 Jul;7(4):345-53. doi: 10.1097/COH.0b013e328354bd44. Tuberculosis and HIV in people who inject drugs: evidence for action for tuberculosis, HIV, prison and harm reduction services. Getahun H, Gunneberg C, Sculier D, Verster A, Raviglione M. Stop TB Department, WHO, Geneva, Switzerland. getahunh@who.int PURPOSE OF REVIEW: To provide a comprehensive summary of the prevention, diagnosis and treatment of HIV-related tuberculosis (TB) in people who inject drugs (PWIDs), and recommend actions to enhance the clinical and programmatic responses to the epidemic.

RECENT FINDINGS: People who live with HIV and inject drugs have a 2-6-fold increased risk of developing TB compared with noninjectors, and commonly have comorbidities with hepatitis B (HBV) and C viral (HCV) infection. Among PWIDs who develop TB, at least one in three will also have HIV and two out of three will have HCV antibodies. They are also at increased risk of criminalization and incarceration. The risk of TB disease in prisons is on average 23 times higher than the level in the general population. Key recent developments to address HIV-related TB among PWIDs include the use of simplified symptom-based algorithm to provide isoniazid-preventive therapy, molecular DNA detection methods for Mycobacterium tuberculosis and the immediate provision of antiretroviral therapy within the first 2 weeks of initiation of anti-TB treatment. SUMMARY: Addressing the challenge posed by HIV-associated TB among PWIDs requires a systematic and integrated response to viral hepatitis and incarceration-related health issues, in addition to ensuring HIV and TB prevention, diagnosis and treatment as core components of harm reduction services. Regionally tailored measures, taking into consideration the epidemiology of these comorbidities, the policy and programmatic environment, and the infrastructure of the health system are needed. PMID: 22678489 [PubMed - indexed for MEDLINE] 25. Drug Alcohol Depend. 2012 Nov 1;126(1-2):156-60. doi: 10.1016/j.drugalcdep.2012.05.008. Epub 2012 May 30. High-risk drug-use practices among a large sample of Australian prisoners. Kinner SA, Jenkinson R, Gouillou M, Milloy MJ. Centre for Population Health, Burnet Institute, Australia. kinner@burnet.edu.au BACKGROUND: Drug injection in prison is associated with a high risk of transmission of blood-borne pathogens including hepatitis C (HCV). The aim of this study was to estimate the prevalence and identify independent correlates of recent in-prison injecting drug use (P-IDU) among a large sample of adult prisoners in Queensland, Australia. METHODS: Confidential, structured interviews with 1,322 adult prisoners in Queensland, Australia. Prevalence estimates were corrected for sampling bias using inverse probability weighting. Independent correlates of recent P-IDU were identified using multivariable Poisson regression with backwards elimination. RESULTS: We estimated that among all adult prisoners in Queensland, Australia, the prevalence of lifetime IDU was 55.1%, of lifetime P-IDU 23.0%, and of recent (during current sentence) P-IDU 13.2%. Significant, independent correlates of recent P-IDU included male gender (ARR=3.07, 95% CI 1.83-5.12), being unemployed prior to incarceration (ARR=1.34, 95% CI 1.01-1.76), use of three or more drug

types prior to incarceration (ARR=1.80, 95% CI 1.40-2.31), a history of needle/syringe sharing (ARR=5.00, 95% CI 3.06-8.16), receiving a tattoo during the current prison sentence (ARR=2.19, 95% CI 1.67-2.86) and HCV exposure (ARR=1.47, 95% CI 1.08-2.02). Older age was protective (ARR=0.90 per 5 years older, 95% CI 0.83-0.99). CONCLUSION: Drug injection in prison is common and, given the associations between in-prison drug injection and syringe sharing, unsafe tattooing and HCV exposure, poses a risk to both prisoner health and public health. There remains an urgent need to implement evidence-based infection control measures, including needle and syringe programs, within prison settings. Copyright 2012 Elsevier Ireland Ltd. All rights reserved. PMID: 22658284 [PubMed - indexed for MEDLINE] 26. J Health Care Poor Underserved. 2012 May;23(2):811-33. doi: 10.1353/hpu.2012.0047. Hepatitis C among clients of health care for the homeless primary care clinics. Strehlow AJ, Robertson MJ, Zerger S, Rongey C, Arangua L, Farrell E, O'Sullivan A, Gelberg L. UCLA School of Nursing, USA. astrehlo@ucla.edu OBJECTIVES: To describe the prevalence, distribution and risk factors for hepatitis C virus (HCV) infection among homeless adults using eight Health Care for the Homeless (HCH) clinics nationally. METHODS: Data were collected for 387 participants through blood draws, structured interviews, chart reviews. RESULTS: Overall prevalence of HCV-antibody positivity was 31.0%, including 70.0% among injection drug users and 15.5% among reported non-injectors. Much HCV infection was hidden as the majority (53.3%) of HCV-antibody positive participants was unaware of their status. Independent risk factors for HCV among the total sample included injection drug use, prison, and tattoos; among injectors, risk factors included prison and three or more years of injection drug use; among reported non-injectors, risk factors included tattoos and prison. CONCLUSION: These HCH clinics serve high concentrations of HCV-infected injectors, making these and similar clinics priority intervention sites for aggressive screening, education, testing, and treatment for HCV and other blood-borne diseases. PMID: 22643626 [PubMed - indexed for MEDLINE]

27. Cien Saude Colet. 2012 May;17(5):1235-46. [Beyond bars and punishments: a systematic review of prison health]. [Article in Portuguese] Gois SM, Santos Junior HP, Silveira Mde F, Gaudncio MM. Universidade Estadual da Paraba, Campina Grande, PB, Brazil. A systematic review of scientific production on Prison Health was conducted, seeking to verify how the subject matter has been dealt with, establishing which is the most exploited focus and identifying possible gaps. The search was carried out in the Virtual Health Library. 1160 articles were located: 1104 on MEDLINE, 19 on LILACS and 37 on SciELO, published from 1993 to 2010. As MEDLINE and LILACS do not show the entire articles, the places, dates and languages of the texts were charted. In-depth analysis was restricted to works which were shown in their entirety and free of charge hosted on SciELO. It revealed that scientific production is present all over the world with a predominantly quantitative approach. It focuses on identifying the socio-demographic profile and health conditions of prisoners, the incidence of tuberculosis, Human Immunodeficiency and Hepatitis C virus infections. There is a predominance of studies carried out with male prisoners, in comparison with the female sex. It is clear that prisoner health is a public health problem on the rise, which demands research that can orient health policies and strategies. PMID: 22634816 [PubMed - indexed for MEDLINE] 28. J Correct Health Care. 2012 Jul;18(3):198-209. doi: 10.1177/1078345812445180. Epub 2012 May 7. Structured information exchange on infectious diseases for prisoners. Flhmann P, Wassmer M, Schwendimann R. Strafanstalt Schngrn, Solothurn, Switzerland. Infectious diseases such as HIV/AIDS, hepatitis C, and sexually transmitted diseases are more prevalent in prisoners than in the general population. In Western European prisons, inmates have HIV infection rates 25 times higher and hepatitis C infection rates 40 times higher than their national averages. To inform prisoners about the dangers of these diseases, a structured information exchange was developed. In a pre-/post- design with repeated measurement, 21 male prisoners' knowledge of infectious diseases was analyzed. A significant

improvement of knowledge (p < .0001) was observed. One striking finding was that knowledge of hepatitis C was clearly lower than that of HIV and that prisoners enrolled in drug substitution programs were significantly better informed about hepatitis C than the other participating prisoners. PMID: 22569902 [PubMed - indexed for MEDLINE] 29. CMAJ. 2012 Jun 12;184(9):1017-8. doi: 10.1503/cmaj.109-4191. Epub 2012 May 7. Prison puzzle: treating hepatitis C. Webster PC. PMCID: PMC3381755 PMID: 22566525 [PubMed - indexed for MEDLINE] 30. Lakartidningen. 2012 Jan 25-31;109(4):161-3. [Screening for HIV and hepatitis C virus using saliva tests in a prison in Ghana. A study of the prevalence and the status of knowledge]. [Article in Swedish] Ljungdahl M, Montgomerie C, Gyan BA, Hagbe FS, Britton S. Mora lasarett. PMID: 22482225 [PubMed - indexed for MEDLINE] 31. Emerg Infect Dis. 2012 Apr;18(4):689-91. doi: 10.3201/eid1804.111016. Tuberculosis screening before anti-hepatitis C virus therapy in prisons. Babudieri S, Soddu A, Murino M, Molicotti P, Muredda AA, Madeddu G, Fois AG, Zanetti S, Pirina P, Mura MS. PMCID: PMC3309670 PMID: 22469015 [PubMed - indexed for MEDLINE] 32. Epidemiol Infect. 2012 Dec;140(12):2190-8. doi: 10.1017/S0950268812000489. Epub 2012 Mar 30.

Estimating the variability in the risk of infection for hepatitis C in the Glasgow injecting drug user population. Sutton AJ, McDonald SA, Palmateer N, Taylor A, Hutchinson SJ. Health Economics Unit, Public Health Building, University of Birmingham, Edgbaston, Birmingham, UK. A.J.Sutton@bham.ac.uk Glasgow (Scotland's largest city) has a high prevalence of injecting drug use and has one of the highest prevalences of hepatitis C virus (HCV) infection in injecting drug users (IDUs) in Western Europe. HCV prevalence data from surveys of Glasgow's IDUs from 1990 to 2007 were utilized and a model was applied that described the prevalence of HCV as a function of the rate (force) of infection. Force-of-infection estimates for HCV that may vary over time and injecting career length over a range of variables were investigated. New initiates to injecting were found to be at increased risk of HCV infection, with being recruited from a street location and reporting injecting in prison leading to a significant increase in the risk of infection in new initiates. These results indicate areas of importance for the planning of public health measures that target the IDU population. PMID: 22459739 [PubMed - indexed for MEDLINE] 33. JAMA. 2012 Mar 28;307(12):1259-60. doi: 10.1001/jama.2012.374. Screening for HCV infection in jails. Spaulding AC, Thomas DL. Rollins School of Public Health, Emory University, 1518 Clifton Rd, Room 3033, Atlanta, GA 30033, USA. aspauld@emory.edu PMID: 22453565 [PubMed - indexed for MEDLINE] 34. Hepat Mon. 2012 Jan;12(1):23-31. doi: 10.5812/kowsar.1735143X.806. Epub 2012 Jan 20. Factors Correlated With Hepatitis C and B Virus Infections Among Injecting Drug Users in Tehran, IR Iran. Amin-Esmaeili M, Rahimi-Movaghar A, Razaghi EM, Baghestani AR, Jafari S.

Iranian Research Center for HIV/AIDS, Tehran University of Medical Sciences, Tehran, IR Iran. BACKGROUND: In Iran, the number of injecting drug users (IDUs) has increased in recent years. The rates of hepatitis C virus (HCV) and hepatitis B virus (HBV) infections among IDUs are reportedly high. OBJECTIVES: The purpose of this study was to assess factors correlated with HCV and HBV infections among IDUs in Tehran. PATIENTS AND METHODS: A cross-sectional study included 899 IDUs recruited from the community, drug treatment centers, and drop-in-centers. The study involved interviews conducted using an adapted version of the WHO Drug Injection Study Phase II (Version 2b) questionnaire and blood testing for the HCV antibody, hepatitis B surface antigen, and hepatitis B core antibody. A logistic regression model was used to identify independent factors correlated with HCV and HBV infections. RESULTS: HCV infection was found to be primarily associated with female gender [odds ratio (OR) 5.0, 95% confidence interval (CI) 2.0-10.0)], unmarried status (OR 2.9, 95% CI 1.9-4.4), drug use for more than 10 years (OR 2.7, 95% CI 1.8-3.9), drug injection frequency of more than once per day (OR 2.6, 95% CI 1.6-4.2), history of imprisonment (OR 2.5, 95% CI 1.6-4.0)], and a history of shared injection needles in prison (OR 2.3, 95% CI 1.5-3.6). HBV infection was mainly correlated with a history of imprisonment (OR 1.9, 95% CI 1.4-2.7) and drug use for more than 10 years (OR 1.4, 95% CI 1.1-1.9). CONCLUSIONS: Because a considerable number of IDUs in Iran are receiving reduction services, tailoring services for prevention of hepatitis infection are necessary. PMCID: PMC3298872 PMID: 22451840 [PubMed] 35. Rev Esp Sanid Penit. 2012 Jun;14(1):3-11. doi: 10.1590/S1575-06202012000100002. [Evaluation of needle exchange program at Pereiro de Aguiar prison (Ourense, Spain): ten years of experience]. [Article in Spanish] Ferrer-Castro V, Crespo-Leiro MR, Garca-Marcos LS, Prez-Rivas M, Alonso-Conde A, Garca-Fernndez I, Lorenzo-Guisado A, Snchez-Fernndez JL, Seara-Selas M, Sanjos-Vallejo R. Servicios Mdicos, Centro Penitenciario de Pereiro de Aguiar, Pereiro de Aguiar, Espaa. ventura.ferrer@gmail.com OBJECTIVES: To evaluate the effectiveness of NEPs in prison to reduce the

prevalence of infections associated with intravenous drug use and to know more about acceptance of the program by inmates and staff. MATERIAL AND METHODS: cross-sectional observational study at baseline, 6 and 12 months and 10 years of program development. Interviews were conducted with program users, as well as random sample surveys of officials at the various cuts, and a random sample of inmates from the centre after10 years. Activity indicators of the program were recorded continuously, and the prevalence of HIV, HBV and HCV at baseline and after 10 years was evaluated. For the statistical analysis, the chi-square test was used with the Yates correction when necessary. RESULTS: In ten years we have supplied a total of 15,962 syringes to 429 users, (average 20.2 users/month), and 11,327 (70.9%) were returned. The prevalence of HIV infection decreased from 21% in 1999 to 8.5% in 2009, HCV prevalence from 40% to 26.1% (p <0.01), finding no significant differences in the prevalence of HBsAg +. Most of the inmates and civil servants believe that the program did not increase intravenous drug use and improves hygienic living conditions in prison. CONCLUSIONS: After ten years of development of the NEP, there was a significant decrease in the prevalence of HIV and HCV in the prison population at the centre, and the program is accepted as beneficial by most of the inmates and staff participating in the survey. PMID: 22437903 [PubMed - indexed for MEDLINE] 36. Clin Infect Dis. 2012 May;54(10):1465-72. doi: 10.1093/cid/cis227. Epub 2012 Mar 19. Expanding access to treatment for hepatitis C in resource-limited settings: lessons from HIV/AIDS. Ford N, Singh K, Cooke GS, Mills EJ, von Schoen-Angerer T, Kamarulzaman A, du Cros P. Mdecins Sans Frontires, Geneva, Switzerland. nathan.ford@msf.org The need to improve access to care and treatment for chronic hepatitis C virus (HCV) infection in resource-limited settings is receiving increasing attention. Key priorities for scaling up HCV treatment and care include reducing the cost of current and future treatment; simplifying the package of care; identifying opportunities to shift specific tasks to nonspecialists to overcome human resource constraints; service integration with human immunodeficiency virus (HIV) clinics, prison health services, and needle syringe and oral substitution therapy programs; improving surveillance, monitoring, and research; encouraging patient and community engagement; focusing specifically on the needs of vulnerable groups; and increasing financial and political commitment. Many of these obstacles have been addressed in rolling out treatment for human immunodeficiency virus during the last decade, and a number of lessons can be drawn to help

improve access to HCV care. PMID: 22431808 [PubMed - in process] 37. Ir J Med Sci. 2012 Dec;181(4):541-8. doi: 10.1007/s11845-012-0814-9. Epub 2012 Mar 20. The natural history of injecting drug use: a 25-year longitudinal study of a cohort of injecting drug users in inner city Dublin. O'Kelly FD, O'Kelly CM. Department of Primary Care and Public Health, Trinity College Dublin, Dublin, Ireland. feokelly@tcd.ie BACKGROUND: Injecting drug use is associated with increased morbidity and mortality. This is the first longitudinal study of a community-based population of injecting drug users (IDUs) in the Republic of Ireland. AIM: To establish the natural history of IDUs in a deprived Dublin community. METHODS: Eighty-two IDUs (heroin) were recruited over the summer months of 1985. The prevalence of drug use in this district electoral area was established in 1985 and followed-up over a 25-year period with two formal interviews in 1995 and 2010. RESULTS: It is a descriptive study of a cohort of IDUs established in 1985 prior to human immunodeficiency virus (HIV) testing being available. The majority of the cohort recruited included single, unemployed males aged 20 to 29 years, who had served a prison sentence. Fifty-one (63 %) of the cohort had died by 2010, of which 26 were attributed to HIV disease. The mean age of death was 35.9 years of age (standard deviation 4.1 years). Fifty-two (63 %) of the cohort tested positive for HIV and 58 (71 %) for hepatitis B between 1985 and 2010. The median survival time for those with a positive HIV status was 17 years (95 % CI 14.0-20.0) and for those with a positive hepatitis C status, 21 years (95 % CI 15.5-26.5). CONCLUSIONS: The lifestyle of IDUs, as demonstrated by the experience of this cohort, has hazardous consequences resulting in high levels of morbidity and mortality. A relatively stable picture of HIV associated with IDUs is now emerging in Ireland, as is the case throughout most of the EU. HIV is a more manageable chronic disease, posing challenges for primary care in its treatment of former and existing IDUs who are ageing and now have other chronic diseases. PMID: 22430070 [PubMed - indexed for MEDLINE] 38. Int J Tuberc Lung Dis. 2012 May;16(5):633-8. doi: 10.5588/ijtld.11.0504. Epub 2012 Mar 8.

Latent tuberculosis infection treatment for prison inmates: a randomised controlled trial. Chan PC, Yang CH, Chang LY, Wang KF, Lu BY, Lu CY, Shao PL, Hsueh PR, Fang CT, Huang LM. Centers for Disease Control, Taipei, Taiwan. SETTING: A prison in northern Taiwan. OBJECTIVE: To compare safety and the completion rate of the 4-month daily rifampicin regimen (4R) vs. the standard 6-month daily isoniazid regimen (6H) for latent tuberculosis infection (LTBI) in prison inmates. DESIGN: This was an open-label randomised trial among human immunodeficiency virus negative male inmates. Inmates without active tuberculosis (TB) who tested positive for both the tuberculin skin test and QuantiFERON-TB Gold In-Tube were eligible, but those with baseline glutamic pyruvic transaminase (GPT) levels 120 U/l, bilirubin levels 2.4 U/l or a platelet count < 150 k/mm(3) were excluded. The primary endpoint was any adverse event that resulted in discontinuation of LTBI treatment. RESULTS: Participants (n = 373; 14% hepatitis B surface antigen positive, 21% anti-hepatitis C virus [HCV] positive) were randomised (stratified by hepatitis B virus, HCV status and 2-year prison term) to receive either 4R or 6H under directly observed treatment. The 4R group (n = 190) was less likely to experience an adverse event leading to discontinuation of treatment (2% vs. 12%, P < 0.001 for all adverse events; 0% vs. 8%, P < 0.001 for hepatotoxicity), and more likely to complete LTBI treatment (86% vs. 78%, P = 0.041), compared with the 6H group (n = 183). CONCLUSIONS: 4R is safer and has a higher completion rate than 6H as treatment for LTBI among male prison inmates. PMID: 22410137 [PubMed - indexed for MEDLINE] 39. Clin Infect Dis. 2012 Apr;54(8):1167-78. doi: 10.1093/cid/cir991. Epub 2012 Jan 30. Transmission of hepatitis C virus infection through tattooing and piercing: a critical review. Tohme RA, Holmberg SD. Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. rtohme@cdc.gov

Tattoos and piercings are increasing, especially among youths, but the risk of hepatitis C virus (HCV) infection from these practices has not been adequately assessed and there are conflicting findings in the literature. We evaluated the risk of HCV infection from tattooing and piercing using the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Studies that specified the venue of tattooing and/or piercing showed no definitive evidence for an increased risk of HCV infection when tattoos and piercings were received in professional parlors. However, the risk of HCV infection is significant, especially among high-risk groups (adjusted odds ratio, 2.0-3.6), when tattoos are applied in prison settings or by friends. Prevention interventions are needed to avoid the transmission of hepatitis C from tattooing and piercing in prisons, homes, and other potentially nonsterile settings. Youths also should be educated on the need to have tattoos and piercings performed under sterile conditions to avoid HCV infection. PMID: 22291098 [PubMed - indexed for MEDLINE] 40. Epidemiol Prev. 2011 Sep-Dec;35(5-6):297-306. [The health conditions of prison inmates in Tuscany]. [Article in Italian] Voller F, Silvestri C, Orsini C, Aversa L, Da Fr M, Cipriani F. Agenzia regionale di Sanit della Toscana, Firenze. OBJECTIVE: Investigation of health conditions of prison inmates in Tuscany (Italy) compared with non-institutionalized population and literature data. DESIGN: Cross-sectional descriptive study of a sample recruited for a prospective cohort study. SETTING E PARTICIPANTS: Prison inmates detained in Tuscany on June 15th 2009. Istat data concerning the survey "Aspects of daily life" 2006-2009 has been used for comparison. MAIN OUTCOME MEASURES: The measures used for the analysis are prevalence data by age classes and odds ratios obtained through a logistic regression model. Outcome variables are: broad disease groups, in particular infectious and parasitic diseases and psychic disorders. RESULTS: Prison inmates from Northern Africa and Eastern Europe are 40% of the population studied. A high consumption of tobacco is observed, with 70.6% of regular smokers among prisoners vs 33.2% among free citizens. Digestive system diseases are the most frequent diseases (25.1%), followed by infectious and parasitic diseases (15.7%). Among digestive disease,more than half are teeth and oral cavity pathologies that affect 13.7% of prisoners.Other frequently reported

disease groups were diseases of the bone-muscular and connective systems (11.0%), of the circulatory system (10.8%), endocrine and metabolic systems (9.2%), traumatisms and poisonings (6.8%), respiratory system diseases (5.9%), and nervous system diseases (4.9%). The prevalence of ischemic heart diseases, diabetes, obesity and esophagitis, gastritis and gastro-duodenal ulcers is significantly higher among prisoners than in the general population. The most frequent infectious and parasitic diseases are Hepatitis C Virus (HCV) infection with a prevalence of 9.0%, Hepatitis B Virus (HBV) infection (2.2%), and Human Immunodeficiency Virus (HIV) infection (1.4%). Hepatitis C, HIV and hepatitis A have a higher prevalence among inmates of Italian nationality, while syphilis is more common among prisoners from Eastern Europe (1.2%). The prevalence of psychic disorders among prison inmates is 33.3% (vs 11.6% in the general population), while it decreases to 29.3% if we exclude the population detained in the Psychiatric Prison. CONCLUSIONS: According to previous national and international studies, the cohort is more affected than the general population by physical and psychic disorders, partly associated to the prison inmate's country of origin. PMID: 22166776 [PubMed - indexed for MEDLINE] 41. J Urban Health. 2012 Feb;89(1):108-16. doi: 10.1007/s11524-011-9626-x. Prevalence and correlates of HCV, HVB, and HIV infection among prison inmates and staff, Hungary. Tres B, Barcsay E, Tarjn A, Horvth G, Dencs A, Hettmann A, Cspai MM, Gyori Z, Rusvai E, Takcs M. National Center for Epidemiology, Budapest, 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. PMCID: PMC3284587 PMID: 22143408 [PubMed - indexed for MEDLINE] 42. Drug Alcohol Depend. 2012 Jun 1;123(1-3):269-72. doi: 10.1016/j.drugalcdep.2011.11.009. Epub 2011 Dec 3. Non-injection drug use and hepatitis C among drug treatment clients in west central Mexico. Campollo O, Roman S, Panduro A, Hernandez G, Diaz-Barriga L, Balanzario MC, Cunningham JK. Center of Studies on Alcohol and Addictions, CUCS, Universidad de Guadalajara, Hospital Civil de Guadalajara, Hospital 278, Guadalajara, Jal. 44280, Mexico. renaceboy@hotmail. BACKGROUND: Research on hepatitis C virus (HCV) prevalence among non-injecting drug treatment clients in the United States, Europe and Asia indicate substantial differences by place. To date, little or no research on HCV and non-injection drug use (NIDU) has been conducted in Mexico. METHODS: We examined the prevalence of HCV, hepatitis B virus (HBV), and HIV among non-injecting drug users (NIDUs) in community-based drug treatment (N=122) and NIDUs in a prison-based drug treatment program (N=30), both located in west central Mexico. RESULTS: Among the community clients, prevalence was 4.1% (95% confidence interval [CI]: 1.8-9.2) for HCV, 5.7% for HBV (95% CI: 2.8-11.4), and 1.6% for HIV (95% CI: 0.4-5.8). Among the in-prison clients, prevalence was 40.0% (95% CI: 24.6-57.7) for HCV, 20.0% for HBV (95% CI: 9.5-37.3), and 6.7% for HIV (95% CI: 1.9-21.3). None of the clients were aware of being infected. CONCLUSION: The HCV prevalence found for the NIDU community treatment clients ranks among the lower HCV estimates published for NIDUs in treatment to date. The prevalence found for the in-prison clients ranks among the higher, raising a concern of possible elevated HCV infection among NIDUs in the west central Mexico prison--one compounded by the finding that none of this study's clients knew they were HCV positive. Copyright 2011 Elsevier Ireland Ltd. All rights reserved. PMID: 22138538 [PubMed - indexed for MEDLINE]

43. Hepat Mon. 2011 Jan;11(1):19-22. Incarceration is a major risk factor for blood-borne infection among intravenous drug users: Incarceration and blood borne infection among intravenous drug users. Mir-Nasseri MM, Mohammadkhani A, Tavakkoli H, Ansari E, Poustchi H. Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, IR Iran. BACKGROUND: There is a strong association between hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infection which are mainly transmitted by contamination with blood via intravenous drug abuse (IVDU) or sexual contact. OBJECTIVES: To determine the prevalence of these infections and the risk factors associated with them among prisoner and non-prisoner IVDUs in Tehran, Iran. PATIENTS AND METHODS: This cross-sectional study was performed in two jails and three drug rehabilitation centers between 2001 and 2002 in Tehran. HBsAg and HBcAb were checked using highly specific third generation enzyme immunoassays (DIA.PRO, Italy, specificity >99%, and Radim, Italy, specificity 99.7%, respectively). HCVAb was detected using ELISA (DIA.PRO, Italy) with both sensitivity and specificity >98%. HIVAb test (DRG Diagnostics kit, Germany) was performed for 459 of the 468 IDU subjects. RESULTS: 392 prisoners and 135 individual attending drug rehabilitation centers were approached. Of the 518 subjects studied, 464 (89.5%) were male, 386 (74.5%) were prisoners and 132 (25.5%) were non-prisoners. In this study, HBsAg, HCVAb and HIVAb were positive in 19 (3.7%), 359 (69.5%) and 70 (15.5%) of subjects, respectively. These tests were positive in 17 (4.5%), 311 (80.5%) and 63 (17%) among prisoners and 2 (1.5%), 48 (36.5%) and 7 (7.8%) in non-prisoners, respectively. Multiple logistic regression analysis revealed that independent factors related to co-infection of HCV and HIV infection were imprisonment (p<0.001. OR: 7.5) and using common syringe (p=0.03, OR: 4.5). CONCLUSIONS: Our findings strongly suggest that drug injection inside prison carries is a risk for HIV infection and that HIV infection among IDUs is likely to be bridged to the broader population through sexual contact without using effective prevention programs. PMCID: PMC3206659 PMID: 22087111 [PubMed] 44. Rev Med Chir Soc Med Nat Iasi. 2011 Jul-Sep;115(3):736-41. [Characteristics of hepatitis C virus (HCV) infection in closed communities]. [Article in Romanian]

Nazare C, Girleanu I, Cojocariu-Salloum C, Trifan A. Universitii de Medicin i Farmacie "Gr.T. Popa" Iai, Penitenciarul Bacu. AIM: To determine the prevalence of HCV in closed communities and the relations between risk behavior and HCV infection. MATERIAL AND METHODS: The persons deprived of personal freedom selected for this study have filled out an epidemio logical questionnaire including identity and epidemiological data (detention history, evaluation of the risk factors), as well as a written consent. All the subjects were tested for the presence of anti-HCV antibodies. RESULTS: This study included 326 of the total of 500 persons deprived of personal freedoms at the Bacau Correctional Facility The prevalence of hepatitis B and C was 15.34 %, and that of HCV 5.21%, higher than in the general population. Risk factors associated with HCV in closed communities were injected drugs, homosexuality, and tattooing. CONCLUSIONS: The results confirm that the population in correctional facilities is at high risk for infection with hepatitis viruses (both B and C), the modes of disease transmission being already known. PMID: 22046780 [PubMed - indexed for MEDLINE] 45. Open Med. 2011;5(3):e132-3. Epub 2011 Jul 5. Prisons and public health. Cowan-Dewar J, Kendall C, Palepu A. PMCID: PMC3205828 PMID: 22046225 [PubMed - indexed for MEDLINE] 46. J Correct Health Care. 2012 Jan;18(1):53-61. doi: 10.1177/1078345811421732. Epub 2011 Oct 18. An innovative approach to pharmacy management in a state correctional system. Marcoux RM, Simeone JC, Colavita M, Larrat EP. Healthcare Utilization Management Center, College of Pharmacy, University of Rhode Island, Kingston, RI 02881, USA. Numerous models are employed for medication distribution and pharmacy services

management in correctional facilities. Since 2003, the University of Rhode Island College of Pharmacy and the Rhode Island Department of Corrections (RIDOC) have collaborated on a pharmacy management program designed to better integrate medical care, improve medication utilization, and reduce pharmaceuticals costs. The program introduced staff education, waste-reduction strategies, treatment protocols, and a responsive formulary system. RIDOC pharmaceutical expenditures grew at a rate of approximately 1.5% Per Inmate Per Year from 2003 to 2009, considerably below the annual pharmaceutical inflation rate. Analyses of projected and actual drug spending indicate that RIDOC benefited from savings of almost $5 million during this period. This innovative approach to pharmacy management addressed many pharmaceutical care issues that had challenged RIDOC while providing educational opportunities for doctor of pharmacy students in this practice setting. PMID: 22013144 [PubMed - indexed for MEDLINE] 47. Addiction. 2012 Mar;107(3):501-17. doi: 10.1111/j.1360-0443.2011.03676.x. The effectiveness of opioid maintenance treatment in prison settings: a systematic review. Hedrich D, Alves P, Farrell M, Stver H, Mller L, Mayet S. European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal. dagmar.hedrich@emcdda.europa.eu Comment in Addiction. 2012 Mar;107(3):461-3. AIMS: To review evidence on the effectiveness of opioid maintenance treatment (OMT) in prison and post-release. METHODS: Systematic review of experimental and observational studies of prisoners receiving OMT regarding treatment retention, opioid use, risk behaviours, human immunodeficiency virus (HIV)/hepatitis C virus (HCV) incidence, criminality, re-incarceration and mortality. We searched electronic research databases, specialist journals and the EMCDDA library for relevant studies until January 2011. Review conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: Twenty-one studies were identified: six experimental and 15 observational. OMT was associated significantly with reduced heroin use, injecting and syringe-sharing in prison if doses were adequate. Pre-release OMT was associated significantly with increased treatment entry and retention after release if arrangements existed to continue treatment. For other outcomes, associations with pre-release OMT were weaker. Four of five studies found post-release reductions in heroin use. Evidence regarding crime and

re-incarceration was equivocal. There was insufficient evidence concerning HIV/HCV incidence. There was limited evidence that pre-release OMT reduces post-release mortality. Disruption of OMT continuity, especially due to brief periods of imprisonment, was associated with very significant increases in HCV incidence. CONCLUSIONS: Benefits of prison OMT are similar to those in community settings. OMT presents an opportunity to recruit problem opioid users into treatment, to reduce illicit opioid use and risk behaviours in prison and potentially minimize overdose risks on release. If liaison with community-based programmes exists, prison OMT facilitates continuity of treatment and longer-term benefits can be achieved. For prisoners in OMT before imprisonment, prison OMT provides treatment continuity. 2011 The Authors, Addiction 2011 Society for the Study of Addiction. PMID: 21955033 [PubMed - indexed for MEDLINE] 48. Rev Med Chir Soc Med Nat Iasi. 2011 Apr-Jun;115(2):325-30. [Prevalence of chronic hepatitis B virus (HBV) infection in closed communities and risk behaviour]. [Article in Romanian] Nazare C, Grleanu I, Cojocariu-Salloum C, Trifan A. Universitii de Medicin i Farmacie Gr. T. Popa Iai, Penitenciarul Bacu. AIM: To determine the prevalence of chronic hepatitis B virus infection in closed communities and the relations between the risk behavior and VHB infection. MATERIAL AND METHODS: In this study we included persons deprived of personal freedom at Bacau Correctional Facility. The subjects filled out a questionnaire, which contained identification and epidemiologic data (detention history, evaluation of the risk factors), as well as an informed consent. All subjects were tested for HBsAg. RESULTS: According to the performed tests, the general prevalence of hepatitis B and C in this correctional facility was 15.34%, with a prevalence of hepatitis B of 10.74%. Although these figures show a higher prevalence in this population than within the general population, they are lower than the figures reported in correctional facilities from other countries. CONCLUSIONS: The results confirm the fact that the population in correctional facilities is at high risk for hepatitis B infection, the ways of disease transmission being already known (infected blood, injected drugs, tattooing, homosexual relationships).

PMID: 21870718 [PubMed - indexed for MEDLINE] 49. Sex Transm Dis. 2011 Jul;38(7):634-9. doi: 10.1097/OLQ.0b013e31820bc86c. Sexually transmitted infections and hepatitis in men with a history of incarceration. Sosman J, Macgowan R, Margolis A, Gaydos CA, Eldridge G, Moss S, Flanigan T, Iqbal K, Belcher L; Project START Biologics Study Group. Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA. jms@medicine.wisc.edu BACKGROUND: Men entering correctional facilities have high rates of human immunodeficiency virus, sexually transmitted infections (STI), and hepatitis. Many prisons offer screening, treatment, and vaccination services; however, little is known about the rates of these infections in men after release to the community. METHODS: Young men were recruited from prisons in Mississippi, Rhode Island, and Wisconsin as part of a human immunodeficiency virus/STI/hepatitis intervention study. Participants were offered screening for Neisseria gonorrhoeae (GC), Chlamydia trachomatis, trichomoniasis, syphilis, hepatitis B (HBV) and C (HCV) 6 months after release. Logistic regression was performed to identify associations with prevalent infections. RESULTS: Of 248 eligible men, 178 (71.8%) participated. Their mean age was 22.5 years, and 92% reported multiple lifetime incarcerations. At 6-month postrelease, 79% reported unprotected vaginal or anal sex, and 26% tested positive for 1 or more infections (GC, 1%; C. trachomatis, 12%; trichomoniasis, 8%; syphilis, 0%; HCV, 6%; HBV, 1%). Of all, 55% were susceptible to HBV infection. Active STI (GC, C. trachomatis, or trichomoniasis) was associated with less education (odds ratios [OR], 2.25; P < 0.05). HCV infection was associated with injection drug use (OR, 69.70; P < 0.05) and being white (OR, 7.54; P < 0.05). HBV susceptibility was associated with older age (OR, 3.02; P < 0.05), more education (OR, 2.39; P < 0.05), or incarceration in Mississippi (OR, 6.69; P < 0.05) or Rhode Island (OR, 2.84; P < 0.05). CONCLUSIONS: Effective screening and prevention programs are needed for this population before and after release from custody to prevent acquisition and further transmission of these infections. PMID: 21844713 [PubMed - indexed for MEDLINE] 50. J Health Care Poor Underserved. 2011 Aug;22(3):962-82. doi: 10.1353/hpu.2011.0084.

Prevalence of HCV risk behaviors among prison inmates: tattooing and injection drug use. Pea-Orellana M, Hernndez-Viver A, Caraballo-Correa G, Albizu-Garca CE. Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico. Hepatitis C virus (HCV) is the most common blood-borne chronic viral infection in the United States and it is over represented in incarcerated populations. This study estimates if in prison tattooing is associated with self reported HCV infection in a probabilistic sample of 1,331 sentenced inmates in Puerto Rico prisons anonymously surveyed in 2004, who had previously been tested for HCV. Analysis were carried out with the total sample and among non-injectors (n=796) to control for injection drug use (IDU) and other confounders. Nearly 60% of inmates had acquired tattoos in prison. HCV was reported by 27% of subjects in the total sample and by 12% of non-injectors who had undergone tattoos in prison. IDU was the strongest predictor of HCV in the total sample (OR=5.6, 95% CI=3.2-9.7). Among non injectors, tattooing with reused needles or sharp objects and/ or reusing ink was positively associated with HCV self-report (OR=2.6, 95% CI=1.3-5.5). Tattooing is a common occurrence in this prison setting. Findings suggest that preventive interventions are required to reduce the risk of HCV transmission through unsterile tattooing and injection practices. PMID: 21841290 [PubMed - indexed for MEDLINE] 51. World J Gastroenterol. 2011 Jul 7;17(25):3027-34. doi: 10.3748/wjg.v17.i25.3027. Prevalence, genotypes and factors associated with HCV infection among prisoners in Northeastern Brazil. Santos BF, de Santana NO, Franca AV. Department of Medicine, Federal University of Sergipe, Aracaju, Sergipe 49060-100, Brazil. AIM: To determine hepatitis C virus (HCV) seroprevalence and its genotypes, and to identify the factors associated with HCV infection. METHODS: This cross-sectional study, conducted in two prisons (one male and one female) in the State of Sergipe, Brazil, comprised 422 subjects. All of the prisoners underwent a rapid test for the detection of HCV antibodies. Patients with a positive result were tested for anti-HCV by enzyme linked immunosorbent assay and for HCV RNA by qualitative polymerase chain reaction (PCR). The virus genotype was defined in every serum sample that presented positive for PCR-HCV. In order to determine the factors independently associated with positive serology

for HCV, multivariate logistic regression was used. RESULTS: HCV seroprevalence was 3.1%. Of the 13 subjects with positive anti-HCV, 11 had viremia confirmed by PCR. Of these, 90.9% had genotype 1. A total of 43 (10.2%) were injecting drug users, and HCV seroprevalence in this subgroup was 20.6%. The variable most strongly associated with positive serology for HCV was use of injecting drugs [odds ratio (OR), 23.3; 95% confidence interval (CI), 6.0-90.8]. Age over 30 years (OR, 5.5; 95%CI, 1.1-29.2), history of syphilis (OR, 9.8; 95%CI, 1.7-55.2) and history of household contact with HCV positive individual (OR, 14.1; 95%CI, 2.3-85.4) were also independently associated with HCV infection. CONCLUSION: Most of the HCV transmissions result from parenteral exposure. However, there is evidence to suggest a role for sex and household contact with an infected subject in virus transmission. PMCID: PMC3132254 PMID: 21799649 [PubMed - indexed for MEDLINE] 52. Rev Esp Sanid Penit. 2011 Oct;13(2):44-51. doi: 10.1590/S157506202011000200003. [Reasons for not initating HCV treatment in prison: a subanalysis of the EPIBAND study]. [Article in Spanish] de Juan J, Faraco I, Saiz de la Hoya P, Marco A, Yllobre C, Da Silva A, del Pozo E, Veiras FM; Grupo del Estudio EPIBAND. Servicios Mdicos, Centro Penitenciario Crdoba, Espaa. VIVAPEREJIL1@telefonica.net OBJECTIVE: This sub-analysis was designed within the framework of the EPIBAND study to establish the reasons why prison patients do not initiate HCV treatment. METHODS: Epidemiological, prospective, multicentre study conducted in 26 centres. We present the results from those patients included in the EPIBAND study who did not initiate HCV treatment for different reasons. RESULTS: A total of 195 patients were evaluated (average age 39 6.6 years, 86.7% male and 96.9% Spanish nationality). The reasons why this population did not initiate HCV treatment were secondary ones relating to the patient (41%), medical reasons (30.8%), and the prison environment (3.6%). 47.5% of patients reported lack of awareness and motivation, and 18.8% did not initiate treatment as a result of adverse events. Immunological status (35%). as well as psychiatric and neurological disorders (28.3%) were the main medical reasons for contraindication. Aspects associated to prison environment such as impending release or change of prison (64.4%) were among the various reasons that

influenced treatment initiation. CONCLUSIONS: Lack of motivation and awareness in patients as well as adverse events were the main reasons for not initiating therapy. These factors are subjective, modifiable aspects that depend on patient education and adequate medical care. PMID: 21750854 [PubMed - indexed for MEDLINE] 53. Rev Esp Sanid Penit. 2011 Oct;13(2):38-43. doi: 10.1590/S157506202011000200002. [Evolution of the main diagnoses of hospital discharges amongst the prison population in Valencia, 2000-2009]. [Article in Spanish] Abad-Prez I, Carbonell-Franco E, Navarro-Garca D, Roig-Sena FJ, Salazar A. Unitat de Documentac Clnica i Admissi, Consorci Hospital General Universitari, Valncia, Espaa. Comment in Rev Esp Sanid Penit. 2011 Feb;13(3):114. The aim of our study was to quantify the hospital demand originating from prisons and describe the main diagnoses as a measure of prevalence, as well as communicable diseases and their evolution during the period 2000-09. Using the discharge records of the University General Hospital under the terms of an agreement that meets the demand for hospitals from prisons in the province of Valencia, we carried out a cross-sectional study of the frequency distribution of diagnoses and their distribution according to personal characteristics. More than 2,415 discharges were recovered, which, after the removal of inconsistencies, provided 2,332 episodes of hospitalization. The average age of the subject ranged from 32.8 to 39.5 years. The most common grouped primary and secondary diagnoses (table 2) were: 1. HIV (34.05%), 2. Hepatitis C (14.67%), 3 . Drug dependence (10.25%), 4 . Pneumonia (8.58%), 5. TBC (7.46%). In the last decade there has been a change in the patterns of infection in the prison population. This may be related to: the relative aging of the prison population, the replacement of intravenous use by other non-invasive means, the change of nationality of prisoners and therapeutic advances in the treatment of HIV infection. PMID: 21750853 [PubMed - indexed for MEDLINE] 54. Br J Nurs. 2011 May 27-Jun 9;20(10):611-4.

Prisoner health: assessing a nurse-led hepatitis C testing clinic. Perrett SE. South East Wales Health Protection Team, Public Health Wales, Temple of Peace and Health, Cardiff. Prisons provide an ideal setting in which to carry out blood-borne virus testing among a high-risk population. This paper describes a nurse-led testing programme offered to all prisoners within the substance misuse unit at a local prison in South Wales over a 4-year period. Challenges to organizing such a clinic within the prison setting are discussed. Between April 2006 and April 2010, approximately 4500 prisoners were admitted through the substance misuse unit. Blood-borne virus testing took place among 176 prisoners, of which 24 were hepatitis C seropositive, 19 were confirmed as virus-positive, and eight were referred to specialist teams to consider treatment. Among prison populations blood-borne virus testing needs to be encouraged and improved. Offering testing provides opportunities for harm minimization, education and referrals for treatment. Such provisions are needed to benefit the health of individuals, their families and the wider public health. PMID: 21646992 [PubMed - indexed for MEDLINE] 55. Br J Nurs. 2011 May 27-Jun 9;20(10):605-6, 608, 610. Prisoner health: HIV infection and other blood-borne viral infections. Peate I. School of Nursing, Midwifery and Healthcare, Faculty of Health and Human Sciences, University of West London. All prisoners should be entitled to the same standards of health care as the general population. This is the principle of equivalence. Inmates who are physically or mentally ill, addicted to substances, or disabled should receive equivalent care to what is expected of the NHS. There are a number of variations and inequalities in the health services that prisoners receive across the UK. A number of prisons have no policies in place for HIV, hepatitis C or sexual health. The prevalence of HIV is significantly higher in the prison population than it is in the wider community. This article considers and outlines the important principle of equivalence and the needs of the prison population in relation to HIV infection and other blood-borne virus infections. Methods used to minimize risk are described and the importance of development, implementation and evaluation of harm minimization strategies are discussed. The term 'prison' in

this article is used to identify all places of detention in England and the term 'prisoner' is used to describe all adults who are held in such places. Prison services and healthcare provision in other UK countries are also outlined. PMID: 21646991 [PubMed - indexed for MEDLINE] 56. N Engl J Med. 2011 Jun 9;364(23):2199-207. doi: 10.1056/NEJMoa1009370. Epub 2011 Jun 1. Outcomes of treatment for hepatitis C virus infection by primary care providers. Arora S, Thornton K, Murata G, Deming P, Kalishman S, Dion D, Parish B, Burke T, Pak W, Dunkelberg J, Kistin M, Brown J, Jenkusky S, Komaromy M, Qualls C. Department of Internal Medicine, University of New Mexico, Albuquerque, USA. sarora@salud.unm.edu Comment in Hepatology. 2011 Dec;54(6):2258-60. N Engl J Med. 2011 Jun 9;364(23):2258-9. N Engl J Med. 2011 Sep 8;365(10):959-60; author reply 960. BACKGROUND: The Extension for Community Healthcare Outcomes (ECHO) model was developed to improve access to care for underserved populations with complex health problems such as hepatitis C virus (HCV) infection. With the use of video-conferencing technology, the ECHO program trains primary care providers to treat complex diseases. METHODS: We conducted a prospective cohort study comparing treatment for HCV infection at the University of New Mexico (UNM) HCV clinic with treatment by primary care clinicians at 21 ECHO sites in rural areas and prisons in New Mexico. A total of 407 patients with chronic HCV infection who had received no previous treatment for the infection were enrolled. The primary end point was a sustained virologic response. RESULTS: A total of 57.5% of the patients treated at the UNM HCV clinic (84 of 146 patients) and 58.2% of those treated at ECHO sites (152 of 261 patients) had a sustained viral response (difference in rates between sites, 0.7 percentage points; 95% confidence interval, -9.2 to 10.7; P=0.89). Among patients with HCV genotype 1 infection, the rate of sustained viral response was 45.8% (38 of 83 patients) at the UNM HCV clinic and 49.7% (73 of 147 patients) at ECHO sites (P=0.57). Serious adverse events occurred in 13.7% of the patients at the UNM HCV clinic and in 6.9% of the patients at ECHO sites. CONCLUSIONS: The results of this study show that the ECHO model is an effective way to treat HCV infection in underserved communities. Implementation of this

model would allow other states and nations to treat a greater number of patients infected with HCV than they are currently able to treat. (Funded by the Agency for Healthcare Research and Quality and others.). PMID: 21631316 [PubMed - indexed for MEDLINE] 57. BMC Public Health. 2011 May 19;11:351. doi: 10.1186/1471-2458-11-351. A hepatitis A, B, C and HIV prevalence and risk factor study in ever injecting and non-injecting drug users in Luxembourg associated with HAV and HBV immunisations. Removille N, Origer A, Couffignal S, Vaillant M, Schmit JC, Lair ML. Centre de Recherche Public de la Sant, Luxembourg. nathalie.removille@crp-sante.lu BACKGROUND: In Luxembourg, viral hepatitis and HIV infection data in problem drug users (PDUs) are primarily based on self-reporting. Our study aimed to determine the prevalence of HAV, HBV, HCV and HIV infections in ever injecting (IDUs) and non-injecting drug users (nIDUs) including inherent risk factors analysis for IDUs. Secondary objectives were immunisation against HAV and HBV, referral to care and treatment facilities as well as reduction in risk behaviour. METHODS: A nationwide, cross-sectional multi-site survey, involving 5 in-, 8 out-treatment and 2 prison centres, included both an assisted questionnaire (n = 368) and serological detection of HIV and Hepatitis A, B, C (n = 334). A response rate of 31% resulted in the participation of 310 IDUs and 58 nIDUs. Risk factors such as drug use, sexual behaviour, imprisonment, protection and health knowledge (HAV, HBV status and immunisations, HCV, HIV), piercing/tattoo and use of social and medical services were studied by means of chi2 and logistic models. RESULTS: Seroprevalence results for IDUs were 81.3% (218/268, 95%CI=[76.6; 86.0]) for HCV, 29.1% (74/254, 95%CI=[25.5;34.7 ]) for HBV (acute/chronic infection or past cured infection), 2.5% (5/202, 95%CI=[0.3; 4.6]) for HIV-1 and 57.1% (108/189, 95%CI=[50.0; 64.1]) for HAV (cured infections or past vaccinations). Seroprevalence results for nIDUs were 19.1% (9/47, 95%CI=[7.9;30.3]) for HCV, 8.9% (4/45, 95%CI=[0.6;17.2]) for HBV (acute/chronic infection or past cured infection), 4.8% (2/42, 95%CI=[-1.7;11.3]) for HIV-1 and 65.9% (27/41, 95%CI=[51.4;80.4]) for HAV. Prisoners showed the highest rates for all infections. Age, imprisonment and setting of recruitment were statistically associated with HCV seropositivity. Age, speedball career and nationality were significantly associated with HBV seropositivity. Only 56% of the participants in outpatient centres collected their serology results and 43 doses of vaccine against HAV and/or HBV were administered. CONCLUSIONS: Despite the existing national risk-reduction strategies implemented since 1993, high prevalence of HCV and HBV infections in injecting drug users is

observed. Our study showed that implementing risk-prevention strategies, including immunisation remains difficult with PDUs. Improvement should be looked for by the provision of field healthcare structures providing tests with immediate results, advice, immunisation or treatment if appropriate. PMCID: PMC3123592 PMID: 21595969 [PubMed - indexed for MEDLINE] 58. J Acquir Immune Defic Syndr. 2011 Aug 15;57(5):429-34. doi: 10.1097/QAI.0b013e31821e9f41. HIV risk after release from prison: a qualitative study of former inmates. Adams J, Nowels C, Corsi K, Long J, Steiner JF, Binswanger IA. Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Denver, CO 80204, USA. Jennifer.adams@dhha.org BACKGROUND: Former prison inmates are at risk for HIV and hepatitis C (HCV) infection. This study was designed to understand how former inmates perceived their risk for HIV and HCV infection after release from prison, the behaviors and environmental factors that put patients at risk for new infection, and the barriers to accessing health care. METHODS: This was a qualitative study using individual, face-to-face, semistructured interviews exploring participants' perceptions and behaviors putting them at risk for HIV and HCV infection and barriers to engaging in regular medical care after release. Interview transcripts were coded and analyzed using a team-based general inductive approach. RESULTS: Participants were racially and ethnically diverse and consisted of 20 men and 9 women with an age range of 22-57 years who were interviewed within the first 2 months after their release from prison to the Denver, Colorado community. Four major themes emerged: (1) risk factors including unprotected sex, transactional sex, and drug use were prevalent in the postrelease period; (2) engagement in risky behavior occurred disproportionately in the first few days after release; (3) former inmates had educational needs about HIV and HCV infection; and (4) former inmates faced major challenges in accessing health care and medications. CONCLUSIONS: Risk factors for HIV and HCV infection were prevalent among former inmates immediately after release. Prevention efforts should focus on education, promotion of safe sex and needle practices, substance abuse treatment, and drug-free transitional housing. Improved coordination between correctional staff, parole officers, and community health care providers may improve continuity of care. PMCID: PMC3685495

PMID: 21522015 [PubMed - indexed for MEDLINE] 59. Braz J Infect Dis. 2011 Mar-Apr;15(2):163-6. Difficulties with interferon treatment in former intravenous drug users. Gazdag G, Horvth G, Szab O, Ungvari GS. Consultation-Liaison Psychiatric Service, Szent Istvn and Szent Lszl Hospitals, Gyali ut 5-7, Budapest, Hungary. gazdag@lamb.hu OBJECTIVES: Intravenous drug use accounts for most of the new hepatitis C infections worldwide. Although there is an urgent need for antiviral treatment of infected intravenous drug users (IDUs), several factors compromise their treatment including lack of treatment adherence and high dropout rate. The aim of this study was to compare antiviral treatment-related problems among former IDUs to HCV-infected patients without a history of IDU. METHODS: This was a retrospective chart review of HCV-infected IDUs who received combined antiviral therapy at the Hepatology Outpatient Clinic of Szent Lszl Hospital between 1 January 2006 and 31 December 2008. A control group of interferon treated patients with no history of IDU matched for age and sex was selected. RESULTS: Dropout rate was significantly higher in the IDU group (p = 0.016). Treatment response at the 12th week of treatment was significantly better in the IDU group (p = 0.004). Significantly more IDUs underwent antiviral treatment while in prison (p = 0.008). CONCLUSIONS: In this study higher dropout rate was found among IDUs. IDUs had a better response rate to antiviral therapy compared to controls. More attention should be paid to factors that worsen treatment adherence of IDUs - particularly lack of abstinence - in order to increase the effectiveness of antiviral therapy. PMID: 21503405 [PubMed - indexed for MEDLINE] 60. Rev Esp Sanid Penit. 2011;13(1):21-9. [Future perspective in the treatment of chronic hepatitis C]. [Article in Spanish] Fernndez-Montero JV, Soriano V. Servicio de Enfermedades Infecciosas, Hospital Carlos III, Madrid, Espaa. The main lines of research into new drugs and treatment strategies against type C

viral hepatitis are described. This disease is a major public health problem, with more than 700,000 people affected by the illness in Spain and with a high degree of prevalence amongst prison inmates. Limitations on current treatment for viral hepatitis C have led to research into new drugs in the form of two main product lines, some of which are soon to be available on the market: NS3/4 serine-protease inhibitors (telaprevir, boceprevir, danoprevir and vaniprevir) and the NS5B RNA polymerase inhibitors (RG-7128, RG-7227, Filibuvir, ANA-598). The latter are in a somewhat earlier stage of development. It is expected that these new drugs will have to be used alongside the current standard treatment of pegylated interferon plus ribavirin and under these conditions of use the new drugs have already shown greater effectiveness than the current standard treatment. Despite this encouraging perspective, the new medicines have limitations such as the development of resistances, toxicity, and the little knowledge available of their effectiveness on viral genotypes that are different from 1. That being said, their appearance opens up new possibilities in the treatment of this disease. PMID: 21484075 [PubMed - indexed for MEDLINE] 61. J Urban Health. 2011 Aug;88(4):690-9. doi: 10.1007/s11524-011-9565-6. Results of a pilot study of pre-release STD testing and inmates' risk behaviors in an Ohio prison. Sieck CJ, Dembe AE. College of Public Health, Center for Health Outcomes, Policy & Evaluation Studies, The Ohio State University, Ohio, OH, USA. csieck@cph.osu.edu This study presents the results of a pilot study of mandatory pre-release testing for sexually transmitted disease (STD) and a behavioral risk survey for male inmates at an Ohio prison. Approximately 4-6 weeks prior to scheduled release, inmates took part in a mandatory blood test and optional genital swab and physical examination to test for STDs. At the time of testing, a voluntary behavioral and knowledge survey was administered to inmates. Pre-release testing identified 53 new cases of STDs among the 916 inmates (5.5%) scheduled for release during the pilot study period. Trichomoniasis and hepatitis C were the most common infections identified through pre-release testing. Nearly all inmates participated in the required blood test. Participation rates for the other testing methods averaged less than 45%. Inmates reported engaging in various risky behaviors during incarceration such as having sex (12.1%), tattooing (36.5%), and drug use (19.5%). Pre-release testing identified several new cases of STDs not identified through existing intake and for-cause testing procedures. Substantial useful information about the prevalence of STD risk behaviors can be obtained through a pre-release survey.

PMCID: PMC3157500 PMID: 21448579 [PubMed - indexed for MEDLINE] 62. HIV AIDS Policy Law Rev. 2010 Oct;15(1):5-6. HIV prevalence in prison is 15 times greater than in the community as a whole. [No authors listed] A report released in April 2010 by Correctional Service of Canada (CSC) on infectious diseases and risky behaviours reveals elevated HIV and hepatitis C (HCV) rates in federal prisons, and calls for the implementation of urgent comprehensive harm reduction measures. PMID: 21413606 [PubMed - indexed for MEDLINE] 63. J Public Health (Oxf). 2011 Jun;33(2):197-204. doi: 10.1093/pubmed/fdr011. Epub 2011 Feb 23. Hepatitis C and B testing in English prisons is low but increasing. Kirwan P, Evans B; Sentinel Surveillance of Hepatitis Testing Study Group, Brant L. Health Protection Agency Centre for Infections, London, UK. BACKGROUND: Prisons are important settings for blood-borne virus control because of the high prevalence of hepatitis C and B viral infections (HCV and HBV), and behaviours associated with transmission among prisoners. METHODS: Data from sentinel laboratories in England were used to identify testing for hepatitis C (anti-HCV) and hepatitis B [hepatitis B surface antigen (HBsAg) and anti-hepatitis B core antigen (HBc)] among male and female prisoners between 2005 and 2008. RESULTS: Between 2005 and 2008, 10 723 prisoners from 39 prisons in England were tested for anti-HCV, anti-HBc and/or HBsAg. Overall, 24.2% prisoners tested positive for anti-HCV. Anti-HCV testing increased 47% over 4 years (P < 0.001), whilst the proportion testing positive decreased significantly from 26% in 2005 to 23% in 2008 ((2)= 10.0, df = 3, P = 0.030). In total, 13.9% people tested positive for anti-HBc. Of 5151 people tested for anti-HBc, 4433 were also tested for HBsAg; of these 2.4% were HBsAg positive. HBsAg testing increased 35% between 2005 and 2008, with no significant change in the proportion testing positive. Between 2005 and 2008, 2.4% (CI: 2.32-2.43%) of the prison population (24 prisons) were estimated to have been tested for anti-HCV.

CONCLUSIONS: Although hepatitis testing has increased, only a small proportion of the prison population were tested. More testing is required to identify infected prisoners and refer them for appropriate treatment. PMID: 21345883 [PubMed - indexed for MEDLINE] 64. Eur J Clin Microbiol Infect Dis. 2011 Jul;30(7):857-62. doi: 10.1007/s10096-011-1166-5. Epub 2011 Jan 28. Hepatitis C and B prevalence in Spanish prisons. Saiz de la Hoya P, Marco A, Garca-Guerrero J, Rivera A; Prevalhep study group. Collaborators: de la Hoya Saiz P, Marco A, Garca-Guerrero J, Rivera A, Bedia M, Castro JM, Faraco I, Hoyos C, Isaach MD, De Juan J, Lpez-Palacios G, Mallo A, Martnez-Prez J, Moreno R, Planella R, Pozo E, Quionero J, Sternberg F, Teixido N, Vasallo L. Servicios Mdicos, Centro Penitenciario Fontcalent, 03113, Alicante, Spain. pabloshz@coma.es Purpose The Prevalhep study seeks to determine the prevalence of factors associated with the hepatitis C (HCV) and B (HBV) virus in Spanish prisoners. Methods This was an observational, cross-sectional study which randomly selected 18 Spanish prisons to participate, with 21 prisoners per centre. Results There were 378 prisoners selected, 370 of whom had serological HCV and 342 had HBV data. The HCV population was predominantly male (91.6%), middle age (66.7% 40 years of age), of Spanish origin (60.5%), with a history of injection drug use (IDU; 23.2%), in prison <5 years (71.2%) and having entered prison after 2006 (51.9%). The prevalence of HCV was 22.7% (n = 84; 95% CI, 18.3-27.1) and HBV was 2.6% (n = 9; 95% CI, 0.2-4.9%). Of the patients with HCV, 40.5% were co-infected with HIV, 0.3% co-infected with HBV, and 1.5% with triple virus co-infection (HBV + HCV + HIV). The three markers of HB had been measured in 99 inmates: 32.1% had post-vaccination immunity (antiHBS+) and 30.4% contact status with HBV (HBcAb + and/or HBsAg+), while 37.5% were susceptible to HB. Conclusions The prevalence of HBV and HCV has decreased in the Spanish prison population, probably as a result of decrease in IDU transmission, and an increase in immigrant prisoner population that does not have this risk behaviour. PMID: 21274586 [PubMed - indexed for MEDLINE] 65. Dig Liver Dis. 2011 Aug;43(8):589-95. doi: 10.1016/j.dld.2010.12.004. Epub 2011 Jan 21.

Recommendations for the prevention, diagnosis, and treatment of chronic hepatitis B and C in special population groups (migrants, intravenous drug users and prison inmates). Almasio PL, Babudieri S, Barbarini G, Brunetto M, Conte D, Dentico P, Gaeta GB, Leonardi C, Levrero M, Mazzotta F, Morrone A, Nosotti L, Prati D, Rapicetta M, Sagnelli E, Scotto G, Starnini G. Gastroenterology and Hepatology Unit, University of Palermo, Palermo, Italy. The global spread of hepatitis B virus (HBV) and hepatitis C virus (HCV), their high chronicity rates and their progression to cirrhosis and hepatocellular carcinoma, are major public health problems. Research and intervention programmes for special population groups are needed in order to assess their infection risk and set up suitable prevention and control strategies. Aim of this paper is to give health care professionals information on HBV and HCV infections amongst migrants, drug users and prison inmates. The manuscript is an official Position Paper on behalf of the following Scientific Societies: Italian Association for the Study of the Liver (A.I.S.F.), Italian Society of Infectious and Tropical Diseases (S.I.M.I.T.), Italian Federation Department's Operators and Addiction Services (FederSerD), Italian Prison Medicine and Healthcare Society (S.I.M.S.Pe.). The considered population groups, having a high prevalence HBV and HCV infections, require specific interventions. In this context, the expression "special population" refers to specific vulnerable groups at risk of social exclusion, such as migrants, prison inmates, and intravenous drug users. When dealing with special population groups, social, environmental and clinical factors should be considered when selecting candidates for therapy as indicated by national and international guidelines. Copyright 2010 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved. PMID: 21256097 [PubMed - indexed for MEDLINE] 66. Am J Epidemiol. 2011 Mar 1;173(5):479-87. doi: 10.1093/aje/kwq422. Epub 2011 Jan 14. Prisoner survival inside and outside of the institution: implications for health-care planning. Spaulding AC, Seals RM, McCallum VA, Perez SD, Brzozowski AK, Steenland NK. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA. aspauld@emory.edu

Comment in Am J Epidemiol. 2011 Mar 1;173(5):488-91. The life expectancy of persons cycling through the prison system is unknown. The authors sought to determine the 15.5-year survival of 23,510 persons imprisoned in the state of Georgia on June 30, 1991. After linking prison and mortality records, they calculated standardized mortality ratios (SMRs). The cohort experienced 2,650 deaths during follow-up, which were 799 more than expected (SMR = 1.43, 95% confidence interval (CI): 1.38, 1.49). Mortality during incarceration was low (SMR = 0.85, 95% CI: 0.77, 0.94), while postrelease mortality was high (SMR = 1.54, 95% CI: 1.48, 1.61). SMRs varied by race, with black men exhibiting lower relative mortality than white men. Black men were the only demographic subgroup to experience significantly lower mortality while incarcerated (SMR = 0.66, 95% CI: 0.58, 0.76), while white men experienced elevated mortality while incarcerated (SMR = 1.28, 95% CI: 1.10, 1.48). Four causes of death (homicide, transportation, accidental poisoning, and suicide) accounted for 74% of the decreased mortality during incarceration, while 6 causes (human immunodeficiency virus infection, cancer, cirrhosis, homicide, transportation, and accidental poisoning) accounted for 62% of the excess mortality following release. Adjustment for compassionate releases eliminated the protective effect of incarceration on mortality. These results suggest that the low mortality inside prisons can be explained by the rarity of deaths unlikely to occur in the context of incarceration and compassionate releases of moribund patients. PMCID: PMC3044840 PMID: 21239522 [PubMed - indexed for MEDLINE] 67. Neuropsychopharmacol Hung. 2010 Dec;12(4):459-62. Barriers to antiviral treatment in hepatitis C infected intravenous drug users. Gazdag G, Horvath G, Szabo O, Ungvari GS. Consultation-Liaison Psychiatric Service, Szent Istvn and Szent Lszl Hospitals, Budapest, Hungary. gazdag@lamb.hu BACKGROUND: Nowadays intravenous drug use is the main source of hepatitis C transmission, but only a small proportion of those who acquired infection via intravenous drug use receive antiviral treatment. AIM: to assess the barriers of access to antiviral treatment of infected intravenous drug users. METHODS: A retrospective chart review was carried out in a hepatology outpatient clinic including all hepatitis C infected intravenous drug users in a 3-year period.

RESULTS: Only one-third of the infected former intravenous drug users received antiviral treatment. The main barrier to antiviral treatment was the lack of abstinence. Former intravenous drug users in prison or in long-term drug rehabilitation institutes were more likely to enter antiviral treatment. CONCLUSIONS: The low proportion of patients entering antiviral treatment calls the attention to further improving the pretreatment management of this patient population. Special attention should be paid to the maintenance of abstinence. PMID: 21220790 [PubMed - indexed for MEDLINE] 68. Compr Psychiatry. 2011 Nov-Dec;52(6):763-8. doi: 10.1016/j.comppsych.2010.10.015. Epub 2010 Dec 30. Gender differences in the perceived self-efficacy of safer HIV practices among polydrug abusers in Taiwan. Lee TS, Chen YP, Chang CW. Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei City, 106 Taiwan. tonylee@ntnu.edu.tw Studies have documented that the perceived self-efficacy of attempts to engage in safer behavior is critical for the prevention of blood-borne diseases, including hepatitis C and HIV. The aim of this study was to examine gender differences in the perceived self-efficacy of safer HIV-related behavior among heroin and amphetamine abusers. Of the eligible participants from Taiwan prisons, 1622 polydrug users voluntarily agreed to complete a questionnaire regarding HIV risks. Participants had to be polydrug abusers (amphetamines and heroin), 18 years or older, sexually experienced, and literate. The questionnaire addressed background information, drug abuse, sexual behavior, and perceived self-efficacy in drug- and sex-related HIV risk situations. Twenty-four percent of respondents were HIV positive. Compared to men, women started illicit drug use at a younger age and were less likely to share syringes. Women also tended to have their first sexual coitus at an older age and were less likely to use a condom in their last sexual encounter. Men were more likely to have multiple sexual partners in the past 6 months. Results from a multinomial logistic regression indicate that gender, age, their interaction, age of first sexual encounter, HIV knowledge, condom use at last sexual encounter, and multiple sexual partners were associated with perceived self-efficacy of condom use. Results also show that gender, HIV serostatus, HIV knowledge, condom use at last sexual encounter, and sharing needles at last injection were associated with perceived self-efficacy in not sharing needles. The findings provide evidence for gender differences among polydrug abusers in Taiwan regarding perceived self-efficacy in adopting HIV prevention practices. Findings also provide evidence that knowledge about HIV

transmission is related to perceived self-efficacy in promoting safe behavior. To raise polydrug abusers' perceived self-efficacy, gender and HIV/AIDS education must be taken into consideration in counseling and/or public health education related to HIV prevention for drug abusers. Copyright 2011 Elsevier Inc. All rights reserved. PMID: 21195395 [PubMed - indexed for MEDLINE] 69. Iran Red Crescent Med J. 2011 Jan;13(1):42-6. Epub 2011 Jan 1. Seroprevalence of HIV, HBV and HCV in Persons Referred to Hamadan Behavioral Counseling Center, West of Iran. Keramat F, Eini P, Majzoobi MM. Department of Infectious Diseases, Hamadan University of Medical Sciences, Hamadan, Iran. BACKGROUND: Human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) are three important prevalent infections all over the world. The aim of this study was to determine seroprevalence of HIV, HBV and HCV infections and high risk behaviors in persons who referred to the behavioral counseling center of Hamadan, west of Iran. METHODS: This was a cross-sectional study which was done on 379 persons who referred to the behavioral counseling center of Hamadan. All persons after obtaining the informed consent were tested for serologic markers including HBs Ag, HCV-Ab and HIV-Ab by ELISA and western blot methods. RESULTS: Of the 379 persons, 71.5 % (271 cases) were male and 28.5% (108 cases) were female. HIV infection was reported in 4% (15) of persons. HBV and HCV infections were reported in 2.9% (11 cases) and 35.6% (135 cases), respectively. The most common high risk behaviors were injection drug user and history of prison with 52.5% (199 cases) and 40.4% (153 cases), respectively. CONCLUSION: According to the results, injection drug users and prisoners are at the highest risk for HCV, HIV and HBV infections. PMCID: PMC3407584 PMID: 22946017 [PubMed] 70. Clin Infect Dis. 2011 Feb 1;52(3):361-3. doi: 10.1093/cid/ciq159. Epub 2010 Dec 28. A "one-two punch" leading to hepatitis C seroconversion.

Nagami EH, Kim AY, Birch CE, Bowen MJ, McGovern BH. Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology, and Harvard University, USA. enagami@partners.org We report a case of acute hepatitis C virus infection that occurred after a traumatic altercation among prison inmates. This report has significant implications for infection control policies and procedures in prisons and jails, where the estimated prevalence of hepatitis C virus infection is 20 times that of the general population. PMCID: PMC3060887 PMID: 21189425 [PubMed - indexed for MEDLINE] 71. BMC Public Health. 2010 Dec 21;10:777. doi: 10.1186/1471-2458-10-777. HIV and hepatitis B and C incidence rates in US correctional populations and high risk groups: a systematic review and meta-analysis. Gough E, Kempf MC, Graham L, Manzanero M, Hook EW, Bartolucci A, Chamot E. Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA. BACKGROUND: High Human Immunodeficiency Virus (HIV) prevalence and high risk behaviors have been well documented within United States (US) correctional systems. However, uncertainty remains regarding the extent to which placing people in prison or jail increases their risk of HIV infection, and regarding which inmate populations experience an increased incidence of HIV. Describing these dynamics more clearly is essential to understanding how inmates and former detainees may be a source for further spread of HIV to the general US population. METHODS: The authors conducted a systematic review and meta-analysis of studies describing HIV incidence in US correctional facility residents and, for comparison, in high risk groups for HIV infection, such as non-incarcerated intravenous drug users (IVDU) and men who have sex with men (MSM) in the US. HIV incidence rates were further compared with Hepatitis B and Hepatitis C Virus rates in these same populations. RESULTS: Thirty-six predominantly prospective cohort studies were included. Across all infection outcomes, continuously incarcerated inmates and treatment recruited IVDU showed the lowest incidence, while MSM and street recruited IVDU showed the highest. HIV incidence was highest among inmates released and re-incarcerated. Possible sources of heterogeneity identified among HIV studies were risk population and race. CONCLUSIONS: Although important literature gaps were found, current evidence suggests that policies and interventions for HIV prevention in correctional

populations should prioritize curtailing risk of infection during the post-release period. Future research should evaluate HIV incidence rates in inmate populations, accounting for proportion of high risk sub-groups. PMCID: PMC3016391 PMID: 21176146 [PubMed - indexed for MEDLINE] 72. Int J Drug Policy. 2011 Mar;22(2):145-52. doi: 10.1016/j.drugpo.2010.10.006. Epub 2010 Dec 10. Prevalence of HIV, hepatitis B and hepatitis C and associated risk behaviours amongst injecting drug users in three Afghan cities. Nasir A, Todd CS, Stanekzai MR, Bautista CT, Botros BA, Scott PT, Strathdee SA, Tjaden J. International Rescue Committee, Kabul, Afghanistan. BACKGROUND: HIV amongst injecting drug users (IDUs) has been described in Kabul but little data exists for other Afghan cities. We assessed HIV, hepatitis B virus (HBV), and C virus (HCV) prevalence and associated risk behaviours amongst IDUs in Hirat, Jalalabad, and Mazar-i-Sharif, Afghanistan. METHODS: Consented participants reporting injecting drugs within the previous 6 months completed interviewer-administered questionnaires and testing for HIV, hepatitis C antibody (HCV Ab), and hepatitis B surface antigen (HBsAg). Logistic regression was used to determine characteristics associated with each infection. RESULTS: Of 623 participants, most (98.7%) were male. Prevalence of HIV, HCV, and HBV was 1.8% (95% CI: 0.88-3.2), 36.0% (95% CI: 33-41), and 5.8% (95% CI: 3.9-7.6), respectively. All HIV cases and highest HCV prevalence were detected in Hirat; HBV prevalence was highest in Jalalabad. Amongst male IDUs, 62.9% had been imprisoned, of whom 17.2% (n=66) injected in prison. High risk behaviours were common; 30.2% reported needle sharing in the last 6 months, 23.1% reported sex with another male, and 50.4% reported paying females for sex. Behaviours varied significantly by site; generally, Hirat participants reported fewer sexual risk behaviours. Sex with other males was negatively associated with both HBV and HCV in multivariate logistic regression analysis; no injecting behaviours were associated with both HBV and HCV. CONCLUSIONS: Whilst HIV prevalence is low, HCV prevalence and high risk behaviours were common in these populations. Regional variations should be considered in programming to prevent transmission of HIV and viral hepatitis amongst IDUs in Afghanistan. Copyright 2010 Elsevier B.V. All rights reserved. PMID: 21146392 [PubMed - indexed for MEDLINE]

73. Rev Esp Salud Publica. 2010 Jul-Aug;84(4):423-31. [Predictors of adherence to treatment of chronic hepatitis C in drug-dependent inmate patients in four prisons in Barcelona, Spain]. [Article in Spanish] Marco Mourio A, da Silva Morn A, Ortiz Seuma J, Sol Carb C, Roget Alemany M, Sarriera Gracia C, Teixid Prez N, Robres Guilln P, Guerrero Moreno RA. Servicios Mdicos Penitenciarios, La Modelo, Barcelona. andres.marco.m@gmail.com BACKGROUND: Drug addiction is not a contraindication to indicate treatment of chronic hepatitis C (CHC), but it has been observed that consumers are more abandon. To study the clinical outcome of hepatitis C treatment in inmate patients with a history in injecting drugs and to analyze which were the causes of abandon. METHODS: A multicenter retrospective clinical trial including 162 inmate patients that underwent HCV therapy with pegylated interpheron and ribavirin between January 2003 and January 2008 was performed. It was found in medical history who completed treatment. We used a questionnaire to determine variables associated with discontinuation of treatment and multivariate analysis was performed using logistic regression to identify predictors. RESULTS: 82.7% were intravenous drug users, 21.7% had HIV coinfection and 20.5% were on methadone maintenance therapy. 91.4% completed the whole treatment; 33.1% admitted heroin and/or cocaine consumption during therapy and 7.9% admitted needle and syringe-sharing. Relapse in intravenous consumption in or out of prison was the only one predictive factor of treatment interruption (OR: 10.39, IC: 1.93-55.88; p = 0.006). CONCLUSION: Only 9,6% of patients discontinued treatment. Drug use was the main cause of discontinuation of treatment. We recommend the treatment of drug addiction to reduce the discontinuations of treatment for chronic hepatitis C. PMID: 21141269 [PubMed - indexed for MEDLINE] 74. J Health Care Poor Underserved. 2010 Nov;21(4):1194-202. doi: 10.1353/hpu.2010.0938. Incarceration as a risk factor for hepatitis C virus (HCV) and human immunodeficiency virus (HIV) co-infection in Mississippi. Burton MJ, Reilly KH, Penman A.

University of Mississippi Medical Center, Jackson, Mississippi, USA. mary.burton2@va.gov BACKGROUND: Injection drug use (IDU) is the most commonly recognized risk factor for co-infection with human immunodeficiency virus (HIV) and hepatitis C virus (HCV). We examined risks for HIV/HCV co-infection in a population with a low rate of IDU. METHODS: A sample of 32 HIV/HCV co-infected patients and 79 HIV-infected patients were enrolled from two clinics in Mississippi. Patients completed an audio computer-assisted self-interview (ACASI) assessing risks for infection with both viruses. RESULTS: In a multivariable logistic regression model, greater age (p=.01), alcohol use (p=.02), history of incarceration (p=.04), and blood transfusion prior to 1992 (p=.03) were independently associated with HIV/HCV co-infection. CONCLUSIONS: Incarceration was significantly associated with HIV-HCV co-infection in our sample. Further examination is warranted to develop policies for HCV prevention and treatment within the prison system. PMID: 21099071 [PubMed - indexed for MEDLINE] 75. J Infect. 2011 Jan;62(1):59-66. doi: 10.1016/j.jinf.2010.10.011. Epub 2010 Nov 16. Hepatitis A, B, C and HIV infections among Finnish female prisoners--young females a risk group. Viitanen P, Vartiainen H, Aarnio J, von Gruenewaldt V, Hakamki S, Lintonen T, Mattila AK, Wuolijoki T, Joukamaa M. Prison Health Services, Vanajantie 10 B, Hmeenlinna, Finland. paivi.viitanen@om.fi OBJECTIVES: Previous prison studies have shown that the female gender is associated with higher hepatitis C prevalence. However, there are few prison studies of gender differences concerning the risk factors of hepatitis C infections. We studied the prevalence of hepatitis and HIV infections and the risk factors among Finnish female prisoners. METHODS: The material consisted of 88 females and 300 male prisoners as controls. RESULTS: The prevalence of hepatitis C virus antibodies was 52%, hepatitis B surface antigen 0%, hepatitis A virus antibodies 38% and HIV antibodies 1% among women, and 44%, 0.7%, 4% and 0.7% respectively among men. Among women, 71% of the age group 16-24 had HCV. There was no significant association between gender and HCV. Women were more commonly sharing syringes/needles and had unsafe sexual habits. Among women, HCV was associated only with IDU and syringe/needle sharing

whereas among men also with tattoos, cumulative years in prison and age. CONCLUSIONS: Especially young females had a high prevalence of HCV. The study showed that the risk factors are differentiated by gender. This should be taken into account when assessing earlier studies which mainly concentrate on men. Copyright 2010 The British Infection Association. Published by Elsevier Ltd. All rights reserved. PMID: 21087630 [PubMed - indexed for MEDLINE] 76. J Acquir Immune Defic Syndr. 2010 Dec;55 Suppl 1:S37-42. doi: 10.1097/QAI.0b013e3181f9c0b6. Infectious disease comorbidities adversely affecting substance users with HIV: hepatitis C and tuberculosis. Friedland G. AIDS Program, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA. gerald.friedland@yale.edu The linkage between drug use, particularly injection drug use, and HIV/AIDS, hepatitis C (HCV), and tuberculosis (TB) has been recognized since the beginning of the HIV pandemic. These comorbid conditions affect drug users worldwide and act synergistically, with resultant adverse biologic, epidemiologic, and clinical consequences. Prevention, care, and treatment of TB and HCV can be successful, and both diseases can be cured. Special clinical challenges among drug users, however, can result in increased morbidity, mortality, and decreased therapeutic success. Among these are limited disease screening, inadequate and insensitive diagnostics, difficult treatment regimens with varying toxicities, and complicated pharmacokinetic and pharmacodynamic drug interactions. These may result in delayed diagnosis, deferred treatment initiation, and low completion rates, with the potential for generation and transmission of drug resistant organisms. Strategies to address these challenges include outreach programs to engage substance abusers in nonmedical settings, such as prisons and the streets, active screening programs for HIV, HCV, and TB, increased and broadened clinician expertise, knowledge and avoidance of drug interactions, attention to infection control, use of isoniazid preventive therapy, and creative strategies to insure medication adherence. All of these require structural changes directed at comprehensive prevention and treatment programs and increased collaboration and integration of needed services for substance abusers. PMID: 21045598 [PubMed - indexed for MEDLINE]

77. Hepatology. 2010 Nov;52(5):1564-72. doi: 10.1002/hep.23885. Frequent multiple hepatitis C virus infections among injection drug users in a prison setting. Pham ST, Bull RA, Bennett JM, Rawlinson WD, Dore GJ, Lloyd AR, White PA. School of Biotechnology and Biomolecular Sciences, Faculty of Science, Sydney, Australia. Recent data indicate that multiple hepatitis C virus (HCV) infections (mixed infection, superinfection, and reinfection) are common among injection drug users (IDUs). In this study, we identified and characterized multiple HCV infection episodes among HCV-seronegative IDU prison inmates (n = 488) enrolled in the Hepatitis C Incidence and Transmission Study cohort. Incident HCV infection with detectable HCV RNA was identified in 87 subjects, 48 of whom completed additional follow-up to screen for reinfection or superinfection. All HCV RNA-detectable samples were tested for multiple infection through a series of specifically designed nested reverse-transcription polymerase chain reaction (nRT-PCR) with sequencing and HCV RNA level measurement. Sequencing revealed that 22 of 87 (25.3%) subjects were infected by two or more viruses. Nine (10.3%) subjects were designated as prevalent cases of incident mixed infection, because two distinct HCV strains were detected at the first viremic time point. Fifteen further cases of multiple HCV infection (superinfection or reinfection) were identified, two of which also showed baseline incident mixed infections. The incidence of new HCV infection (superinfection and reinfection) during follow-up was 40/100 person-years (95% confidence interval, 33-44/100 person-years). Spontaneous clearance of viruses from one subtype and persistence of the other subtype after mixed infection was observed in eight subjects. In these subjects, the virus with higher HCV RNA levels superseded the other.CONCLUSION: This study comprehensively analyzed frequent multiple HCV infections in a high-risk cohort and provides further insight into infection dynamics and immunity after exposure to variant viral strains. The data presented suggest that HCV RNA levels play an important role in viral competition. PMID: 21038409 [PubMed - indexed for MEDLINE] 78. BMC Public Health. 2010 Oct 22;10:633. doi: 10.1186/1471-2458-10-633. Incidence of primary hepatitis C infection and risk factors for transmission in an Australian prisoner cohort. Teutsch S, Luciani F, Scheuer N, McCredie L, Hosseiny P, Rawlinson W, Kaldor J, Dore GJ, Dolan K, Ffrench R, Lloyd A, Haber P, Levy M.

School of Medical Sciences, The University of New South Wales, Sydney, New South Wales, Australia. s.teutsch@unsw.edu.au BACKGROUND: Hepatitis C virus (HCV) infection is common in prisoner populations, particularly those with a history of injecting drug use (IDU). Previous studies of HCV incidence have been based on small case numbers and have not distinguished risk events in prison from those in the community. METHODS: HCV incidence was examined in a longitudinal cohort of 488 Australian prisoners with a history of IDU and documented to be seronegative within 12 months prior to enrollment. Inmates were tested for anti-HCV antibodies and viremia, and interviewed about demographic and behavioral risk factors for transmission. RESULTS: The cohort was predominantly male (65%) with high rates of prior imprisonment (72%) and tattooing (73%), as well as longstanding IDU (mean 8.5 years). Ninety-four incident HCV cases were identified (incidence 31.6 per 100 person years). Independent associations were observed between incident infection and prior imprisonment (p = 0.02) and tattooing (p = 0.03), and surprisingly also with methadone maintenance treatment (MMT) (p < 0.001). CONCLUSIONS: High rates of new HCV infection were found in this prisoner cohort reflecting their substantive risk behavior profile, despite having remained uninfected for many years. The association with MMT is challenging and highlights the need for better understanding of prison-specific HCV transmission risks, as well as the uptake and effectiveness of prevention programs. PMCID: PMC2975656 PMID: 20964864 [PubMed - indexed for MEDLINE] 79. Trop Med Int Health. 2010 Dec;15(12):1491-8. doi: 10.1111/j.1365-3156.2010.02655.x. Epub 2010 Oct 18. Human immunodeficiency virus, hepatitis B and hepatitis C in an Indonesian prison: prevalence, risk factors and implications of HIV screening. Nelwan EJ, Van Crevel R, Alisjahbana B, Indrati AK, Dwiyana RF, Nuralam N, Pohan HT, Jaya I, Meheus A, Van Der Ven A. Department of Internal Medicine, University of Indonesia, Jakarta, Indonesia. erninelwan@hotmail.com OBJECTIVE: To determine the prevalence and behavioural correlates of HIV, HBV and HCV infections among Indonesian prisoners and to examine the impact of voluntary counselling and testing for all incoming prisoners on access to antiretroviral treatment (ART). METHODS: In a non-anonymous survey in an Indonesian prison for drug-related

offences, all incoming prisoners and symptomatic resident prisoners were counselled and offered testing for HIV, hepatitis B and C. RESULTS: Screening was performed in 679 incoming prisoners, of whom 639 (94.1%) agreed to be tested, revealing a seroprevalence of 7.2% (95% CI 5.2-9.2) for HIV, 5.8% (95% CI 3.9-7.6) for HBsAg and 18.6% (95% CI 15.5-21.6) for HCV. Of 57 resident prisoners tested, 29.8% were HIV-positive. HIV infection was strongly associated with injecting drug use (IDU; P<0.001), but not with a history of unsafe sex. Screening of incoming prisoners was responsible for diagnosing and treating HIV in 73.0%, respectively, and 68.0% of HIV-positive individuals. CONCLUSIONS: HIV and HCV are highly prevalent among incoming Indonesian prisoners and almost entirely explained by IDU. Our study is the first to show that voluntary HIV counselling and testing during the intake process in prison may greatly improve access to ART in a developing country. 2010 Blackwell Publishing Ltd. PMID: 20955370 [PubMed - indexed for MEDLINE] 80. Cent Eur J Public Health. 2010 Jun;18(2):104-9. Seroprevalence of blood-borne infections and population sizes estimates in a population of injecting drug users in Croatia. Kolari B, Stajduhar D, Gajnik D, Rukavina T, Wiessing L. Public Health, Social Medicine and Gerontology Service, Zagreb County Institute of Public Health, Zagreb, Croatia. branko.kolaric@gmail.com Similar to some other Central European countries, Croatia has low HIV prevalence among injecting drug users (IDUs) but high hepatitis C (HCV) prevalence. This may indicate different patterns of risk behaviour in this region than in other parts of Europe. The main objectives of this study were to assess the seroprevalence of HIV and hepatitis B and C and related risk factors among IDUs in the three largest Croatian cities (Zagreb, Split, Rijeka) and within the national prison system, as well as to apply a multiplier-method population size estimation of IDUs in Zagreb, Split and Rijeka. Recruitment sites were selected in collaboration with the local public health institutes, NGOs, Centers for treatment municipalities and the judiciary system. Participants were recruited during September and October 2007. Trained peer-recruiters were used to recruit IDU participants at treatment and harm reduction centres as well as pre-identified social, commercial and street based venues. Participants completed the study questionnaire and provided venous blood samples for HIV, hepatitis B and hepatitis C testing. The study included 601 participants, of whom 121 were recruited in Split, 130 in Zagreb, 150 in Rijeka and 200 in the prison system.

The prevalence of positive anti-HCV tests was 65% in Split, 51% in Zagreb, 29% in Rijeka and 44% in the prisons. The prevalence of anti-HBcAg was 31% in Split, 13% in Zagreb, 9% in Rijeka and 24% in prison. No case of HIV infection was found. The estimated IDUs population sizes were 2,805 for Zagreb area, 3,347 for Split and 1,370 for Rijeka area, however confidence intervals were very large, indicating the need for larger samples. A high frequency of positive markers on hepatitis B virus and C virus in the population of injecting drug users in Croatia has been confirmed with this research, as well as a low prevalence of HIV infection. This may be related to relatively low levels of injecting risk behaviour and injecting frequency although it is not possible to make strong conclusions on risk behaviour, as participants were mostly recruited in harm reduction programmes. This research should be followed by targeted activities for reducing risks of infectious diseases among injecting drug users in the Republic of Croatia and future research at the national level. PMID: 20939261 [PubMed - indexed for MEDLINE] 81. Am J Med Sci. 2011 Feb;341(2):110-2. doi: 10.1097/MAJ.0b013e3181f5582f. Diversity of hepatitis C virus genotypes among intravenous heroin users in Taiwan. Liao KF, Lai SW, Lin CY, Huang CH, Lin YY. Department of Internal Medicine, Taichung Tzu Chi General Hospital, Taichung County, Taiwan. INTRODUCTION: Limited information is available about genotypes of hepatitis C virus (HCV) in intravenous heroin users in Taiwan. The purpose of this study was to examine the concordance of the detection of antibody to HCV and HCV-RNA and to determine the distribution of HCV genotypes in male intravenous heroin users. METHODS: This was a cross-sectional study. The study population included 274 intravenous heroin drug users newly sentenced in a male prison in central Taiwan from November 2004 to February 2005, whose antibodies to HCV were positive, and antibodies to human immunodeficiency virus were negative. The mean age was 33.9 years (standard deviation, 7.8). The molecular diagnosis used to identify HCV-RNA was PCR. RESULTS: Among 274 subjects, 214 subjects were found to contain HCV-RNA. Positive predictive value of HCV infection using antibody to HCV as an indicator was 78.1%. Among 214 subjects, HCV genotype 2a was the most predominant (58.9%, n = 126), followed by 1a (17.3%, n = 37), 1b (14.5%, n = 31), 2b (8.9%, n = 19) and 1a + 2b (0.4%, n = 1). Age-specific analysis also showed genotype 2a was the most prominent genotype among the 4 age groups, with the highest prevalence in groups aged 20 to 29 years and 30 to 39 years (53.3% and 67.6%, respectively).

CONCLUSIONS: The concordance of antibody to HCV and HCV-RNA is remarkable in selected high-risk groups. HCV genotype 2a is the most prevalent in male intravenous heroin users in central Taiwan, especially in aged 20 to 29 years and aged 30 to 39 years. PMID: 20924285 [PubMed - indexed for MEDLINE] 82. Public Health Rep. 2010 Jul-Aug;125 Suppl 4:25-33. Prisons as social determinants of hepatitis C virus and tuberculosis infections. Awofeso N. School of Population Health, The University of Western Australia, c/o M431, 35 Stirling Hwy, Crawley, WA 6009, Australia. niyi.awofeso@uwa.edu.au Effects of place or neighborhood--locations where individuals reside, shop, recreate, and work--have been widely studied as sources of environmental influences on individual behaviors, exposures, and physiology, as well as reference points for public health interventions. However, despite modern prisons' strong influence on the transmission and clinical outcomes of infectious diseases, custodial authorities and public health officials in many countries have yet to implement credible interventions to minimize the adverse impacts prison settings exert on the epidemiology of communicable diseases--particularly with respect to inmates. Among many vulnerable populations, prisons are evolving as one of the social institutions that determine their health status and health outcomes. This article highlights the effects of prisons in mediating the risk of hepatitis C virus and tuberculosis infections, as well as feasible interventions and policy approaches for limiting the deleterious consequences prisons exert on the transmission and clinical courses of these diseases. PMCID: PMC2882972 PMID: 20626190 [PubMed - indexed for MEDLINE] 83. Hepatology. 2010 Sep;52(3):1124-33. doi: 10.1002/hep.23802. Expanding access to hepatitis C virus treatment--Extension for Community Healthcare Outcomes (ECHO) project: disruptive innovation in specialty care. Arora S, Kalishman S, Thornton K, Dion D, Murata G, Deming P, Parish B, Brown J, Komaromy M, Colleran K, Bankhurst A, Katzman J, Harkins M, Curet L, Cosgrove E, Pak W. University of New Mexico Health Sciences Center, Project ECHO, Albuquerque, NM,

USA. sarora@salud.unm.edu The Extension for Community Healthcare Outcomes (ECHO) Model was developed by the University of New Mexico Health Sciences Center as a platform to deliver complex specialty medical care to underserved populations through an innovative educational model of team-based interdisciplinary development. Using state-of-the-art telehealth technology, best practice protocols, and case-based learning, ECHO trains and supports primary care providers to develop knowledge and self-efficacy on a variety of diseases. As a result, they can deliver best practice care for complex health conditions in communities where specialty care is unavailable. ECHO was first developed for the management of hepatitis C virus (HCV), optimal management of which requires consultation with multidisciplinary experts in medical specialties, mental health, and substance abuse. Few practitioners, particularly in rural and underserved areas, have the knowledge to manage its emerging treatment options, side effects, drug toxicities, and treatment-induced depression. In addition, data were obtained from observation of ECHO weekly clinics and database of ECHO clinic participation and patient presentations by clinical provider. Evaluation of the ECHO program incorporates an annual survey integrated into the ECHO annual meeting and routine surveys of community providers about workplace learning, personal and professional experiences, systems and environmental factors associated with professional practice, self-efficacy, facilitators, and barriers to ECHO. The initial survey data show a significant improvement in provider knowledge, self-efficacy, and professional satisfaction through participation in ECHO HCV clinics. Clinicians reported a moderate to major benefit from participation. We conclude that ECHO expands access to best practice care for underserved populations, builds communities of practice to enhance professional development and satisfaction of primary care clinicians, and expands sustainable capacity for care by building local centers of excellence. PMID: 20607688 [PubMed - indexed for MEDLINE] 84. J Gastroenterol Hepatol. 2010 Jul;25(7):1184-6. doi: 10.1111/j.1440-1746.2010.06357.x. Prisons, prisoners, and hepatitis C. Ferguson L, Batey R. Comment on J Gastroenterol Hepatol. 2010 Jul;25(7):1281-4. J Gastroenterol Hepatol. 2010 Jul;25(7):1276-80. PMID: 20594243 [PubMed - indexed for MEDLINE]

85. Expert Rev Gastroenterol Hepatol. 2010 Jun;4(3):355-64. doi: 10.1586/egh.10.26. Chronic hepatitis C in the state prison system: insights into the problems and possible solutions. Imperial JC. Correctional Medicine Consultation Network, University of California, San Francisco, 1940 Bryant Street, San Francisco, CA 94110, USA. imperialj@fcm.ucsf.edu The prevalence of chronic hepatitis C virus (HCV) within the correctional system is estimated to be 10-20-times greater than that which is reported in the general population. High-risk behavioral patterns probably account for the greater estimates in this population. Recent observations of more than 780 patient-inmates infected with HCV within the California Department of Corrections suggest a very high prevalence of advanced fibrosis in this population. Observational studies performed in Texas have shown that the rates of chronic liver disease-related deaths have increased significantly between 1989 and 2003, especially among Hispanic patient-inmates. Viral hepatitis accounts for a significant number of these chronic liver disease-related deaths. Identification of high-risk patient-inmates infected with HCV, as well as appropriation of funds for their treatment, should result in a decreased rate of liver-related complications. This should translate into reduced morbidity and cost to correctional institutions, as well as to improved public health and safety. PMID: 20528122 [PubMed - indexed for MEDLINE] 86. J Pak Med Assoc. 2010 Jun;60(6):476-9. Seropositivity of hepatitis C in prison inmates of Pakistan--a cross sectional study in prisons of Sindh. Gorar ZA, Zulfikar I. National Program for Prevention and Control of Hepatitis in Pakistan, Ministry of Health Government of Pakistan, Health Services Sindh, Old Wahdat Colony, Hyderabad. OBJECTIVE: To assess the proportion of seropositivity of Hepatitis C amongst the prison inmates in the jails of Sindh. METHODS: A cross sectional HCV seroprevalence survey was done at 14 out of 19 prisons in the Sindh province from November 2008 to January 2009. A team of

Pathologist, phlebotomist and laboratory technician took the blood sample of the inmates inside the correctional facility; the blood was centrifuged at the spot and brought back to the pathology laboratory on same day in cold chain i.e. a temperature-controlled supply chain. Serum was analyzed on 3rd generation ELISA for HCV antibodies. Standard ethical considerations were properly followed. RESULTS: Atotal of 9508 prison inmates were approached. Refusal rate was 20%. Remaining, 7539 prisoners were screened at 14 out of 19 jails in Sindh. HCV antibody positive were 965 making the proportion of seropositivity 12.8% (95% C.I. 8.92% - 12.92%). Higher seropositivity in the jails of northern Sindh jails was identified. CONCLUSIONS: Hepatitis C prevalence in the prison population of Sindh is higher than the national prevalence of 4.9% amongst general population. However it is lower than that reported from correctional facilities of developed countries. Hepatitis prevention and control activities in the correctional facilities of Pakistan need to be institutionalized (JPMA 60:476; 2010). PMID: 20527648 [PubMed - indexed for MEDLINE] 87. J Correct Health Care. 2010 Jul;16(3):230-8. doi: 10.1177/1078345810366867. Epub 2010 May 12. The health of Italian prison inmates today: a critical approach. Esposito M. Human and Social Sciences Department, University of Cassino, Cassino, Frosinone, Italy. m.esposito@unicas.it Despite declarations about health and social inequalities by the World Health Organization (WHO) and the Italian Constitution, the Italian penitentiary health system often does not meet the needs of the prisoners. This article summarizes the findings concerning contextual and structural reasons for these deficiencies (in part as reported by a prisoner rights association) and describes an Italian Ministry of Justice project to promote health by creating homogeneous groups of comorbidity for epidemiological study. Data and analysis on certain pathologies in the prison population are presented with special regard to addictions, hepatitis C virus, and cardiovascular problems. One etiological hypothesis focuses on the factors of promiscuity, excessive smoking, sedentary life, and stress. The conclusion is that prisoner health is a problem not only of inmates but for society. PMID: 20466704 [PubMed - indexed for MEDLINE] 88. J Fam Pract. 2010 Apr;59(4 Suppl):S43-50.

Reports from today's health care environment on the implementation of screening, diagnosis, and treatment recommendations. Kim WR, Valdiserri RO, Wright LN, Manos MM, Do ST. Mayo Clinic College of Medicine, Rochester, Minnesota, USA. PMID: 20398590 [PubMed - indexed for MEDLINE] 89. Biomedica. 2009 Dec;29(4):647-52. [Low prevalence of hepatitis C virus infection in a prisoner population from Maracaibo, Venezuela]. [Article in Spanish] Monsalve-Castillo F, Chacn-Bonilla L, Atencio RJ, Porto LD, Costa-Len LA, Estvez JE, Callejas-Valero DE. Ctedra de Virologa, Escuela de Bioanlisis, Facultad de Medicina, Universidad del Zulia, Maracaibo, Estado Zulia, Venezuela. monsalve22000@hotmail.com INTRODUCTION: The high risk behaviors observed in prison centers have favored the transmission of hepatitis C virus infection. The main risk factor to acquire hepatitis C virus infection seems to be the use of intravenous drugs. In Venezuela, the prevalence of the infection in these centers is unknown since studies of the hepatitis C virus there are lacking. OBJECTIVE: The aim of this study was to determine the prevalence of hepatitis C virus and the risk factors involved in the transmission in prisoner populations. MATERIAL AND METHODS: A sample of 200 prisoners was studied from Sabaneta Jail, Maracaibo, Venezuela. The ages were between 18-69 years (average +/- DS: 31.6+/-9.9 years). Serum samples were tested by a fourth generation enzyme-linked immunosorbent assay ELISA and a confirmatory assay INNO-LIA. Both kits were from Innogenetic Laboratories N.V. (Belgium). Viral RNA was tested by the reverse transcription polymerase chain reaction technique (RT-PCR). RESULTS: The ELISA assay determined a hepatitis C virus prevalence of 5.0% (10/200); 3/200 (1.5%) individuals were positive by both INNO-LIA and RT-PCR tests. CONCLUSIONS: The observed prevalence of hepatitis C virus antibodies in this population was very low, suggesting a low circulation of the virus in this environment and a low level of associated risk behaviors. PMID: 20440463 [PubMed - indexed for MEDLINE]

90. Med J Aust. 2010 May 3;192(9):496-500. Establishment of a successful assessment and treatment service for Australian prison inmates with chronic hepatitis C. Boonwaat L, Haber PS, Levy MH, Lloyd AR. Blood Borne Viruses and Sexual Assault Services, Population Health, Justice Health, Sydney, NSW, Australia. OBJECTIVE: To evaluate the assessment and treatment outcomes of a prison hepatitis service. DESIGN AND SETTING: A retrospective, observational cohort study of prison inmates who attended hepatitis clinics from 1996 to 2005 at correctional centres in New South Wales. PATIENTS: Inmates who attended the clinics, including a nested case-control series of patients who received antiviral treatment and age- and sex-matched patients who did not receive treatment. MAIN OUTCOME MEASURES: Demographic and clinical characteristics of patients who attended the service; correlates of selection for antiviral treatment; and clinical and virological outcomes of treatment. RESULTS: Of the 1043 inmates who attended the clinics, 851 were men (82%) and 994 (95%) were referred for HCV infection; the mean age for this group was 33 years (range, 18-74 years). In the case-control series (185 treated and 186 untreated patients), selection for treatment was not biased by culturally and linguistically diverse background, current methadone treatment or psychiatric status. In the treated group, 76 of 138 genotyped patients had a genotype that is predictive of favourable treatment response, and a small minority of those with available liver biopsy results had established cirrhosis (7/119 patients). Of treated patients for whom complete follow-up data were available, 55% achieved sustained virological response and 100% adhered to therapy. In addition, treatment episodes were not especially complicated. CONCLUSION: Although the prison population has high rates of injecting drug use and poor mental health, imprisonment offers an opportunity for assessment and treatment of chronic HCV infection. PMID: 20438418 [PubMed - indexed for MEDLINE] 91. Med Pr. 2010;61(1):15-22. [Is healthcare personnel the only professional group exposed tothe risk of occupational HBV, HCV or HIV infections?].

[Article in Polish] Krawczyk P, Biakowska J, Dworniak D, Kamerys J, Szosland D, Jabkowski M. Katedra Chorb Zakanych, Klinika Chorb Zakanych i Chorb Watroby, Uniwersytet Medyczny, d. BACKGROUND: Our paper presents the problem of exposure to potentially infectious material among health care workers, and also in police officers, prison guards, cleaning service personnel and ordinary citizens. MATERIALS AND METHOD: In the study period, 200 patients were admitted to the Infectious Diseases Clinic after exposure to potentially infectious materials in order to evaluate the risk of HBV, HCV and HIV infections and initiate post exposure prophylaxis. HBsAg, a-HCV and a-HIV were carried out on the day of admission, a-HBs was measured in patients who had been vaccinated against hepatitis B virus. Clinical evaluation of HBV, HCV, HIV infections was performed in the source patients' plasma. RESULTS: The study population consisted of 93 health-care workers (63 nurses, 25 physicians, and 5 medical students), 30 policemen, 23 prison guards, 42 cleaning service workers employed in health-care centers. The remaining 12 patients were inhabitants of the od region who had not been occupationally exposed to potentially infectious material. CONCLUSIONS: Although "safe needles" are in use, exposure among health care personnel still occurs. The problem of occupational exposure among police officers and prison guards is highly underestimated. The lack of control over the vaccination against hepatitis B virus in groups not related with health care creates the risk of new infections. PMID: 20437885 [PubMed - indexed for MEDLINE] 92. J Public Health Manag Pract. 2010 May-Jun;16(3):240-4. doi: 10.1097/PHH.0b013e3181b43bcd. Legal prison tattooing centers: viable health policy initiative? Awofeso N. School of Population Health, M431, University of Western Australia, Perth, Australia. niyi.awofeso@uwa.edu.au Tattooing exemplifies several important links between criminal justice systems, public health, custodial management, and the social organization and behavior of prisoners. This commentary examines the efficiency of setting up legal, prison-financed tattooing centers as a way of discouraging illicit tattooing and

minimizing bloodborne disease transmission risks in prison settings. The author posits that the impact of legal prison tattooing centers is unlikely to be significant since less than 5 percent of bloodborne infectious diseases have been reliably attributable to tattooing, either in prison or in community settings. Behavioral studies indicate that prisoners at the highest risk of contracting bloodborne infections would probably not utilize legal prison tattooing services. Furthermore, such a service is likely to be very expensive relative to potential health benefits. Strategies focussed on reducing injecting drug use among prisoners will yield greater benefits for reducing bloodborne disease transmission per dollar spent compared with setting up legal prison tattooing parlors. Social marketing of temporary tattooing alternatives (eg, henna tattoos) to traditional illicit tattooing techniques in prison settings is potentially valuable, as temporary tattoos pose no infection risk and may also facilitate reduction in occupational and social stigma associated with many illicit prison tattoos. PMID: 20357610 [PubMed - indexed for MEDLINE] 93. Hepat Mon. 2010 Spring;10(2):101-4. Epub 2010 Jun 1. Seroprevalence study of hepatitis C and Hepatitis B virus among hospitalized intravenous drug users in Ahvaz, Iran (2002-2006). Alavi SM, Behdad F. Infectious and Tropical Disease Research Center Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. alavil329dr@yahoo.com BACKGROUND AND AIMS: Viral hepatitis is a serious complication among intravenous drug users (IDUs). The objectives of this study were to determine the seroprevalence of hepatitis B and C viruses (HBV and HCV), and associated risk factors among IDUs at a teaching hospital in Ahvaz, southwest Iran. METHODS: Medical records of 333 IDUs hospitalized from 2002 to 2006 at Razi Hospital, which is affiliated to Ahvaz Jundishapur University of Medical Sciences, were reviewed. Cases meeting the criteria for a diagnosis of viral hepatitis infection were included in this study. Patients' characteristics, clinical and laboratory findings were extracted. Data of cases with hepatitis virus infection (HVI), called the HVI group and without HVI, called the NHVI group, were compared, using the chi-square test for qualitative variables and the t-test for quantitative variables. Differences with a P < 0.05 were considered significant. RESULTS: Out of a total of 333 IDUs, 115 (34.5%), mostly male, with a mean age of 24.86.2 had HVI. More than 65% had a history of imprisonment. The mean duration of IDU was 4.51.6 years for the HVI group and 1.80.4 years for the NHVI group

(P < 0.05). 85% of the HVI group and 45% of the NHVI group shared injection equipment (P < 0.05). 103 patients (30.9%) had HCV and 12 (3.6%) had HBV infection. There was a significant difference in age, duration of drug abuse, time spent in prison, sharing injection equipment, history of surgery, blood transfusion, packs of cigarettes per year and human immunodeficiency virus (HIV) co-infection between the two groups (P < 0.05). CONCLUSIONS: HVI in IDU population is a prevalent complication, and is associated with heavy smoking (high number of packs of cigarettes per year), sharing injection equipment, long duration of drug usage, long duration of prison stay, HIV co-infection, history of surgery, blood and blood products transfusion. Older age, longer duration of IDU and imprisonment put the cases at higher risk of acquiring HCV in comparison to HBV. PMCID: PMC3270351 PMID: 22312381 [PubMed] 94. J Infect Dev Ctries. 2010 Mar 29;4(3):144-9. Prevalence of antibodies to human immunodeficiency virus (HIV), hepatitis B and hepatitis C and risk factors in prisoners in Lebanon. Mahfoud Z, Kassak K, Kreidieh K, Shamra S, Ramia S. Departments of Epidemiology, Faculty of Health Sciences, American University of Beirut, Lebanon. zm15@aub.edu.lb BACKGROUND: People admitted to correctional facilities often have a history of risky behaviours which frequently lead to transmission of blood-borne viruses, such as human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV). Our aim was to determine the prevalence of HIV, HBV and HCV infections among prisoners in Lebanon. METHODOLOGY: Conducted between August 2007 and February 2008 in Roumieh Prison, Lebanon, the study included a total of 580 male prisoners aged 16 and above who were randomly selected from four prison blocks. Peripheral blood was collected by a finger prick, blotted onto high-quality filter paper, dried and later eluted to be tested for markers of HIV, HBV and HCV infections. RESULTS: A significantly higher seroprevalence of HBV (2.4%) and HCV (3.4%) was found among prisoners compared to the seroprevalence of these virus infections reported in the general Lebanese population (< 1% for HBV and HCV). Only one of the 580 prisoners tested (0.17%) was confirmed as anti-HIV-positive. The majority (89%) of anti-HCV-positive prisoners had a history of previous imprisonment and were injecting drug users (IDUs). Tattooing was also associated with HCV transmission: all nine anti-HCV-positive prisoners had tattoos compared to only 60% who were anti-HCV-negative. Only HCV genotypes 1 and 3 were detected.

CONCLUSIONS: We provide evidence for an outbreak of HCV and HBV occurring in Roumieh prison. In addition to vaccinating prisoners against HBV, collaborations should develop between the prison's administration, academic institutions, and community-based organizations to provide HCV prevention services within the prisons. PMID: 20351454 [PubMed - indexed for MEDLINE] 95. HIV AIDS Policy Law Rev. 2009 Dec;14(2):5-19. Clean switch: the case for prison needle and syringe programs. [Article in English, French] Chu S. Canadian HIV/AIDS Legal Network. In Canada and in many other countries, prisons have become incubators for the transmission of HIV and hepatitis C virus (HCV). Estimates of HIV and HCV prevalence in Canadian prisons are at least 10 and 20 times, respectively, the reported prevalence in the population as a whole--and prevalence rates have been reported to be significantly higher for people who inject drugs. Although people who inject drugs may inject less frequently while incarcerated, the risks of injection drug use are amplified because of the scarcity of sterile syringes and the sharing of injecting equipment in prison. Making sterile injection equipment available to people in prison is an important response to evidence of the risk of HIV and HCV transmission through sharing syringes to inject drugs. In this article, Sandra Chu explains why the government is obligated under international human rights standards and Canadian correctional and constitutional law to provide prison-based needle and syringe programs (PNSPs). PMID: 20225504 [PubMed - indexed for MEDLINE] 96. Epidemiol Infect. 2010 Nov;138(11):1610-20. doi: 10.1017/S0950268810000476. Epub 2010 Mar 5. Viral hepatitis B, C and HIV infection in Croatian prisons. Burek V, Horvat J, Butorac K, Mikuli R. University Hospital for Infectious Diseases, Zagreb, Croatia. vitomir.burek@zg.htnet.hr

Incarcerated persons comprise about 0.4% of the Croatian population, of whom 25-30% misuse drugs. We attempted to determine the structure of the prison population, prevalence of HBV, HCV, HIV markers, co-infections with HBV, HCV and HIV and acute HBV, HCV and HIV infection. In total, 25.9% of prisoners were positive for some markers for viral hepatitis (HBV 11.3%, HCV 8.3%, HBV/HCV 6.3%). Prevalence of HBV infection in intravenous drug users (IDUs) was 26.2% (highly promiscuous group 20.4%, individuals with psychiatric diseases and personality disorders 16.0%). HCV infection in IDUs was 52.0% and 4.9% in the highly promiscuous group. HBV/HCV co-infection was registered in 34.9% of prisoners positive for HBV markers (203/582). Acute HBV infection was detected in 0.5%, and HCV in 1.2%. Only 0.15% (5/3348) of prisoners were anti-HIV positive. It appears that individuals with psychiatric diseases and personality disorders could be an additional risk population for these viral infections. PMID: 20202285 [PubMed - indexed for MEDLINE] 97. Acta Med Croatica. 2009 Dec;63(5):447-50. [Prevalence of hepatitis B and C among prison population in Croatia]. [Article in Croatian] Burek V, Horvat J, Susi E, Mikuli R. Department of Clinical Immunology, Dr Fran Mihaljevi University Hospital for Infectious Diseases, Zagreb, Croatia. In 2007, incarcerated persons accounted for 0.41% (approximately 16,500) of the Croatian population. In the heterogeneous structure of the prison population in Croatia, some 25%-30% of the prisoners are drug abusers. In this study, we intended to determine precisely the structure of the prison population in Croatia and the prevalence of HBV and HCV markers in this population. It is well known that HBV and HCV infection can spread within prisons, and therefore we tried to determine the rate of acute HBV and HCV infection among prisoners in Croatian prisons. In total, 25.7% of prisoners were positive for some viral hepatitis markers (HBV 11.3%, HCV 8.3%, and HBV/HCV 6.3%). The rate of HBV infection was very high among intravenous drug users (26.2%) and relatively high among highly promiscuous individuals (19.9%). HCV infection was most prevalent among intravenous drug users (50.2%) and relatively high among highly promiscuous individuals (7.5%). HBV/HCV coinfection was recorded in 23.5% of prisoners. Acute infection with HBV was detected in 0.3% and with HCV in 1.2% of the study population. One fourth of all prisoners had contact with HBV, HCV, or both viruses. It is evident that both hepatitis virus infections (HCV more and HBV less) are spreading within prisons among prisoners. The opportunity of screening,

testing, vaccination, treatment and education of high-risk individuals while they are in the controlled environment of a correctional facility is a good policy for both individuals and the community. PMID: 20198906 [PubMed - indexed for MEDLINE] 98. Acta Med Croatica. 2009 Dec;63(5):443-6. [Treatment for viral hepatitis in institutionalized individuals]. [Article in Croatian] Horvat J. Ward of Internal Medicine, Zagreb Prison Hospital, Zagreb, Croatia. The presence and spread of viral hepatitis infection in the prison population is much higher than in the general population. Prisoners represent a combination of several high risk subpopulations and are therefore generally considered a high risk category. When outside the prison system, members of these high risk groups are generally not available for education, prevention and therapy. While within the prison system, they are available for systematic and continuing monitoring and therapy. This includes testing of their HBV, HCV and HIV status. Due to the high incidence of viral hepatitis in the prison population and based on the results of a study from 2007, we established the Prison System Viral Hepatitis Counseling Center. The Center operates within the internal ward of the Prison Hospital. Currently, 42 patients are treated for chronic hepatitis C. The Center's Plan and Operating Program and treatment results are presented. PMID: 20198905 [PubMed - indexed for MEDLINE] 99. Int J Infect Dis. 2010 Sep;14 Suppl 3:e60-6. doi: 10.1016/j.ijid.2009.11.012. Epub 2010 Mar 1. Risk factors and prevalence of tuberculosis, human immunodeficiency virus, syphilis, hepatitis B virus, and hepatitis C virus among prisoners in Pakistan. Kazi AM, Shah SA, Jenkins CA, Shepherd BE, Vermund SH. Departments of Preventive Medicine, Biostatistics and Pediatrics, Vanderbilt University Institute for Global Health, 2215 Garland Ave., Nashville, TN 37232-0242, USA. mominkazi@gmail.com OBJECTIVE: The objective of this study was to evaluate the burden of sexual- and

injection drug use-related infections in male prisoners in Karachi, Pakistan. METHODS: We administered a structured questionnaire in a cross-sectional survey of 365 randomly selected imprisoned men. We analyzed blood for the human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) by ELISA, and for syphilis by rapid plasma reagin with Treponema pallidum hemagglutination assay confirmation. Subjects with possible tuberculosis (World Health Organization criteria) provided sputum samples for an acid-fast bacillus smear and culture. RESULTS: The prevalence of tuberculosis was 2.2% (95% CI 0.71-3.8%). Of 357 of the randomly selected prisoners (eight refused to give blood), 2.0% (95% CI 0.6-3.4) were HIV-infected; syphilis was confirmed in 8.9% (95% CI 6.0-11.8%), HBV in 5.9% (95% CI 3.5-8.3%), and HCV in 15.2% (95% CI 11.7-18.8). By self-report, 59.2% had used any illicit drugs, among whom 11.8% (95% CI 8.5-15.0) had injected drugs. The median length of stay in the prison had been 3.2 (range 1-72) months. CONCLUSIONS: All four infections were prevalent among the prisoners in Pakistan. Prisons are excellent venues for infectious disease screening and intervention given the conditions of poverty and drug addiction. Collaboration with community-based health providers is vital for post-discharge planning. Copyright 2010 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved. PMCID: PMC2905608 PMID: 20189863 [PubMed - indexed for MEDLINE] 100. J Womens Health (Larchmt). 2010 Jan;19(1):17-22. doi: 10.1089/jwh.2009.1469. Preventive healthcare for underserved women: results of a prison survey. Nijhawan AE, Salloway R, Nunn AS, Poshkus M, Clarke JG. Miriam Hospital, Albert Medical School of Brown University, Providence, Rhode Island 02906, USA. anijhawan@lifespan.org OBJECTIVES: We sought to determine the preventive healthcare needs of incarcerated women in the following areas: cervical cancer and breast cancer screening, sexually transmitted infection (STI) screening, hepatitis screening and vaccination, and smoking cessation. METHODS: A cross-sectional interview survey of a random sample of 100 incarcerated women at the Rhode Island Department of Corrections (RIDOC) in Cranston, Rhode Island, was conducted. RESULTS: Participants were 62% white, 11% African American, 13% Hispanic, and 14% of mixed race. Mean age was 35 years. Of those surveyed, 67% reported having had

a Papanicolou (Pap) smear in the past year, the strongest predictor of which was having received a Pap smear while incarcerated. Of the inmates >40 years old, 58% reported having had a mammogram in the past 2 years. The majority (88%) reported testing for STIs in the past, and 39% desired testing during their current incarceration. As for hepatitis C, 70% had been tested previously and 37% of those reported testing positive. Hispanics were less likely than whites to have been tested for hepatitis C (OR 0.1). Over half (54%) of the women who reported testing positive for hepatitis C also reported having completed the hepatitis A and B vaccine series. Among smokers (80% of all survey participants), 61% were interested in quitting. Those who had been incarcerated multiple times were less likely to want to quit smoking (OR 0.1). CONCLUSIONS: Incarceration presents a unique opportunity to provide preventive healthcare to high-risk, medically underserved women. PMCID: PMC2828235 PMID: 20088654 [PubMed - indexed for MEDLINE] 101. Eur J Epidemiol. 2010 Feb;25(2):143-8. doi: 10.1007/s10654-009-9421-0. Incidence and risk for acute hepatitis C infection during imprisonment in Australia. Dolan K, Teutsch S, Scheuer N, Levy M, Rawlinson W, Kaldor J, Lloyd A, Haber P. National Drug and Alcohol Research Centre, Univeristy of New South Wales, Sydney, NSW, 2052, Australia. k.dolan@unse.edu.au To determine hepatitis C incidence and the demographic and behavioural predictors in seronegative drug injecting prisoners. Prisoners in New South Wales, Australia who: were aged 18 years and over; reported IDU; had been continuously imprisoned; had a documented negative HCV antibody test result in prison in the last 12 months; provided written informed consent. Subjects were interviewed about their demographic characteristics and detailed risk factors for transmission prior to, and since, imprisonment. A blood sample was collected to screen for HCV antibodies by ELISA and RNA by PCR. Of 253 inmates recruited, 120 were continuously imprisoned and included in this analysis. Sixteen acquired HCV infection indicating an incidence of 34.2 per 100 person years (CI: 19.6-55.6). Risk factors for transmission included prior imprisonment, methadone treatment and greater than 10 years of education. Although the frequency of injecting was reduced in prison, 33.6% continued to inject drugs, most commonly methamphetamine, and 90% of these reported sharing injecting equipment. Prison inmates were at high risk of HCV infection, despite some reduction in high-risk behaviours and access to prevention services. To prevent HCV transmission in prisons, better prevention strategies are required.

PMID: 20084429 [PubMed - indexed for MEDLINE] 102. Hepat Mon. 2010 Winter;10(1):26-30. Epub 2010 Mar 1. Evaluation of the Prevalence of Hepatitis B, Hepatitis C, and HIV in Inmates with Drug-Related Convictions in Birjand, Iran in 2008. Azarkar Z, Sharifzadeh G. Department of Infectious Disease, Birjand University Medical Sciences, Birjand, Iran. BACKGROUND AND AIMS: Hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) are common infections among prisoners. Addicted prisoners are at a higher risk than the normal population for contracting these diseases. Many studies have reported higher prevalence rates of HBV, HCV, and HIV in prisoners. Because of this problem, this study was conducted to evaluate the serologic prevalence of these three diseases in prisoners convicted of drug-related crimes. METHODS: A descriptive cross-sectional study was conducted on a random sample of prisoners with drug charges who were inmates in a prison in Birjand, Iran. Information was collected via questionnaire after obtaining prisoners' informed consent and blood samples were tested for hepatitis B surface antigen (HBsAg), antibodies to HCV (anti-HCV), and antibodies to HIV (anti-HIV). The results were analyzed by chi-square tests. RESULTS: In this study, 358 prisoners were selected. 80.2% of prisoners were male, and 19.8% were female. The average age was 34.712 years. 39.1% were addicted to drugs, 54.2% were smokers, and 19.3% had tattoos. 8.4% had had extramarital intercourse, and 16.8% had had a sexually transmitted disease (STD) in past. HBsAg, anti-HCV, and anti- HIV prevalence in these samples were 6.1%, 8.1%, and 0%, respectively.The prevalence rate of HBV in the addicted prisoners was 4.3%, and the rate in non-addicted prisoners was 7.3% (P = 0.24).The prevalence of HCV in addicted prisoners was 15.7%, and the prevalence in non-addicted prisoners was 3.2%; this difference was significant (P < 0.001).Furthermore, a significant difference between the prevalence of HBV and extramarital intercourse was noted (P < 0.005).A significant difference between HCV and transfusion, history of STDs, addiction, and tattooing was noted. CONCLUSIONS: The survey showed that HCV, HBV, and HIV prevalence rates in prisoners were 8.1%, 6.1%, 0%, respectively. The prevalence rates of HCV and HBV in addicted prisoners were 15.7% and 4.3 %, respectively. Studies performed in Iran and other countries have shown that the prevalence rates of HBV, HCV, and HIV in addicted prisoners were higher than the rates in non-addicted prisoners. These results indicate that HBV, HCV, and HIV are significant problems in prisons, and efforts to reduce the risk of these infections, such as education

and vaccination, should be considered. PMCID: PMC3270341 PMID: 22308122 [PubMed] 103. Am J Public Health. 2010 Jan;100(1):13-7. doi: 10.2105/AJPH.2008.147629. New opportunities for the management and therapy of hepatitis C in correctional settings. Martin CK, Hostetter JE, Hagan JJ. Medcenter One Health Systems, 222 N 7th St, Bismark, ND 58501, USA. kentmartin@bis.midco.net Hepatitis C in prison populations is now a major public health problem, and large numbers of correctional facilities have no comprehensive management program, often because of formidable projected costs and tightening budget constraints. The North Dakota Department of Corrections and Rehabilitation has operated a management and therapy program since 2002 using consensus interferon and ribavirin with 45% cost savings. The program has provided excellent sustained viral responses: 54.2% for genotype 1 hepatitis C, 75% for genotypes 2 and 3, and 63.6% overall. PMCID: PMC2791263 PMID: 20007626 [PubMed - indexed for MEDLINE] 104. J Viral Hepat. 2010 Oct;17(10):698-704. doi: 10.1111/j.1365-2893.2009.01227.x. The impact of a managed care network on attendance, follow-up and treatment at a hepatitis C specialist centre. Tait JM, McIntyre PG, McLeod S, Nathwani D, Dillon JF. Department of Gastroenterology, Ninewells Hospital and Medical School, Dundee, UK. jantait@nhs.net Infection with the hepatitis C virus commonly occurs in patient groups who have difficulty accessing conventional medical care, reducing their chance of successful antiviral therapy. Managed care networks (MCNs) have been suggested as a mechanism of improving access to care; however, there is little evidence to support their use in patients with hepatitis C. The aim of this study was to evaluate the impact of a MCN for patients with hepatitis C. This was a retrospective cohort study of all individuals in our area who had received a

positive hepatitis C antibody test between August 1994 and June 2008. The MCN introduced a new referral pathway, which included nonmedical referrals and outreach nurse-led clinics. These interventions were introduced in 2004 and evaluated in 2008. After the introduction of the MCN, the proportion of individuals who accessed care increased from 61% (280/430) to 82.4% (721/875). There was an increase in nonmedical referrals with 81 (18.3%) being directly referred from Drug Problem Services and 75 (17%) from the Prison Service. The changes to referral did not have a negative impact on treatment outcomes as the number who completed treatment increased from 66.1% (43/65) to 73.7% (98/133) and the sustained virological response increased from 50.7% (33/65) to 60.9% (81/133). This study provides evidence that the collaboration of health care professionals within a network can have a radical effect in improving access to care in a traditionally hard to reach population. This has been achieved with little additional resource, but rather working smarter with existing staff. 2009 Blackwell Publishing Ltd. PMID: 20002561 [PubMed - indexed for MEDLINE] 105. Psychiatr Hung. 2009;24(4):264-81. [The efficacy of needle exchange programs in the prevention of HIV and hepatitis infection among injecting drug users]. [Article in Hungarian] Takcs IG, Demetrovics Z. Trsasg a Szabadsgjogokrt, Budapest, Hungary. takacsistvan@tasz.hu BACKGROUND: HIV infection has become one of the major public health problems of our time. An estimated 33.2 million people lived worldwide with HIV in 2007. Injecting drug users are the most at risk group of HIV infection in many regions of the world. Injecting drug use became the primary route of infection in Western- and Central Europe, also in North America and Australia, and dominated from the beginning of the epidemic in Eastern Europe and Central Asia. GOALS: Identifying drug users as risk groups has evoked a series of intervention possibilities, of which the authors introduce and assess the effectiveness of needle and syringe exchange programs. METHODS: We evaluated a literature search by the use of MEDLINE, PsycINFO and Web of Science databases. RESULTS: After reviewing the scientific literature the authors conclude that needle and syringe exchange programs are an effective way of reducing risky behaviors related to injecting drug use, hence they are effective in reducing the

spread of HIV among injecting drug users and the population. The authors introduce the literature related to the effectiveness of various kinds of programs for distributing sterile injecting equipment. CONCLUSION: Besides various kinds of prevention programs and harm reduction measures, when adopted to the given populations needs and socio-cultural circumstances, the providing of needle and syringe programs are an indispensable condition of successfully preventing the spread of HIV. PMID: 19949245 [PubMed - indexed for MEDLINE] 106. Pak J Biol Sci. 2009 Jul 15;12(14):1012-8. Seroprevalence of hepatitis C infection and associated risk factors among addicted prisoners in Sari-Iran. Zakizad M, Salmeh F, Yaghoobi T, Yaghoubian M, Nesami MB, Esmaeeli Z, Vaezzadeh N, Shahmohammadi S, Modanloo S, Sadeghian AA, Abdolmanafi SJ, Mohammadpour RA, Siamian H, Khosravi A. Department of Community Health Nursing, Nasibeh Nursing and Midwifery College, Mazandaran University of Medical Sciences, Sari, Iran. The aim of this study was to determine the seroprevalence of hepatitis C infection and associated risk factors among addicted prisoners in Sari-Iran. This is a simple random sampling cross sectional study that was performed on 312 addicted prisoner men at Khazarabad addicts' prison in Sari/Iran in September 2001. Their blood samples were examined through third generation enzyme immunoassay. Data were collected through questionnaires and interview. Associated risk factors were compared in 82 hepatitis C antibody positive addicts (the affected group) and 148 hepatitis C antibody negative addicts (the unaffected group). Out of 312 addicted prisoners, 96 were hepatitis C anti body positive. The seroprevalence of hepatitis C infection was found to be 30.8%. Major associated risk factors in the affected group were as follows: duration of addiction, duration of imprisonment (mean 48 months), route of drug administration, length of alcohol consumption, tattooing, shared usage of needles and razors, multiple sexual partners and type of drugs (p < 0.05). On multivariate logistic regression analysis these factors were found to be significant independent risk factors for HCV infection: tattooing (OR 100, 95% CI), multiple sexual partners (OR 4.97, 95% CI) and history of surgery (OR 6.23, 95% CI). It is concluded that hepatitis C infection had a considerable prevalence in addicted prisoners. High risk and unsafe behaviors were found to be the main factors of contamination. PMID: 19947179 [PubMed - indexed for MEDLINE]

107. Rev Esp Salud Publica. 2009 Jul-Aug;83(4):533-41. [HCV and HIV infection, and coinfection in the Len health area in the period 1993-2004]. [Article in Spanish] Martn Snchez V, Lpez Caleya JF, Nez Vsquez MG, Mors Gonzlez ML, Prez Vicente R, Cayl Buqueras JA. Area de Medicina Preventiva y Salud Pblica, Universidad de Len, Len, Espaa. vmars@unileon.es BACKGROUND: As few population studies exist, the study of positive serological tests detected in laboratory services may be an acceptable approximation for the assessment of HIV and Hepatitis C infection and coinfection by both. METHODS: A study was made of the database of positive serologies of the Laboratory Service of Len General Hospital. Data were treated in accordance with the origin of the samples. To calculate rates, the municipal census of persons over 14 was used. For the prison population, the number of inmates on the last day of each year was considered. The period analysed was 1993-2004. The Chi-square test and Chi-square test for tendencies were used. RESULTS: The number of positive serologies for HCV, HIV and coinfection were 467, 112 and 78 in 1993; 217, 24 and 15 in 2002, and 294, 42 and 21 in 2004. According to the samples from the hospital, blood bank and health centres, the average annual rate per 100,000 inhabitants for the three-year periods 1993-95 and 2001-04 in men varied from 153.3 to 69.5 for HCV, from 26.2 to 10,0 for HIV and from 21.7 to 3.8 for coinfection. The figures for women were 56.6-37.7 for HCV, 9.2-2.3 for HIV and 6.3-0.4 for coinfection. In all cases, there was a significant downward trend (p<0.05). The positive serologies from the prison for the period 1993-2004 varied between 34.5% and 7.2% for HCV, 11.7%-1.1% for HIV and 9.55 and 1.0% for coinfection. Of those infected by HCV, 11.5% were HIV positive, and of those infected by HIV, 65.5% were also positive for HCV. CONCLUSIONS: A drop was observed in the number and rates of positive serological tests over the period studied. PMID: 19893881 [PubMed - indexed for MEDLINE] 108. BMC Public Health. 2009 Oct 13;9:385. doi: 10.1186/1471-2458-9-385. Testing for sexually transmitted infections and blood borne viruses on admission to Western Australian prisons.

Watkins RE, Mak DB, Connelly C. Australian Biosecurity CRC, Curtin Health Innovation Research Institute, Curtin University of Technology, Perth, Australia. Rochelle.Watkins@curtin.edu.au BACKGROUND: Prison populations are known to be at high risk of sexually transmitted infections (STIs) and blood borne viruses (BBVs). In accordance with State health guidelines, the Western Australian Department of Correctional Services' policy is to offer testing for STIs and BBVs to all new prison entrants. This audit was undertaken to assess the completeness and timeliness of STI and BBV testing among recent prison entrants in Western Australia, and estimate the prevalence of STIs and BBVs on admission to prison. METHODS: A retrospective audit of prison medical records was conducted among 946 individuals admitted to prison in Western Australia after the 1st January 2005, and discharged between the 1st January and 31st December 2007 inclusive. Quota sampling was used to ensure adequate sampling of females, juveniles, and individuals from regional prisons. Main outcomes of interest were the proportion of prisoners undergoing STI and BBV testing, and the prevalence of STIs and BBVs. RESULTS: Approximately half the sample underwent testing for the STIs chlamydia and gonorrhoea, and almost 40% underwent testing for at least one BBV. Completeness of chlamydia and gonorrhoea testing was significantly higher among juveniles (84.1%) compared with adults (39.8%; p < 0.001), and Aboriginal prisoners (58.3%) compared with non-Aboriginal prisoners (40.4%; p < 0.001). Completeness of BBV testing was significantly higher among adults (46.5%) compared with juveniles (15.8%; p < 0.001) and males (43.3%) compared with females (33.1%; p = 0.001). Among prisoners who underwent testing, 7.3% had a positive chlamydia test result and 24.8% had a positive hepatitis C test result. CONCLUSION: The documented coverage of STI and BBV testing among prisoners in Western Australia is not comprehensive, and varies significantly by age, gender and Aboriginality. Given the high prevalence of STIs and BBVs among prisoners, increased test coverage is required to ensure optimal use of the opportunity that prison admission presents for the treatment and control of STIs and BBVs among this high risk group. PMCID: PMC2766389 PMID: 19825156 [PubMed - indexed for MEDLINE] 109. Rev Soc Bras Med Trop. 2009 Jul-Aug;42(4):369-72. Predictive markers for hepatitis C virus infection among Brazilian inmates. Coelho HC, de Oliveira SA, Miguel JC, Oliveira Mde L, Figueiredo JF, Perdon GC, Passos AD. Faculty of Pharmaceutical Sciences of Ribeiro Preto, University of So Paulo,

Ribeiro Preto, SP, Brazil. harnoldo@usp.br Hepatitis C virus (HCV) infection has quite high prevalence in the prison system, reaching rates of up to 40%. This survey aimed to estimate the prevalence of HCV infection and evaluate risk factors for this exposure among male inmates at the Ribeiro Preto Prison, State of So Paulo, Brazil, between May and August 2003. A total of 333 participants were interviewed using a standardized questionnaire and underwent immunoenzymatic assaying to investigate anti-HCV. The prevalence of HCV infection among the inmates was 8.7% (95% CI: 5.7-11.7). The participants'mean age was 30.1 years, and the prevalence was predominantly among individuals over 30 years of age. Multivariate analysis showed that the variables that were independently associated with HCV infection were age > 30 years, tattooing, history of previous hepatitis, previous injection drug use and previous needle-sharing. PMID: 19802469 [PubMed - indexed for MEDLINE] 110. J Gastroenterol Hepatol. 2009 Oct;24(10):1655-7. doi: 10.1111/j.1440-1746.2009.05978.x. Presence of hepatitis C virus in syringes confiscated in prisons in Australia. Dolan K, Larney S, Jacka B, Rawlinson W. National Drug and Alcohol Research Center, University of New South Wales, Sydney, NSW 2052, Australia. BACKGROUND AND AIMS: Needlestick injuries are an occupational hazard for prison officers. This study aimed to assess the presence of hepatitis C virus (HCV) in syringes found in prisons. METHODS: Sixty-nine syringes found in prisons were tested for HCV RNA using previously published methods. RESULTS: Three syringes tested positive for HCV RNA. CONCLUSION: Compared to the prevalence of HCV among injecting drug users in prisons, few syringes were found to contain HCV RNA. It is likely that conditions under which syringes are kept in prisons are not favorable for survival of detectable HCV RNA. Further work is needed to establish the risk of HCV transmission posed by needlestick injuries in prison settings. PMID: 19788605 [PubMed - indexed for MEDLINE] 111. Trans Am Clin Climatol Assoc. 2009;120:73-83. HIV and infectious disease care in jails and prisons: breaking down the walls

with the help of academic medicine. Flanigan TP, Zaller N, Taylor L, Beckwith C, Kuester L, Rich J, Carpenter CC. The Warren Alpert Medical School of Brown University and TheMiriam Hospital, 164 Summit Avenue, Providence, RI 02906, USA. tflanigan@lifespan.org Health care within correctional facilities has traditionally been marginalized from excellence in academic medicine. The armamentarium of a medical school, which includes excellence in research, teaching and clinical care, can be successfully applied to the correctional setting both in the United States and internationally. At any one time, there are over 2 million people incarcerated in the US who are disproportionately poor and from communities of color. Rates of human immunodeficiency virus (HIV) and hepatitis C virus infection (HCV) in prisons are 5 and 17-28-times higher than in the general population, respectively. The correctional setting provides an excellent opportunity to screen for and treat sexually transmitted infections (STIs), HIV, HCV, chronic hepatitis B virus (HBV) infections and tuberculosis (TB) and to develop effective prevention programs. PMCID: PMC2744543 PMID: 19768164 [PubMed - indexed for MEDLINE] 112. J Infect Dev Ctries. 2009 Aug 30;3(7):539-47. Human immunonodeficiency virus, hepatitis B virus and hepatitis C virus: sero-prevalence, co-infection and risk factors among prison inmates in Nasarawa State, Nigeria. Adoga MP, Banwat EB, Forbi JC, Nimzing L, Pam CR, Gyar SD, Agabi YA, Agwale SM. Virology Department, Innovative Biotech Ltd, 1 Abdu Abubakar Street, GRA, P.O.Box 30, Keffi, Nigeria. madoga@innovativebiotechng.com BACKGROUND: Published data on HIV, HBV, and HCV in correctional facilities in Nigeria is scarce. We set out to establish the seroprevalence, co-infection, and risk factors for these infections for the first time among prison inmates in Nasarawa State, Nigeria. METHODOLOGY: In a cross-sectional study conducted between April and May, 2007, blood samples were collected from 300 male prisoners of a mean age of 29.2 years, in the state's four medium-security prisons (overall population: 587). Prior to the study, ethical clearance and informed consent were obtained and structured questionnaires were administered. Samples were analyzed for HIV, HBsAg, and HCV

using anti-HIV 1+2-EIA-avicenna, Shantest-HBsAg ELISA, and anti-HCV-EIAavicenna, respectively. Specimens initially reactive for HIV were retested with vironostika microelisa. Data were analyzed using SPSS version 13.0. P values < or = 0.05 were considered significant. RESULTS: Of the 300 subjects, 54 (18.0 %), 69 (23.0 %), and 37 (12.3 %) tested positive for HIV, HBV, and HCV, respectively. Co-infections were eight (2.7 %) for HIV/HBV and two (0.7 %) for HBV/HCV. Those aged 21-26 years were more likely to be infected with HIV and HBV, while those aged 33-38 years had the highest HCV infection. Associated risk factors included duration in prison, previous incarceration (for HIV, HBV and HCV), intra-prison anal sex, multiple sex partners (for HIV and HBV), ignorance of transmission modes, blood transfusion, and alcohol consumption (for HBV and HCV). No inmate injected drugs. CONCLUSIONS: The overall outcome represents the need for prison-focused intervention initiatives in Nigeria. Injected drug use is an unlikely major transmission mode among Nigerian inmates. PMID: 19762972 [PubMed - indexed for MEDLINE] 113. Clin Infect Dis. 2009 Oct 1;49(7):1051-60. doi: 10.1086/605561. Improving the diagnosis of acute hepatitis C virus infection with expanded viral load criteria. McGovern BH, Birch CE, Bowen MJ, Reyor LL, Nagami EH, Chung RT, Kim AY. Lemuel Shattuck Hospital, Division of Infectious Diseases, 170 Morton St., Jamaica Plain, MA 02130, USA. bmcgovern@tuftsmedicalcenter.org BACKGROUND: The diagnosis of acute hepatitis C virus (HCV) infection is imprecise because antibody testing does not differentiate between acute and chronic infection. Although virologic features, such as viral load fluctuations and low levels of viremia, have been noted to be characteristic of acute HCV infection, these parameters have not been used for diagnosis. METHODS: We validated the use of these novel parameters (ie, viral load fluctuations >1 log and HCV RNA levels <100,000 IU/mL) in a cohort of acute HCV seroconverters. We then applied standard diagnostic criteria for acute HCV infection in a cohort of high-risk injection drug users entering prison with suspected acute HCV infection (n=37). We subsequently assessed whether these novel virologic parameters, measured serially over a 10-week period, could enhance the diagnosis of acute infection. RESULTS: Low-level viremia and viral load fluctuations were highly prevalent in our cohort of acute seroconverters (81% and 86%, respectively), whereas low-level viremia occurred in only 13% of control patients with chronic infection. With use of standard criteria, 37 inmates received a diagnosis of acute HCV infection.

Among the 35 patients with HCV RNA detectable at baseline, we found low-level viremia to be highly prevalent (n=27; 77%); among patients with a minimum of 2 HCV RNA samples, we demonstrated viral fluctuations in more than one-third (n=9; 36%). CONCLUSIONS: The diagnosis of acute infection in HCV-seropositive patients is strengthened by the use of virologic parameters that are uncommon in chronic disease. Viral load fluctuations and low levels of HCV RNA should be incorporated into standard diagnostic criteria. PMCID: PMC2741541 PMID: 19725787 [PubMed - indexed for MEDLINE] 114. Enferm Infecc Microbiol Clin. 2010 Apr;28(4):236-8. doi: 10.1016/j.eimc.2009.06.004. Epub 2009 Aug 19. [Prevalence of human immunodeficiency virus and hepatitis C virus, and associated factors among injecting drug users in Catalonia]. [Article in Spanish] Huntington S, Folch C, Gonzlez V, Meroo M, Ncube F, Casabona J. Centre d'Estudis Epidemiolgics sobre les ITS i Sida de Catalunya, Hospital Universitari Germans Trias i Pujol, Badalona, Espaa. INTRODUCTION: The objectives of this study were to estimate the prevalence of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) among injection drug users (IDUs) and identify the sociodemographic and behavioral factors in this population associated with these infections. METHODS: Cross-sectional study in IDUs recruited in Catalonia in 2006. RESULTS: Ever-sharing syringes was associated with both HIV and HCV infection. Indirect sharing of injecting equipment and injecting cocaine as the main drug were factors associated with HCV infection, and the fact of having injected in prison was associated with HIV infection. CONCLUSION: Identification of sociodemographic and behavioral factors associated with these infections can be of help when designing specific preventive interventions for IDUs. Copyright 2008 Elsevier Espaa, S.L. All rights reserved. PMID: 19695744 [PubMed - indexed for MEDLINE] 115. AIDS Policy Law. 2009 May;24(6):6.

Prisons. Nurse could have exposed inmates to bloodborne diseases. [No authors listed] PMID: 19496210 [PubMed - indexed for MEDLINE] 116. Am J Gastroenterol. 2009 Jun;104(6):1412-9. doi: 10.1038/ajg.2009.106. Epub 2009 Apr 21. Chronic liver disease mortality among male prison inmates in Texas, 1989-2003. Harzke AJ, Baillargeon J, Paar DP, Pulvino J, Murray OJ. Correctional Managed Care Division, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA. ajharzke@utmb.edu OBJECTIVES: Alcohol abuse and chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are the major etiologic factors for chronic liver disease/cirrhosis (CLD) in the United States. These CLD risk factors are highly prevalent in US adult incarcerated populations, but CLD-related mortality data from these populations are lacking. The primary objective of this study was to assess CLD-related mortality over time and across categories of race-ethnicity from 1989 through 2003 among male inmates in the Texas state prison system. The secondary objective was to examine patterns of recorded underlying, intervening, and contributing causes of death for CLD-related deaths. METHODS: Prisoner decedent data were linked with Texas Vital Statistics multiple-cause-of-death data. Deaths were considered CLD-related if CLD or common sequelae were recorded as the underlying, intervening, or contributing causes of death. CLD-related crude annual death rates, 5-year average annual death rates, and average annual percentage changes were estimated. RESULTS: Among male Texas prisoners from 1989 to 2003, CLD-related deaths accounted for 16% of deaths (688/4,316). CLD-related crude annual death rates were high and increased over the study period by an average of 4.5% annually, with similar rate increases across categories of race-ethnicity. CLD-related average annual death rates were higher among Hispanic prisoners than among black prisoners in each 5-year period, and were higher than those for white prisoners in the 1994-1998 and 1999-2003 periods. HBV or HCV was identified as a causal factor in more than a third (34%) of CLD-related deaths. CONCLUSIONS: From 1989 to 2003, CLD-related death rates among male Texas prisoners were high and increased over time, particularly among Hispanics. Targeted prevention, screening, and treatment of CLD risk factors, especially HCV, and early detection and treatment of CLD should be considered as priorities of the US prison healthcare systems. PMCID: PMC2856927

PMID: 19491854 [PubMed - indexed for MEDLINE] 117. Gastroenterol Hepatol. 2009 Jun-Jul;32(6):387-94. doi: 10.1016/j.gastrohep.2009.01.176. Epub 2009 May 27. [Utility of 2 biochemical models predictive of liver fibrosis grade in prison inmates with hepatitis C]. [Article in Spanish] Portilla J, Lpez-Burgos A, Saiz-De-La-Hoya-Zamcola P, Snchez-Pay J, Beda-Collantes M, Faraco-Atienzar I, Lissen E. Unidad de Enfermedades Infecciosas, Hospital General Universitario de Alicante, Alicante, Espaa. portilla_joa@gva.es OBJECTIVE: To evaluate the utility of two biochemical tests (APRI and FIB-4) to predict liver fibrosis (LF) in prison inmates with chronic hepatitis C. METHOD: We performed a cross-sectional study in 165 inmates with chronic hepatitis C and liver biopsy from two Spanish prisons. LF was staged according to the Metavir Index and was subsequently reclassified as mild or absent (LF<or=1), significant (LF>or=2) or serious (LF>or=3). APRI and FIB-4 were calculated in all patients. The predictive value was calculated by the area under the curve and the optimal cut-off was obtained based on the best specificity value for each LF stage. Then, we analyzed the sensitivity, positive predictive value (PPV) and negative predictive value (NPV) for each cut-off point. RESULTS: LF<or=1 was found in 116 inmates (80.3%), significant LF in 49 (29.3%) and serious LF in 24 (14.5%). An APRI value >or=0.55 or FIB-4 >or=1.0 showed a PPV of 91% and 92%, respectively, for the presence of any grade of LF (>or=1), but both tests had low diagnostic sensitivity: 61.8% and 61.1%, respectively. An APRI value >or=0.86 or FIB-4 >or=1.3 showed a high NPV for serious LF (92.5% and 88.4% respectively). CONCLUSIONS: Both tests have a high predictive capacity to detect the presence of LF in inmates with chronic hepatitis C, but their predictive value in detecting intermediate stages of LF is low. Moreover, a significant number of inmates with LF are not identified. PMID: 19477553 [PubMed - indexed for MEDLINE] 118. Ann Epidemiol. 2009 Aug;19(8):582-9. doi: 10.1016/j.annepidem.2009.03.009. Epub 2009 May 13. HCV-related mortality among male prison inmates in Texas, 1994-2003.

Harzke AJ, Baillargeon JG, Kelley MF, Diamond PM, Goodman KJ, Paar DP. Department of Preventive Medicine and Community Health and the Correctional Managed Care Division, University of Texas Medical Branch, Galveston, Texas 77555, USA. ajharzke@utmb.edu PURPOSE: The prevalence of hepatitis C virus (HCV) infection is high among adult incarcerated populations, but HCV-related mortality data are lacking. The study purpose was to assess HCV-related mortality over time and across racial/ethnic categories from 1994 through 2003 among male prisoners in the Texas Department of Criminal Justice (TDCJ). METHODS: TDCJ decedent data were linked with Texas Vital Statistics multiple-cause-of-death data. Crude annual HCV death rates, age- and race-adjusted summary rates, and average annual percent changes were estimated. The proportion of deaths due to chronic liver disease/cirrhosis, liver cancer, hepatitis B, and HIV for which HCV was identified as an intervening or contributing cause of death was calculated. RESULTS: Among Texas male prisoners, HCV death rates were high and increased over the 10-year study period by an average 21% annually, with the largest increase occurring among Hispanic prisoners. HCV was identified as an intervening or contributing cause of death in 15% of chronic liver disease/cirrhosis deaths, 33% of liver cancer deaths, 81% of hepatitis B deaths, and 7% of HIV deaths. CONCLUSIONS: Because HCV-related deaths among Texas male prisoners are high and increasing, particularly among Hispanics, targeted prevention, screening, and treatment of HCV infections should be among the priorities of U.S. correctional healthcare systems. PMCID: PMC2857775 PMID: 19443239 [PubMed - indexed for MEDLINE] 119. Public Health Rep. 2009 Jan-Feb;124(1):120-6. Hepatocellular carcinoma prevalence and mortality in a male state prison population. Baillargeon J, Snyder N, Soloway RD, Paar D, Baillargeon G, Spaulding AC, Pollock BH, Arcari CM, Williams BA, Raimer BG. Department of Preventive Medicine and Community Health, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA. jbaillar@utmb.edu OBJECTIVES: The incidence of hepatocellular carcinoma (HCC) in the United States has increased dramatically over the last two decades, largely because of an increase in the number of people with advanced hepatitis C virus (HCV) infection.

U.S. prisoners are at high risk for HCC, given their elevated rates of HCV infection, comorbid hepatitis B virus (HBV) infection, and alcoholic liver disease. The purpose of our study was to examine the prevalence and mortality of HCC in the nation's largest state prison system. METHODS: The study population consisted of 325,477 male Texas Department of Criminal Justice (TDCJ) inmates who were incarcerated between January 1, 2003, and July 31, 2006. Information on medical conditions and demographic characteristics was obtained from an institution-wide medical information system. RESULTS: During the 3.5-year study period, 176 male TDCJ inmates (54 per 100,000) were diagnosed with HCC and 108 (33 per 100,000) died as a result of HCC. Inmates who were Hispanic, older, and infected with HCV, HBV, or human immunodeficiency virus had elevated rates of both HCC prevalence and mortality. After adjusting for all study covariates, HCC prevalence, but not mortality, was modestly elevated among inmates with diabetes. CONCLUSIONS: Our study showed that the Texas male prison population had a sevenfold higher prevalence of HCC than the general U.S. male population and a fourfold higher death rate from HCC. These findings likely reflect the high concentration of HCC-related risk factors, particularly HCV, among prisoners. PMCID: PMC2602937 PMID: 19413034 [PubMed - indexed for MEDLINE] 120. Gastroenterology. 2009 Jun;136(7):2410-1. doi: 10.1053/j.gastro.2009.04.041. Epub 2009 May 3. Acute hepatitis C infection in correctional settings. McGovern B, Kim A, Lauer G. Comment on Gastroenterology. 2009 Jan;136(1):26-31. PMID: 19409289 [PubMed - indexed for MEDLINE] 121. Health Promot J Austr. 2009 Apr;20(1):37-41. Hepatitis C education and support in Australian prisons: preliminary findings of a nationwide survey. Dyer J, Tolliday L. Hepatitis Council of Western Australia, WA, Australia. jade.dyer@med.monash.edu ISSUE ADDRESSED: Rates of hepatitis C infection are up to 60 times higher in

correctional facilities than in the general population, yet prisoners have limited access to many methods of blood-borne virus prevention. The aim of this study was therefore to explore the efficiency of hepatitis C education and support services available in custodial settings, from the perspective of health educators and policy makers. METHODS: Semi-structured interviews were conducted with 23 health professionals, from all states and territories of Australia, who were involved in the management or provision of hepatitis C education or support to prisoners. Results were interpreted using thematic analysis. RESULTS: Participant reports regarding the provision of hepatitis C education and support services varied considerably between prisons and across states. Interviewees identified successful services and barriers to improvement, including limited time, insufficient funding and frequent personnel changes. Many prisons were believed to have unique needs and educators from external agencies were not always aware of the medical procedures or methods of harm reduction available in particular facilities. CONCLUSIONS: Interviewee perceptions indicated that the delivery of hepatitis C education and support services in Australian custodial settings is marred by inconsistency. However, both education programs and psychological support services could be developed by external agencies wishing to reduce the impact of hepatitis C within the prison system. PMID: 19402814 [PubMed - indexed for MEDLINE] 122. Drug Alcohol Rev. 2008 Nov;27(6):693-9. Incarceration experiences in a cohort of active injection drug users. Milloy MJ, Wood E, Small W, Tyndall M, Lai C, Montaner J, Kerr T. British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada. BACKGROUND: Incarceration has been associated with a number of health-related harms among injection drug users (IDU). However, little is known about the prevalence and correlates of incarceration among community-based samples of IDU. METHODS: We examined the prevalence and correlates of recent incarceration among IDU in the Scientific Evaluation of Supervised Injecting (SEOSI) cohort examined between 1 July 2004 and 30 June 2006 using generalised estimating equations (GEE). RESULTS: A total of 902 individuals were included in the analysis, of whom 255 (28.72%) were female and 536 (59.42%) reported a history of incarceration. In a multivariate GEE model, recent incarceration was associated positively and independently with a number of high-risk drug using behaviours, including syringe sharing.

CONCLUSIONS: An alarmingly high proportion of active IDU reported recent incarceration and injecting while incarcerated. Recent incarceration was associated independently with syringe sharing. These findings add further evidence to repeated demands for an expansion of appropriate harm-reduction measures in Canada's prisons. PMID: 19378451 [PubMed - indexed for MEDLINE] 123. Am J Public Health. 2009 Jun;99(6):1123-30. doi: 10.2105/AJPH.2007.133389. Epub 2009 Apr 16. Characteristics and behaviors associated with HIV infection among inmates in the North Carolina prison system. Rosen DL, Schoenbach VJ, Wohl DA, White BL, Stewart PW, Golin CE. University of North Carolina, Chapel Hill, 27599-7435, USA. OBJECTIVES: We identified factors associated with testing HIV positive in a prison system performing voluntary HIV testing on inmates and estimated the number of undetected HIV cases to evaluate the efficacy of risk-factor-based HIV testing. METHODS: We used logistic regression to estimate associations between HIV serostatus and HIV risk behaviors, mental health, coinfection status, and sociodemographic characteristics for prisoners entering the North Carolina Department of Correction from January 2004 through May 2006. We estimated the number of undetected HIV cases on the basis of age-, gender-, and race-specific HIV prevalences among prisoners and in the state. RESULTS: Nearly 3.4% (718/21 419) of tested prisoners were HIV positive. The strongest risk factors for infection among men were having sex with men (odds ratio [OR] = 8.0), Black race (OR = 6.2), other non-White race (OR = 7.4), and being aged 35 to 44 years (OR = 4.1). The strongest risk factor among women was Black race (OR = 3.8). Among HIV-positive prisoners, 65% were coinfected with HCV. We estimated that between 24% (223) and 61% (1101) of HIV cases remained undetected. CONCLUSIONS: The associations between HIV serostatus and a variety of factors highlight the potential limitations of risk-factor-based HIV testing in prisons, as do the high number of potential undetected HIV cases. PMCID: PMC2679772 PMID: 19372527 [PubMed - indexed for MEDLINE] 124. J Infect. 2009 May;58(5):375-82. doi: 10.1016/j.jinf.2009.02.014. Epub 2009 Mar

27. Markers and risk factors for HCV, HBV and HIV in a network of injecting drug users in Melbourne, Australia. Miller ER, Hellard ME, Bowden S, Bharadwaj M, Aitken CK. Victorian Infectious Diseases Reference Laboratory, Locked Bag 815, Carlton South, Victoria 3053, Australia. emma.miller@deakin.edu.au BACKGROUND AND AIMS: Current injecting drug users (IDU) in major street drug markets within greater Melbourne were recruited to a longitudinal study on blood borne viruses. Here we investigated risk factors for hepatitis C virus (HCV), hepatitis B virus (HBV) and HIV infection in these IDU at the time of their recruitment. METHODS: Three hundred and eighty-two IDU completed detailed questionnaires on their drug use and risk behaviours, and provided blood samples for serology testing. These data were analysed using univariate and multivariate techniques. RESULTS: The overall prevalence of exposure to HCV, HBV and HIV was estimated at 70%, 34% and <1%, respectively. Independent predictors of HCV exposure were history of imprisonment (RR 1.34, 95% CI 1.19-1.52), use of someone else's needle or syringe (RR 1.23, 95% CI 1.07-1.42), >7.6years length of time injecting (RR 1.21, 95% CI 1.07-1.37), and originating from Vietnam (RR 1.12, 95% CI 1.07-1.18). Independent predictors of HBV exposure were HCV exposure (RR 2.15, 95% CI 1.35-3.43), >7.6years length of time injecting (RR 1.57, 95% CI 1.17-2.13) and originating from outside Australia (RR 1.60, 95% CI 1.22-2.10). Neither prison- nor community-applied tattoos predicted HCV or HBV exposure. Up to 31% of IDU who injected for 1year or less were HCV antibody positive, as were 53% of those who injected for 2years or less. CONCLUSIONS: Ongoing engagement with young IDU, through the provision of harm reduction education and resources, is critical if we are to address blood borne viral infections and other health and social harms associated with injecting drug use. PMID: 19328555 [PubMed - indexed for MEDLINE] 125. J Clin Gastroenterol. 2009 Aug;43(7):686-91. doi: 10.1097/MCG.0b013e31818dd94c. Treatment outcomes with pegylated interferon and ribavirin for male prisoners with chronic hepatitis C. Chew KW, Allen SA, Taylor LE, Rich JD, Feller E. Department of Medicine, University of California at San Francisco, San Francisco,

CA 94115, USA. kara.chew@ucsf.edu Erratum in J Clin Gastroenterol. 2009 Nov-Dec;43(10):1010. GOALS: To report our experience with pegylated interferon and ribavirin treatment of hepatitis C virus (HCV) RNA-positive inmates at the Rhode Island Department of Corrections. BACKGROUND: An estimated 1 out of 3 HCV-infected individuals will spend time in a jail or prison within a 1-year period, making prisons a unique setting for management of chronic HCV. STUDY: Chart review of all inmates identified as having initiated HCV treatment between October 2000 and April 2004. HCV-infected individuals were identified by HCV antibody screening at intake for known risk factors, elevated aminotransferase levels, or per individual request. Treatment followed standard guidelines with weight-based dosing of pegylated interferon-alpha2b and ribavirin. End points were completion of therapy plus 6 months for sustained virologic response (SVR), therapy discontinuation, and loss to follow-up. RESULTS: The cohort included 71 male patients, was mostly white (80%), and genotype 1 (65%). All 9 African Americans (AA) had genotype 1. Of 59 patients having liver biopsy, 41 had early stage disease. Overall SVR was 28%. Response rate was lower for genotype 1 compared with genotypes 2 and 3 (SVR 18% vs. 60% and 50%). Of inmates with genotype 1, no difference existed in treatment response by race (SVR 22% AA vs. 18% white). Thirty-three patients completed treatment, 26 stopped for side effects, and 5 for initial nonresponse. Eleven were lost to follow-up. CONCLUSIONS: Acceptable HCV treatment outcomes can be achieved in prisons. Our small study indicates no difference in treatment response by AA versus white race for genotype 1. PMCID: PMC2936234 PMID: 19295448 [PubMed - indexed for MEDLINE] 126. Prev Med. 2009 Jun;48(6):588-92. doi: 10.1016/j.ypmed.2009.03.011. Epub 2009 Mar 13. Liver cancer mortality among male prison inmates in Texas, 1992-2003. Harzke AJ, Baillargeon JG, Goodman KJ, Pruitt SL. Division of Epidemiology and Outcomes, Correctional Managed Care, University of Texas Medical Branch, Galveston, TX 77555, USA. ajharzke@utmb.edu OBJECTIVES: Prevalence estimates for several liver cancer risk factors-hepatitis

C, hepatitis B, and history of alcohol abuse-are substantially higher in U.S. prison populations than in the general population. However, liver cancer mortality data from these populations are lacking. The primary aims of this study were to examine trends in liver cancer mortality rates from 1992 to 2003 among male prisoners in the Texas Department of Criminal Justice (TDCJ) and to compare these rates to general population rates. METHODS: TDCJ data on male decedents (N=4026) were linked with Texas Vital Statistics multiple-cause-of-death data. Crude average annual liver cancer death rates, average annual percent changes, and standardized mortality ratios were estimated. RESULTS: Crude liver cancer death rates increased by an average annual 6.1% among male prisoners, which was considerably higher than the average annual percent change among similarly aged males in Texas (2.0%) and the U.S. (2.9%). The number of liver cancer deaths among male prisoners was 4.7 (4.0-5.6) and 6.3 (5.3-7.5) times higher than the expected number of deaths estimated using age-specific rates from these reference populations. CONCLUSIONS: From 1992 to 2003, liver cancer death rates and rate increases were elevated among Texas male prisoners. Findings support previous recommendations for targeted prevention, screening, and treatment of liver cancer risk factors in prison populations. PMCID: PMC2879635 PMID: 19289141 [PubMed - indexed for MEDLINE] 127. J Psychoactive Drugs. 2008 Dec;40(4):493-501. HCV in incarcerated populations: an analysis of gender and criminality on risk. Rhodes AG, Taxman FS, Friedmann PD, Cropsey KL. CJDATS Coordinating Center, George Mason University, Fairfax, VA, USA. arhodes1@gmu.edu While studies have explored the prevalence and correlates for hepatitis C (HCV) infection in substance-using and incarcerated populations these studies have not examined the attributes of criminal histories for those with HCV infection. This study examines the HCV infection rate as it relates to criminal risk factors using baseline data from a randomized trial of re-entering offenders and examines how these risk factors vary by gender. The HCV-positive population had a longer amount of time in confinement (105 vs. 61 months) than those who tested negative. HCV positive men were more likely to currently be receiving drug treatment than women. Criminal risk was positively associated with HCV infection while controlling for major risk factors (OR 1.25,95% CI: 1.07, 1.46), suggesting that the relationship was not spurious. While criminologists tend to examine risk relative to public safety threats, it appears that the public health needs

equally require attention. Policy issues are examined regarding how services can be delivered to treat those with HCV infections within the correctional system and address criminal risk factors. PMCID: PMC3651872 PMID: 19283953 [PubMed - indexed for MEDLINE] 128. Enferm Infecc Microbiol Clin. 2009 Apr;27(4):206-12. doi: 10.1016/j.eimc.2008.07.003. Epub 2009 Feb 25. [Chronic hepatitis C virus infection and associated liver disease among the inmates of a Spanish prison]. [Article in Spanish] Murcia J, Portilla J, Bedia M, Palazn JM, Snchez-Pay J, Saiz de la Hoya P, Pay A, Boix V, Merino E, Reus S. Unidad de Enfermedades Infecciosas, Hospital General Universitario de Alicante, Alicante, Espaa. OBJECTIVE: The objective of this study was to determine the prevalence and genotype distribution of chronic hepatitis C virus (HCV) infection in a penitentiary population. The secondary objective was to describe histological findings in liver of the biopsied population, and identify risk factors associated with liver fibrosis and inflammatory activity. METHODS: Among 800 inmates, 730 accepted HCV antibody screening and PCR confirmation. Sociodemographic, behavioral, and incarceration-related variables were analyzed. Liver biopsy was offered to individuals with chronic HCV infection. Advanced liver disease was defined as fibrosis 3 and/or an inflammatory activity index score 8). RESULTS: HCV antibodies were found in 279 inmates. PCR confirmed HCV infection in 250 inmates, yielding a prevalence of 34.2% (95% confidence interval [CI]: 30.8-37.8). Intravenous drug use was independently associated with HCV infection, odds ratio (OR) 51.7 (95% CI: 31-86). Genotypes were 1a 32.9%, 3 29.7%, 1b 18.4% and 4 17.1%. Fifty-one liver biopsies were performed; advanced liver disease was found in 7 patients (13.7%) based on fibrosis and in 31 patients (60.7%) based on the inflammatory activity index. High AST and ALT levels were associated with advanced liver disease established on both fibrosis and inflammatory activity (P<.05). Lengthy intravenous drug use was associated with inflammatory activity (P=.02; OR 1.2; 95% CI: 1.03-1.7). CONCLUSIONS: Persistent HCV infection is highly prevalent among prison inmates and is associated with intravenous drug abuse. HCV genotype diversity is higher in prison inmates than in the general population. Higher transaminase levels are

associated with advanced liver disease. PMID: 19246126 [PubMed - indexed for MEDLINE] 129. Am J Gastroenterol. 2009 Apr;104(4):1024-31. doi: 10.1038/ajg.2008.143. Epub 2009 Feb 24. Viral hepatitis in incarcerated adults: a medical and public health concern. Hunt DR, Saab S. Department of Medicine, Harbor-UCLA Medical Center, Torrance, California, USA. Viral hepatitis is a common problem in the incarcerated population. It causes significant morbidity and mortality, and incarcerated inmates receive their health care almost exclusively from corrections-based health systems. The seroprevalence of hepatitis B and C infections is increased in this population, and a number of risk factors for viral hepatitis are particularly common and infer higher risk among inmates, including injection drug use (IDU), high-risk sexual activity, and tattoos. IDU, in particular, has been identified as an important and common risk factor for viral hepatitis in inmates, and variable rates of IDU among inmates have been found to be the most important cause of the marked variability of seroprevalence rates for exposure to hepatitis C virus. A number of risk reduction and management strategies have been identified that can decrease transmission to other inmates. Prison-based hepatitis A and hepatitis B vaccination programs, needle exchange programs, methadone maintenance programs, risk education programs, and hepatitis C virus antiviral programs, for example, have been shown to be safe and effective risk reduction and management strategies. Preliminary studies have shown that these strategies are underutilized in the United States. Reasons for this phenomenon are multifactorial, involving financial as well as ethical and political considerations. Additional funding, research, and formal consideration / discussion of the complex issues involving viral hepatitis in the US incarcerated population are clearly important for the sake of inmates and the community at large. In this article, the published medical literature regarding this important topic is reviewed. PMID: 19240708 [PubMed - indexed for MEDLINE] 130. Int J Law Psychiatry. 2009 Mar-Apr;32(2):101-7. doi: 10.1016/j.ijlp.2009.01.006. Epub 2009 Feb 23. Co-occurring psychiatric and substance use disorders among male detainees in

Italy. Piselli M, Elisei S, Murgia N, Quartesan R, Abram KM. University of Perugia, Italy. This paper presents data on the prevalence of co-occurring substance use and psychiatric disorders among newly imprisoned males in Italy. Interviewers conducted semi-structured clinical interviews with n=302 male detainees seven days after their admission to the prison of Perugia from August 2005 through July 2006. Over half of male detainees (54.3%) had either a substance use disorder or another psychiatric disorder. One of every five detainees (20.9%) had comorbid substance use and psychiatric disorders. Compared to detainees with psychiatric disorder only, substance use disorder only, or no disorder, detainees with comorbid substance use and psychiatric disorders were significantly more likely to have severe impairment in the areas of employment, substance abuse, family and social functioning, and psychiatric symptoms. Findings underscore the need for careful diagnostic screening at intake, access to treatment during detention, and an effective transition to services at the time of release. PMID: 19237198 [PubMed - indexed for MEDLINE] 131. Gastroenterol Nurs. 2009 Jan-Feb;32(1):42-8. doi: 10.1097/SGA.0b013e3181965d1a. Peer education for hepatitis C prevention. Zucker DM. School of Nursing, University of Massachusetts, Amherst, MA 01003, USA. donna@acad.umass.edu The purpose of this article is to describe a model of education about hepatitis C virus prevention tested in a county correctional facility. The Teach One Method and Relational Communication models inform this work. Using a one-group pretest-posttest prospective design our aims were to (1) convey education about prevention, protection, and safety; (2) provide this information through relationship-centered communication; (3) test the reliability and validity of the instruments; and (4) measure changes in behavior, knowledge, and relationship in the learner. A convenience sample of 25 men was recruited at a Massachusetts county jail. Subscale reliability was 0.78 and 0.79 for the relationship and behavior subscales, respectively. Knowledge questions were evaluated using face and content validity by teachers before and during this study. All subscale mean scores improved in the posttest condition. The level of significance of the calculated t value for the behavior subscale was 0.16. The level of significance

for the relationship t value was nonsignificant at 0.65. Knowledge, behavior, and relationship scores improved after the intervention. Recommendations include retesting study instruments on a larger sample and using a control group. PMID: 19197190 [PubMed - indexed for MEDLINE] 132. J Infect Public Health. 2009;2(1):47-51. doi: 10.1016/j.jiph.2009.01.001. Epub 2009 Mar 6. Seroprevalence study of HCV among hospitalized intravenous drug users in Ahvaz, Iran (2001-2006). Alavi SM, Alavi L. Infectious Diseases and Tropical Medicine Research Center, Jundishapoor University of Medical Sciences, Ahvaz, Iran. alavi1329dr@yahoo.com BACKGROUND AND AIMS: Prevalence of hepatitis C virus (HCV) in intravenous drug users (IDU) varies in different areas according to socioeconomic and geographical circumstances. The present study was performed to determine seroprevalence of HCV in IDU individuals in Ahvaz, Iran. MATERIALS AND METHODS: 142 IDU patients were included in this retrospective study in Ahvaz southwest Iran from 2001 to 2006. Patients were placed in two groups determined by HCV Ab positive or negative status. Data were analyzed using SPSS for Windows (version 11.5; SPSS Inc., USA) software. RESULTS: Out of total 142 cases, 74 persons (52.11%) had a positive HCV-Ab test according to the ELISA method. There was no difference in age, sex, level of education, residency and co-infection with HIV and hepatitis B virus between HCV-Ab positive (HAP) and HCV-Ab negative (HAN) groups (p>0.05). HCV-Ab positivity was significantly related to imprisonment and duration spent in prison [OR: 3.22, 95% (CI) 2.61-3.76, p<0.0001]. CONCLUSION: Patients with IDU constitute a high-risk group for acquisition of HCV infection. Transmission of HCV via sharing syringe and needle as well as blood transfusion has been a significant source of hepatitis C infection for patients with intravenous drug addiction. PMID: 20701860 [PubMed - indexed for MEDLINE] 133. Aust N Z J Public Health. 2008 Dec;32(6):549-53. doi: 10.1111/j.1753-6405.2008.00308.x. Prison health and public health responses at a regional prison in Western

Australia. Gilles M, Swingler E, Craven C, Larson A. Combined Universities Centre for Rural Health (CUCRH) Medical Faculty, University of Western Australia, Geraldton WA 6531, Australia. mgilles@cucrh.uwa.edu.au OBJECTIVE: To describe the health of inmates in a Western Australian regional prison and evaluate the coverage of public health interventions. DESIGN: Cross-sectional audit of all paper-based and electronic medical notes of inmates at one regional prison in Western Australia. SETTING: A mixed medium-security prison in regional Western Australia. PARTICIPANTS: 185 prisoners, 170 men and 15 women. MAIN RESULTS: The prisoners were mainly young (70% < 35 years of age) and Indigenous (84%). Fifty two percent of prisoners had at least one chronic health condition. There was a significantly higher prevalence of diabetes to that found in the general Indigenous population (15% vs 6% p=0.001), and a significantly lower prevalence hepatitis C (4.5%) compared with both national (29-61%) and State (20%) data. Screening for sexually transmitted infections and blood borne viruses within the first month of incarceration was achieved for 43% of inmates. Vaccination coverage for influenza (36%) and pneumococcal disease (12%) was low. CONCLUSION: This study makes visible the burden of disease and reach of public health interventions within a largely Indigenous regional prisoner population. Our study demonstrates that the additional risks associated with being Indigenous remain in a regional Australian prison but also shows that interventions can be delivered equitably to Indigenous and non-Indigenous inmates. IMPLICATIONS: Ongoing monitoring of prisoner health is critical to take advantage of opportunities to improve public health interventions with timely STI and BBV screening and increased vaccinations rates. PMID: 19076747 [PubMed - indexed for MEDLINE] 134. Eur J Clin Microbiol Infect Dis. 2009 Apr;28(4):409-13. doi: 10.1007/s10096-008-0642-z. Epub 2008 Nov 8. Prevalence and risk factors of the whole spectrum of sexually transmitted diseases in male incoming prisoners in France. Verneuil L, Vidal JS, Ze Bekolo R, Vabret A, Petitjean J, Leclercq R, Leroy D. Department of Dermatology, CHU Clmenceau, Caen, France. verneuil-l@chu-caen.fr Sexually transmitted diseases (STD) are a public health issue in prison. As inmates are eventually released, it is also a community concern. There are very few data on the entire spectrum of STDs, particularly condyloma among prisoners.

To determine the prevalence of all STDs: infection with human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), herpes simplex virus (HSV), Chlamydia trachomatis, Neisseria gonorrhoea, syphilis, and condyloma among entering inmates. A cross-sectional study was conducted in France from November 2000 to June 2003. Male adults entering a prison remand center in Caen had a medical consultation and physical examination including external genital organs and perianal area for condyloma and herpes infection, a urethral swab for Chlamydia trachomatis and Neisseria gonorrhoea detection, and a blood sample for HBV, HCV, HIV, and syphilis serology. Five hundred and ninety-seven inmates agreed to participate in the study. Sixteen percent had at least one STD: 4.0% had condyloma, 4.0% chlamydia infection, and 4.9% were positive for HCV antibodies. Two had early syphilis and 1 had acute HBV, but no HIV infection, neither genital herpes nor gonorrhea. The analysis of the STD risk behaviors did not show any difference between the infected and uninfected participants, except that HCV-positive participants were more likely to be intravenous drug users. Results suggest that a systematic screening of all STDs should be at least proposed to every entering inmate since no demographic or sexual characteristics are consistently associated with STDs. PMID: 18998176 [PubMed - indexed for MEDLINE] 135. Eur J Health Law. 2008 Jul;15(2):217-21. ECHR 2008/9 Case of Mechenkov v. Russia, 7 February 2008, no. 35421/05 (First Section). Dute J. University of Amsterdam, The Netherlands. PMID: 18988605 [PubMed - indexed for MEDLINE] 136. Cent Eur J Public Health. 2008 Sep;16(3):116-20. A survey of HIV and HCV among female prison inmates in Portugal. Barros H, Ramos E, Lucas R. National Coordination for HIV/AIDS, Lisbon, Portugal. hbarros@sida.acs.min-saude.pt HIV and hepatitis C virus (HCV) monitoring among prison inmates is instrumental in countries with concentrated HIV/AIDS epidemics. Knowledge on these dynamics in imprisoned women in Portugal is scarce. The HIV and HCV prevalence was estimated

among inmates in the largest Portuguese prison for women, which holds 57% of all female inmates in Portugal, according to sociodemographic and behavioural variables and characterised attitudes towards HIV/AIDS according to serological status. Collected variables included age, education, country of birth, penal status, and accumulated time in prison. Drug injection and sharing of injection material were inquired, as well as age at first sexual intercourse. Inmates also characterised their attitudes towards HIV/AIDS. A venous blood sample was collected and tested for anti-HIV and anti-HCV antibodies. In this sample of 445 female inmates, 10% were HIV-positive, while 11% were HCV-positive. Longer imprisonment periods were associated with relatively higher HCV prevalence and women with later ages at first sexual intercourse were less frequently HIV-positive, regardless of drug injecting behaviour. HIV prevalence was 44% in women who had ever injected drugs and 6% in those who had never injected. HCV frequency was 69% among injecting drug users (IDUs) and 4% among non-IDUs. In women who injected drugs both HIV and HCV were more frequent when the number of injections was higher and when women reported sharing of injection material. Similar attitudes towards HIV/AIDS were found for HIV-positive and negative women, but those living with HIV had more tolerant positions. This study emphasizes the role of injecting drug use in the transmission of HIV and HCV in women in Portuguese prisons and reinforces the need for the systematic adoption of harm reduction measures. PMID: 18935775 [PubMed - indexed for MEDLINE] 137. Int J STD AIDS. 2008 Nov;19(11):795. doi: 10.1258/ijsa.2008.008237. Screening blood-borne virus among incarcerated inmates. Chong VH. Comment on Int J STD AIDS. 2008 May;19(5):347-8. PMID: 18931282 [PubMed - indexed for MEDLINE] 138. Hepatology. 2008 Nov;48(5):1387-95. doi: 10.1002/hep.22509. Treating hepatitis C in the prison population is cost-saving. Tan JA, Joseph TA, Saab S. Department of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, USA.

The prevalence of chronic hepatitis C infection in U.S. prisons is 12% to 31%. Treatment of this substantial portion of the population has been subject to much controversy, both medically and legally. Studies have demonstrated that treatment of chronic hepatitis C with pegylated interferon (PEG IFN) and ribavirin is a cost-effective measure in the general population; however, no study has addressed whether the same is true of the prison population. The aim of this study was to determine the cost-effectiveness of hepatitis C treatment with PEG IFN and ribavirin in the U.S. prison population. Cost-effectiveness was determined via a decision analysis model employing Markov simulation. The cohort of prisoners had a distribution of genotypes and stages of fibrosis in accordance with prior studies evaluating inmate populations. The probability of transitioning from one health state to another, reinfection rates, in-prison and out-of-prison mortality rates, sustained viral response rates, costs, and quality of life weights were also obtained from the literature. Sensitivity analysis was performed. In a strategy without a pretreatment liver biopsy, treatment was cost-effective for all ages and genotypes. This model was robust to rates of disease progression, mortality rates, reinfection rates, sustained viral response rates, and costs. In a strategy employing a pretreatment liver biopsy, treatment was also cost-saving for prisoners of all ages and genotypes with portal fibrosis, bridging fibrosis, or compensated cirrhosis. Treatment was not cost-effective in patients between the ages of 40 and 49 with no fibrosis and genotype 1.CONCLUSION: Treatment of chronic hepatitis C with PEG IFN and ribavirin in U.S. prisons results in both improved quality of life and savings in cost for almost all segments of the inmate population. If the decision to treat hepatitis C is based on pharmaco-economic measures, this significant proportion of infected individuals should not be denied access to therapy. PMID: 18924228 [PubMed - indexed for MEDLINE] 139. Int J Public Health. 2008;53(5):268-71. doi: 10.1007/s00038-008-6014-8. Detection and treatment of HIV and hepatitis virus infections in Swiss correctional facilities. Gerlich MG, Frick U, Pirktl L, Uchtenhagen A. Research Institute for Public Health and Addiction, Konradstrasse 32, P.O. Box 8031, Zurich, Switzerland. miriam.gerlich@isgf.uzh.ch OBJECTIVES: The aim of the study was to obtain an overview on diagnostic and therapeutic activities concerning hepatitis A, B, C virus and HIV in Swiss prisons. METHODS: A standardized questionnaire was sent to 91 prisons in the German and Italian speaking parts in October 2004; 41 institutions (45%) answered the questionnaire.

RESULTS: In almost all prisons serological examinations were not done routinely, but were provided when demanded by inmates or recommended by the medical service. Vaccination against hepatitis A or B infection and initiation of antiviral therapy was possible in most institutions. CONCLUSIONS: Most of the prisons investigated offered diagnostic and antiviral treatment for hepatitis virus and HIV infections. A reported problem was the discontinuation of ongoing treatments or vaccination cycles after discharge. In some cases deficient funding was an obstacle. PMID: 18820835 [PubMed - indexed for MEDLINE] 140. Int J Infect Dis. 2009 Mar;13(2):201-8. doi: 10.1016/j.ijid.2008.06.011. Epub 2008 Sep 13. Hepatitis C virus infection in South Australian prisoners: seroprevalence, seroconversion, and risk factors. Miller ER, Bi P, Ryan P. Discipline of Public Health, University of Adelaide, Adelaide, South Australia. emma.miller@deakin.edu.au OBJECTIVES: To determine entry antibody seroprevalence and seroconversion to hepatitis C virus (HCV) and associated risk factors in newly incarcerated prisoners. METHODS: Males and females entering South Australian prisons completed risk factor surveys and were offered HCV-antibody testing. Participants completed additional surveys and, if HCV-negative at last test, underwent further antibody tests at 3-monthly intervals for up to 15 months. Data were analyzed using univariate and multivariate techniques. RESULTS: HCV seroprevalence among 662 prison entrants was estimated at 42%. Previous injecting history was highly prevalent at entry (64%) and both community and prison injecting independently predicted entry HCV status. Tattooing was not an important risk factor. While community exposure could not be ruled out, three seroconversions were noted in 148 initially HCV-seronegative individuals occurring in a median 121 days--4.6 per 100 person-years. Prison injecting was infrequently reported, but HCV-seropositive participants were significantly more likely to commence IDU in prison than seronegative participants (p=0.035). CONCLUSIONS: Entry HCV seroprevalence in South Australian prisoners is extremely high and may have contributed to a 'ceiling effect', minimizing the observable seroconversion rate. Greater frequency of injecting among those already infected with HCV represents a significant threat to other prisoners and prison staff. PMID: 18790659 [PubMed - indexed for MEDLINE]

141. Dig Dis Sci. 2009 Jun;54(6):1325-30. doi: 10.1007/s10620-008-0483-8. Epub 2008 Aug 29. Access to treatment of hepatitis C in prison inmates. Strock P, Mossong J, Hawotte K, Arendt V. Hepatogastroenterology, Service d'Hpato-Gastroentrologie, Centre Hospitalier de Luxembourg, Luxembourg-City, Luxembourg. strock.paul@chl.lu We conducted a prospective study to investigate access to treatment in hepatitis C in 268 prisoners. Hepatitis C positivity had been known for 182 prisoners previously and 19 reported previous attempts to treat (10%). In comparison, during our study, 86/268 prisoners (32%) started therapy (P < 0.0001). They represented 41% of 211 prisoners with a positive viral load. In the genotype 2 or 3 group, 46 prisoners (50%) started therapy versus 40 prisoners (33%) with other genotypes (P = 0.01). This difference was due to prisoners waiting for liver biopsy. On an intention to treat basis, 45 prisoners (52%) achieved sustained virological response 6 months after the end of therapy. We conclude that a stay in prison is an effective opportunity to treat a group of hepatitis C patients which otherwise have very limited access to therapy. PMID: 18758958 [PubMed - indexed for MEDLINE] 142. Int J STD AIDS. 2008 Sep;19(9):586-9. doi: 10.1258/ijsa.2008.008051. Measuring the gap: from Home Office to the National Health Service in the provision of a one-stop shop sexual health service in a female prison in the UK. Mahto M, Zia S. Genitourinary Medicine Department (Central and Eastern Cheshire PCT), Assura Health and Wellness Centre, Sunderland Street, Macclesfield, UK. mrinalini.mahto@echeshire-tr.nwest.nhs.uk The Genitourinary (GU) Medicine Service was transferred from the Home Office to the NHS from April 2006 at this female prison to give prisoners access to the same quality of health care as the general public. Medline search showed no published data on the prevalence of sexually transmitted infections (STIs) among female prisoners in the UK. The main aim was to develop a one stop sexual health shop and to determine the prevalence and risk factors for STIs, to determine the uptake rate for HIV testing, hepatitis B vaccination and cervical cytology along with requests for usage of contraceptive services. Challenges were met when introducing change to bring the services in line with the local GU medicine

clinic. Review of the service at one year along with retrospective case note review from May 2006 to August 2007 was done. Of the 545 new patients seen, history of substance abuse, IVDU, sexual abuse, sex worker and past history of hepatitis C virus and chlamydia were 86%, 41%,12%, 6%, 17% and 24% respectively.The uptake rate for both STI screen and blood-borne viruses (BBVs) testing was high at 87% and 69.3% respectively. STI was diagnosed in 19.6%. Prevalence rates were: Trichomonas vaginalis (TV) 8.2%, chlamydia 5.3%, gonorrhoea 0.2%, genital warts 5.3%, HIV 0.8%, hepatitis C virus 12% and hepatitis B virus 11%. The uptake rate for 1(st) dose hepatitis B vaccination and cervical cytology were 70% and 92% respectively, 36 accessed contraceptive services. Provision of one stop shop in a female prison is feasible and practical. STIs, particularly TV, and BBVs prevalence is high among the female inmates. Prevention methods targeting this population needs to be intensified. PMID: 18725547 [PubMed - indexed for MEDLINE] 143. Clin Infect Dis. 2008 Oct 1;47(7):952-61. doi: 10.1086/591707. Clinical outcomes of hepatitis C treatment in a prison setting: feasibility and effectiveness for challenging treatment populations. Maru DS, Bruce RD, Basu S, Altice FL. Yale AIDS Program, Yale University School of Medicine, New Haven, Connecticut, USA. BACKGROUND: More than one-third of people in the United States with hepatic C virus (HCV) infection pass through the correctional system annually. Data are lacking on outcomes of treatment with pegylated interferon plus ribavirin (PEG-RBV) in correctional settings. METHODS: During 2002-2006, we analyzed patients in the Connecticut Department of Correction who received PEG-RBV. We assessed the rates of sustained virological response, hospitalization, and use of medications to treat psychiatric disorders and anemia. RESULTS: Of 138 treatment-naive patients referred for treatment, 68 (49%) were approved. Overall, sustained virological response occurred in 47.1% of patients (for HCV genotype 1, 43.1%; for HCV genotypes 2 and 3, 58.8%). Only 9 patients (13%) discontinued treatment because of adverse effects. Multiple regression analysis revealed that not achieving a sustained virological response was correlated with HCV genotype 1 infection plus cirrhosis (adjusted odds ratio, 12.9; 95% confidence interval, 1.1-148) and baseline major depression (adjusted odds ratio, 3.4; 95% confidence interval, 1.01-11.6), but not with HIV infection, a baseline HCV RNA level >or=400,000 IU/mL, or black race. Compared with baseline, the rate of prescription of a new mood stabilizer (2.2 vs. 0.8 prescriptions per person-year) or an opioid (1.8 vs. 0.5 prescriptions per

person-year) was higher during treatment, whereas there was no change in the rate of prescription of benzodiazepines and antipsychotic medications. CONCLUSIONS: These results support the feasibility and clinical effectiveness of PEG-RBV for the treatment of chronic HCV infection in correctional facilities. PMID: 18715156 [PubMed - indexed for MEDLINE] 144. Int J Prison Health. 2008 Sep;4(3):156-63. doi: 10.1080/17449200802264712. Prisons and HCV: a review and a report on an experience in New South Wales Australia. Batey RG, Jones T, McAllister C. Drug and Alcohol Clinical Services, Hunter New England Area Health Service, Newcastle, New South Wales, Australia. RBATE@doh.health.nsw.gov.au Prison populations in Western countries are characterised by a high hepatitis C prevalence. This reflects a high rate of imprisonment for drug related offences. Prison entrants who are HCV-negative face a significant risk of acquiring hepatitis C. Effective prevention strategies and successful treatment of a significant percentage of hepatitis C-positive inmates could reduce the risk of transmission in the prison context significantly. Several reports of treating hepatitis C in prisoners in major facilities have been published. We report our experience of establishing a liver clinic service in two regional prisons in New South Wales, Australia. Liver biopsy requirements to access treatment in Australia meant that only 46 of 196 reviewed patients were able to commence treatment in our 5-year experience. Treatment completion rate was 61% and end of treatment viral response was 57%. The removal of liver biopsy requirements in Australia in April 2006 has freed up access to treatment and our results encourage further effort to optimise the process of assessment and treatment in this high-risk population. PMID: 18698530 [PubMed - indexed for MEDLINE] 145. AIDS Policy Law. 2008 Jul;23(8):7. Prisons. Indifference claim fails over withholding of medications. [No authors listed] PMID: 18661662 [PubMed - indexed for MEDLINE]

146. J Viral Hepat. 2008 Oct;15(10):729-39. doi: 10.1111/j.1365-2893.2008.01000.x. Epub 2008 Jul 10. Where are people being tested for anti-HCV in England? Results from sentinel laboratory surveillance. Brant LJ, Hurrelle M, Balogun MA, Klapper P, Ramsay ME; Hepatitis Sentinel Surveillance Study Group. Collaborators: Jalal H, Smith R, Meigh R, Vicca T, Ahmad F, Ibrahim I, Balogun K, Brant L, Ramsay M, Tweed E, Taylor C, Taylor J, Boxall E, Mowbray J, Hale A, Hurrelle M, Lyons D, Zuckerman M, Johnson D, Klapper P, Mutton K, Paver K, Turner A, Irving W, Prichett L, Benge G, Patel BC, Silles J, Ashton L, Hart I, Ushiro-Lumb I, Al-Ghusein H, Rice P, Hewitt G, Underhill G, Aarons E, Luton P, Nash J, Baker M. Immunisation Department, Health Protection Agency, Centre for Infections, Colindale, London, UK. lisa.brant@hpa.org.uk SUMMARY: Many people infected with hepatitis C virus (HCV) are unaware of their infection and are, therefore. potentially infectious to others. To enable effective case-finding policies to be developed, an understanding of where people, and injecting drug users (IDUs) in particular, are accessing HCV antibody testing is needed. HCV antibody testing data were collected electronically from 21 sentinel laboratories in England between 2002 and 2006 in this cross-sectional study. Service types of the physician requesting the HCV test were identified and classified. Differences in people being tested in each service type and over time were investigated. Over half a million people were tested in 5 years. Whilst most testing took place in hospital, a large proportion of people were tested in community care, particularly in general practice surgeries and genito-urinary medicine clinics. Younger people were more likely to be tested in community care, and there was evidence that testing differed according to ethnic status. IDUs were tested in all parts of the health services, although the highest proportion positive were from prisons and specialist services for drug users. Testing increased between 2002 and 2005 whilst the proportion of people testing positive declined. Routine laboratory data can provide valuable information on where people are being tested for HCV. Risk exposures should be investigated and testing targeted to people at higher risk for infection. Local laboratories should review data on testing locations and proportion positive to inform local initiatives to improve testing and yield. PMID: 18637078 [PubMed - indexed for MEDLINE] 147. J Viral Hepat. 2008 Nov;15(11):797-808. doi: 10.1111/j.1365-2893.2008.01008.x. Epub 2008 Jul 10.

The cost-effectiveness of screening and treatment for hepatitis C in prisons in England and Wales: a cost-utility analysis. Sutton AJ, Edmunds WJ, Sweeting MJ, Gill ON. Health Protection Agency, Centre for Infections, London, UK. Andrew.Sutton@warwick.ac.uk Prisoners have a high prevalence of hepatitis C virus (HCV) infection compared with the general population in England and Wales and in many locations throughout the world. This is because of large numbers of injecting drug users that engage in behaviours likely to transmit HCV being present within prison populations. It is, therefore, suggested that prison may be an appropriate location for HCV screening and treatment to be administered. Using cost-utility analysis, this study considers the costs and benefits of administering a single round of screening on reception into prison to all individuals followed by possible later screening in the community and comparing this to individuals who may only be tested and treated in the community at a later date. The cost/QALY of one round of prison testing and treatment was found to be 54,852 pounds sterling, although probabilistic sensitivity analysis showed extensive uncertainty about this estimate. One-way sensitivity analysis revealed the importance of the parameters describing the progression of chronic HCV and the discount rates. While the results presented here at baseline would suggest that screening and treatment for HCV in prisons is not cost-effective, these results are subject to much uncertainty. The importance of the rates describing the progression of chronic HCV on the cost-effectiveness of this intervention has been demonstrated and this suggests that future work should be undertaken to gain further insight into the rates that individuals progress to the later stages of chronic HCV infection. PMID: 18637074 [PubMed - indexed for MEDLINE] 148. J Viral Hepat. 2008 Dec;15(12):871-7. doi: 10.1111/j.1365-2893.2008.01009.x. Epub 2008 Jul 10. Diagnosis of acute hepatitis C virus infection and estimated incidence in lowand high-risk English populations. Brant LJ, Ramsay ME, Balogun MA, Boxall E, Hale A, Hurrelle M, Kaluba L, Klapper P, Lewis D, Patel BC, Parry J, Irving WL. Department of Immunisation, Health Protection Agency, Centre for Infections, London, UK. lisa.brant@hpa.org.uk

The diagnosis of acute hepatitis C virus (HCV) infection is not straightforward; few people exhibit clinical symptoms and genome/antigen detection techniques do not indicate when infection had occurred. Here, a strategy to detect HCV RNA in the absence of antibody ('window-period') for diagnosis of acute infection is assessed. The sentinel surveillance of hepatitis testing study was used to retrospectively identify anti-HCV negative samples from high-risk individuals (2002-2003), for testing singly for HCV RNA. Additional samples were identified prospectively (2005) and tested in pools for HCV RNA. Positive samples were genotyped. Incidence and costs of adopting the pooling strategy were estimated. In the retrospective study, 8/390 (2.1%) samples were confirmed HCV RNA positive, anti-HCV negative. Prospectively, 3237 samples were tested in 325 pools. Five positive pools identified four confirmed HCV RNA positive patients (one false positive). Estimated incidence was 12.9 per 100 person-years in injecting drug users (IDUs) (retrospective study) and 3.7 per 100 person-years among drug/alcohol services and prison attendees (prospective study). Estimated costs were pound 850 per positive sample, in areas of higher risk. The yield from a window-period strategy depends upon the population tested. Pooled HCV RNA testing of anti-HCV negative samples from the current IDUs is realistic and relatively inexpensive to identify recently infected individuals. PMID: 18637073 [PubMed - indexed for MEDLINE] 149. J Urban Health. 2009 Jan;86(1):93-105. doi: 10.1007/s11524-008-9305-8. Epub 2008 Jul 12. Prevalence of infection with hepatitis B and C viruses and co-infection with HIV in three jails: a case for viral hepatitis prevention in jails in the United States. Hennessey KA, Kim AA, Griffin V, Collins NT, Weinbaum CM, Sabin K. Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention NCHHSTP, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30333, USA. khennessey@cdc.gov Hepatitis B vaccination and targeted testing for hepatitis C virus (HCV) are recommended for jails with medical services available. This study estimates hepatitis B virus (HBV) and HCV infection prevalence among jail inmates, since most previous studies have been conducted among prison inmates. Prison and jail populations differ: jails hold a wide spectrum of persons for an average of 10-20 days, including persons awaiting arraignment, trial, conviction, or sentencing, while prisons typically hold convicted criminals for at least 1 year. A stratified random sample of sera obtained during routine syphilis testing of inmates entering jails in Chicago (March-April 2000), Detroit (March-August

1999), and San Francisco (June 1999-December 2000) was tested for serologic markers of HBV and HCV infection. All sera had been previously tested for antibody to HIV (anti-HIV). A total of 1,292 serum samples (12% of new inmates) was tested. Antibody to HCV (anti-HCV) prevalence was 13%. Antibody to hepatitis B core antigen (anti-HBc) prevalence was 19%, and hepatitis B surface antigen (HBsAg) prevalence was 0.9%; 12% had serologic evidence of hepatitis B vaccination. Hispanics had high rates of chronic HBV infection (3.6% HBsAg positive) along with Asians (4.7% HBsAg positive). Among HIV-infected persons, 38% were anti-HCV positive and 8.2% were HBsAg positive. Anti-HBc positivity was associated with anti-HCV positivity (aOR=4.58), anti-HIV positivity (aOR=2.94), syphilis infection (aOR=2.10), and previous incarceration (aOR=1.78). Anti-HCV-positivity was associated with anti-HBc positivity (aOR=4.44), anti-HIV-positivity (aOR=2.51), and previous incarceration (aOR=2.90). Jail entrants had high levels of HCV and HBV infection and HIV co-infection; HBV prevalence was comparable to previous prison studies, and HCV prevalence was lower than prison studies. Hispanics had an unexpectedly high rate of chronic hepatitis B infection and had the lowest rate of hepatitis B vaccination. The finding that hepatitis B vaccination coverage among jail entrants is lower than the general population, despite this population's increased risk for infection, highlights the need to support vaccination in jail settings. PMCID: PMC2629523 PMID: 18622707 [PubMed - indexed for MEDLINE] 150. Praxis (Bern 1994). 2008 Apr 16;97(8):437-42. [Working under pressure]. [Article in German] Vetter Ch, Robert-Tissot L, Cottagnoud P, Stucki A. Klinik und Poliklinik fr Allgemeine Innere Medizin, Universittsspital Bern. chvetter_ol@spital.ktso.ch From medical view the main problems of investigation and convicts are in particular in the range of the drugs and alcohol illnesses to see transferable diseases (HIV, hepatitis B - C and tuberculosis) and psychological illnesses. These complex diseases require a close meshed and intensive support of each individual patient and represent actually the main problem during an arrest. The development of the health service could address the new requirements making possible cost-conscious acting in handling with resources in the health service. In the canton Berne 957197 inhabitants live on a total area of 5959 km2. The police and military management operates the regional and district prisons as well as the transportation service for prisoners in the canton Berne for prisoners.

The canton Berne has altogether 327 places. Since May 1971 persons from the regional and district prison and the penal institutions needing hospitalisation can be accepted. In the University hospital Berne on a specially equipped guard station and be cared for their medical problems. The prisoners profit in such a way from the entire range of the university facilities. PMID: 18551914 [PubMed - indexed for MEDLINE] 151. Int J STD AIDS. 2008 May;19(5):347-8. doi: 10.1258/ijsa.2007.007205. Audit into blood-borne virus services in Her Majesty's Prison Service. Murray E, Jones D. University of Glasgow, Glasgow, Scotland, UK. 0206384m@student.gla.ac.uk Comment in Int J STD AIDS. 2008 Nov;19(11):795. The main objective of this study is to assess current hepatitis C services for female prisoners. The study design includes a retrospective audit of inmates' contact with blood-borne virus (BBV) services and outcomes of service use. The study was carried out at a prison for women in the north of England with 179 prisoners and 69 service users. The outcome measures were proportions in contact with services and outcomes of service use (time to testing/treatment; proportion positive for hepatitis C; HIV status). Almost a quarter of those arriving at the prison have contact with BBV services; most of them report a history of intravenous drug use (75.4%), although one-fifth of such individuals decline testing. The average number of days from imprisonment to testing was 86-half this time if arriving since October 2006. Fifty percent were positive for the hepatitis C antibody, the majority of whom (83.3%) had an active virus and were suitable for treatment. The average number of days from testing to referral was 38. All tested for HIV were negative. Therefore, efficiency is necessary if prisoners are to access BBV services while incarcerated. This is being achieved, although some delays still occur. PMID: 18482968 [PubMed - indexed for MEDLINE] 152. Int J Prison Health. 2008 Jun;4(2):77-82. doi: 10.1080/17449200802038207. Prevalence of Hepatitis B virus and/or Hepatitis C virus co-infections in prisoners infected with the Human Immunodeficiency Virus. Pontali E, Ferrari F.

Prison of Genoa, Genoa, Italy. pontals@yahoo.com Correctional facilities host a disproportionately high prevalence of HBV, HCV and HIV infection. We evaluated the prevalence of HBV and/or HCV co-infection among HIV-infected inmates entering our correctional facility. Over a 30-month period, 173 consecutive HIV-infected inmates entered our institution and were evaluated. HCV co-infection was observed in more than 90% of the tested HIV-infected inmates, past HBV infection in 77.4% and active HBV co-infection in 6.7%; triple coinfection (HIV, HCV and HBs-Ag positivity) was seen in 6.1% of them. Given the observed high prevalence of co-infection, testing for HBV and HCV in all HIV-infected inmates at entry in any correctional system is recommended to identify those in need of specific care and/or preventing interventions. PMID: 18464061 [PubMed - indexed for MEDLINE] 153. Eur J Emerg Med. 2008 Apr;15(2):104-6. doi: 10.1097/MEJ.0b013e3282f08aa4. Complications of heroin abuse. O'Connor G, McMahon G. Emergency Department, St James's Hospital, Dublin, Ireland. gabbyoco@yahoo.com A 21-year-old man presented to the emergency department in St James's Hospital by ambulance. He was found collapsed at home by his uncle. He was complaining of severe pain and swelling to his left lower limb, with reduced sensation to his left foot. He was hepatitis C positive from intravenous drug use, and had most recently used both heroin and cocaine 5 days previously on his release from prison. Musculoskeletal exam showed extensive swelling of his left lower limb, with tense calf compartments. Initial laboratory results showed a raised creatine kinase of more than 155,000 IU/l. Urine toxicology was positive for methadone, heroin and benzodiazepines, whereas urinary dipstick was positive for blood, which was confirmed to be myoglobin by subsequent laboratory analysis. Atraumatic rhabdomyolysis is a syndrome characterized by injury to skeletal muscle with subsequent release of intracellular contents, that is myoglobin and creatine kinase. Drugs have direct toxic effects, but may also cause coma-induced rhabdomyolysis, owing to unrelieved pressure on gravity-dependent body parts. Diagnosis is made with history (i.e. recent heroin or cocaine use), elevated serum CK, plus the possible presence of myoglobinuria. Aggressive i.v. rehydration remains the mainstay of treatment. If there is any evidence of compartment syndrome, urgent fasciotomy is required. Electrolyte imbalances should be corrected, unless very mildly abnormal. We have learned from our experience with this case that a high index of suspicion and thereby early recognition is crucial to prevent complications in intravenous drug users

presenting with unusual symptoms and signs. PMID: 18446076 [PubMed - indexed for MEDLINE] 154. Curr Opin Psychiatry. 2008 May;21(3):252-4. doi: 10.1097/YCO.0b013e3282fc985c. Drug use and health among prison inmates. Kanato M. Department of Community Medicine, Khon Kaen University, Khon Kaen, Thailand. manopkanato@hotmail.com PURPOSE OF REVIEW: Health problems related to substance use are investigated and monitored throughout the world by both international organizations and governments. It is well recognized that prison inmates are a vulnerable group of the population. Research on this group is minimal compared with the general population. The problem of drug use and health consequences among this subpopulation is significant and needs to be explored. RECENT FINDINGS: A higher prevalence of drug use is found among prison inmates than among the general population. The health status of prison inmates seems to be lower because of both the inmates' behavior and the prison environment. Various communicable diseases are commonly found such as hepatitis C virus, HIV, and syphilis. SUMMARY: The health of prison inmates tended to be worse than in the general population, particularly for those who use drugs. Based on the principle of human rights and equity of access, healthcare services provided to prison inmates should be equivalent to those provided to the general population. PMID: 18382223 [PubMed - indexed for MEDLINE] 155. J Epidemiol Community Health. 2008 Apr;62(4):305-13. doi: 10.1136/jech.2006.051599. Correlates of hepatitis C virus seropositivity in prison inmates: a meta-analysis. Vescio MF, Longo B, Babudieri S, Starnini G, Carbonara S, Rezza G, Monarca R. Dipartimento di Malattie Infettive, Istituto Superiore di Sanit, Viale Regina Elena 299, 00161 Rome, Italy. g.rezza@iss.it BACKGROUND: The prevalence of infection with hepatitis C virus (HCV) is higher

among prison inmates compared with the general population because of the high proportion of injecting drug users (IDU). METHODS: A meta-analysis of studies on HCV infection in the correctional system was performed. The main objective was to analyse risk factors for HCV infection and to assess HCV seroprevalence and incidence in prison. RESULTS: Thirty studies were included in the meta-analysis on HCV prevalence. IDU were approximately 24 times more likely than non-IDU to be HCV positive. The odds ratio of being HCV positive was three times higher for inmates exposed to tattooing than those not exposed. The odds ratio among women was 1.44 compared with men. CONCLUSIONS: The differences in HCV seroprevalence among studies can largely be explained by differences in the proportion of inmates who are IDU and partly by differences in seroprevalence among IDU in the community. Tattooing and female gender were also associated with HCV positivity. These findings should be taken into account when planning prevention activities in prisons. PMID: 18339822 [PubMed - indexed for MEDLINE] 156. BMC Infect Dis. 2008 Mar 7;8:33. doi: 10.1186/1471-2334-8-33. Correlates of HIV, HBV, HCV and syphilis infections among prison inmates and officers in Ghana: A national multicenter study. Adjei AA, Armah HB, Gbagbo F, Ampofo WK, Boamah I, Adu-Gyamfi C, Asare I, Hesse IF, Mensah G. Department of Pathology, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana. andrewadjei50@hotmail.com BACKGROUND: Prisons are known to be high-risk environments for the spread of bloodborne and sexually transmitted infections. Prison officers are considered to have an intermittent exposure potential to bloodborne infectious diseases on the job, however there has been no studies on the prevalence of these infections in prison officers in Ghana. METHODS: A national multicenter cross-sectional study was undertaken on correlates of human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), and syphilis infections in sample of prison inmates and officers from eight of ten regional central prisons in Ghana. A total of 1366 inmates and 445 officers were enrolled between May 2004 and December 2005. Subjects completed personal risk-factor questionnaire and provided blood specimens for unlinked anonymous testing for presence of antibodies to HIV, HCV and Treponema pallidum; and surface antigen of HBV (HBsAg). These data were analyzed using both univariate and multivariate techniques. RESULTS: Almost 18% (1336) of 7652 eligible inmates and 21% (445) of 2139

eligible officers in eight study prisons took part. Median ages of inmates and officers were 36.5 years (range 16-84) and 38.1 years (range 25-59), respectively. Among inmates, HIV seroprevalence was 5.9%, syphilis seroprevalence was 16.5%, and 25.5% had HBsAg. Among officers tested, HIV seroprevalence was 4.9%, HCV seroprevalence was 18.7%, syphilis seroprevalence was 7.9%, and 11.7% had HBsAg. Independent determinants for HIV, HBV and syphilis infections among inmates were age between 17-46, being unmarried, being illiterate, female gender, being incarcerated for longer than median time served of 36 months, history of homosexuality, history of intravenous drug use, history of sharing syringes and drug paraphernalia, history of participation in paid sexual activity, and history of sexually transmitted diseases. Independent determinants for HIV, HBV, HCV and syphilis infections among officers were age between 25-46, fale gender, being unmarried, being employed in prison service for longer than median duration of employment of 10 years, and history of sexually transmitted diseases. CONCLUSION: The comparably higher prevalence of HIV, HBV, HCV and syphilis in prison inmates and officers in Ghana suggests probable occupational related transmission. The implementation of infection control practices and risk reduction programs targeted at prison inmates and officers in Ghana is urgently required to address this substantial exposure risk. PMCID: PMC2311310 PMID: 18328097 [PubMed - indexed for MEDLINE] 157. World J Gastroenterol. 2008 Feb 28;14(8):1237-43. Hepatitis C virus genotypes distribution and transmission risk factors in Luxembourg from 1991 to 2006. Roman F, Hawotte K, Struck D, Ternes AM, Servais JY, Arendt V, Hoffman P, Hemmer R, Staub T, Seguin-Devaux C, Schmit JC. Retrovirology laboratory, CRP-Sante, 84 rue Val fleuri, L-1526, Luxembourg. AIM: To analyze the Hepatitis C virus (HCV) genotype distribution and transmission risk factors in a population of unselected patients in Luxembourg. METHODS: Epidemiological information (gender, age and transmission risks) were collected from 802 patients newly diagnosed for hepatitis C and living in Luxembourg, among whom 228 patients referred from prison. Genotyping using 5'noncoding (5'NC) sequencing was performed. We compared categorical data using the Fisher's exact F-test and odds ratios (OR) were calculated for evaluating association of HCV genotype and risk factors. RESULTS: The sex ratio was predominantly male (2.2) and individuals aged less than 40 years represented 49.6% of the population. Genotype 1 was predominant (53.4%) followed by genotype 3 (33%). Among risk factors, intravenous drug usage (IVDU) was the most frequently reported (71.4%) followed by medical-related

transmission (17.6%) including haemophilia, transfusion recipients and other nosocomial reasons. Genotype 3 was significantly associated to IVDU (OR = 4.84, P < 0.0001) whereas genotype 1 was significantly associated with a medical procedure (OR = 2.42, P < 0.001). The HCV genotype distribution from inmate patients differed significantly from the rest of the population (Chi-square test with four degrees of freedom, P < 0.0001) with a higher frequency of genotype 3 (46.5% vs 27.5%) and a lower frequency of genotype 1 and 4 (44.7% vs 56.8% and 5.3% vs 9.6%, respectively). IVDU was nearly exclusively reported as a risk factor in prison. CONCLUSION: We report the first description of the HCV genotype distribution in Luxembourg. The repartition is similar to other European countries, with one of the highest European prevalence rates of genotype 3 (33%). Since serology screening became available in 1991, IVDU remains the most common way of HCV transmission in Luxembourg. PMCID: PMC2690672 PMID: 18300350 [PubMed - indexed for MEDLINE] 158. Aust N Z J Public Health. 2008 Feb;32(1):73-80. doi: 10.1111/j.1753-6405.2008.00169.x. The physical health status of young Australian offenders. Butler T, Belcher JM, Champion U, Kenny D, Allerton M, Fasher M. National Drug Research Institute, Curtin University, Perth, Western Australia. tbutler2@optusnet.com.au AIMS: To describe the socio-economic background and physical health status of young offenders in custody in New South Wales (Australia). DESIGN: Cross-sectional survey of all young offenders held at nine juvenile detention centres across New South Wales (NSW) (eight male and one female) between January and March 2003. METHODS: Demographic and health information was collected by nurse interviewers and psychologists using a face-to-face interview. Blood and urine samples were collected to screen for blood-borne viruses and sexually transmissible infections. RESULTS: The final sample comprised 242 young people (223 males and 19 females). Overall, 90% of those assessed rated their general health as 'excellent', 'very good' or 'good'. Sixty-nine (30%) young offenders reported that they had been previously diagnosed with asthma. Two young women reported a past diagnosis of diabetes with the results of the random blood glucose testing indicating that a further six young people required testing for possible diabetes. None of those tested were positive for HIV, 9% tested positive for hepatitis C antibody, and 11% tested positive for hepatitis B core-antibody.

CONCLUSIONS: Our findings indicate that young offenders in New South Wales have backgrounds characterised by extreme disadvantage (poor educational attainment, unemployment, and care placements) and poor physical health. Parental incarceration was common to 43% of the sample. Our findings reinforce the concept that for marginalised groups, contact with the criminal justice system represents an important opportunity to detect illness, initiate treatment, and promote contact with health services. PMID: 18290917 [PubMed - indexed for MEDLINE] 159. AIDS Care. 2008 Jan;20(1):124-9. doi: 10.1080/09540120701426532. Psychiatric disorders, HIV infection and HIV/hepatitis co-infection in the correctional setting. Baillargeon JG, Paar DP, Wu H, Giordano TP, Murray O, Raimer BG, Avery EN, Diamond PM, Pulvino JS. Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX 77555-1006, USA. jbaillar@utmb.edu Psychiatric disorders such as bipolar disorder, schizophrenia and depression have long been associated with risk behaviors for HIV, hepatitis C virus (HCV) and hepatitis B virus (HBV). The US prison population is reported to have elevated rates of HIV, hepatitis and most psychiatric disorders. This study examined the association of six major psychiatric disorders with HIV mono-infection, HIV/HCV co-infection and HIV/HBV co-infection in one of the nation's largest prison populations. The study population consisted of 370,511 Texas Department of Criminal Justice inmates who were incarcerated for any duration between January 1, 2003 and July 1, 2006. Information on medical conditions and sociodemographic factors was obtained from an institution-wide electronic medical information system. Offenders diagnosed with HIV mono-infection, HIV/HCV, HIV/HBV and all HIV combined exhibited elevated rates of major depression, bipolar disorder, schizophrenia, schizoaffective disorder, non-schizophrenic psychotic disorder and any psychiatric disorder. In comparison to offenders with HIV mono-infection, those with HIV/HCV co-infection had an elevated prevalence of any psychiatric disorder. This cross-sectional study's finding of positive associations between psychiatric disease and both HIV infection and hepatitis co-infection among Texas prison inmates holds both clinical and public health relevance. It will be important for future investigations to examine the extent to which psychiatric disorders serve as a barrier to medical care, communication with clinicians and adherence to prescribed medical regimens among both HIV-mono-infected and HIV/hepatitis-co-infected inmates.

PMID: 18278623 [PubMed - indexed for MEDLINE] 160. Can J Infect Dis Med Microbiol. 2004 Jul;15(4):221-5. HIV and hepatitis C virus testing and seropositivity rates in Canadian federal penitentiaries: A critical opportunity for care and prevention. De P, Connor N, Bouchard F, Sutherland D. Centre for Infectious Disease Prevention and Control, Health Canada; BACKGROUND: Incarcerated persons experience high rates of HIV and hepatitis C virus (HCV) infection, but little is known about the burden of these bloodborne viruses among federal penitentiary inmates in Canada. OBJECTIVE: The present study investigates rates of testing and seropositivity for HIV and HCV among inmates in all 53 Canadian federal penitentiaries. METHODS: A cross-sectional design using surveillance data on voluntary HIV and HCV antibody testing in 2002 were applied to estimate the rate of testing uptake and the rate of incident seropositive tests among new admissions to federal penitentiaries and resident inmates. Rates of testing and infection were further examined by sex and region. Seroprevalence of HIV and HCV was estimated from the number of cumulative positive tests to year-end. RESULTS: Of 7670 new admissions during 2002, 30% were tested for HIV and HCV. Test seropositivity rates in this group were 0.7% for HIV and 10% for HCV. Of the 12,426 resident inmates, 28% were tested for HIV and 27% for HCV. Seropositivity rates in this group were 0.3% for HIV and 7% for HCV. Seroprevalence rates at yearend for 2002 were 2.0% for HIV and 26% for HCV and were substantially higher among women offenders (HIV: 3.7% of women, 1.9% of men; HCV: 34% of women, 26% of men). Variations in testing uptake and test seropositivity were observed across regions. CONCLUSIONS: The present study underscores the value of continued monitoring and evaluation of trends in HIV and HCV infection, which remain prevalent in federal penitentiaries. Higher rates of testing are warranted for at-risk inmates to improve early detection of infection and provide infected inmates with timely care and treatment. For those who remain free of infection, testing can provide the additional benefits of exposing inmates to health counselling and for the reinforcement of prevention messages. The period of incarceration is also a critical opportunity to link inmates with outside resources in preparation for release to the community. PMCID: PMC2094973 PMID: 18159496 [PubMed]

161. J Viral Hepat. 2008 Apr;15(4):250-4. Epub 2007 Dec 11. Increasing the uptake of hepatitis C virus testing among injecting drug users in specialist drug treatment and prison settings by using dried blood spots for diagnostic testing: a cluster randomized controlled trial. Hickman M, McDonald T, Judd A, Nichols T, Hope V, Skidmore S, Parry JV. Department of Social Medicine, University of Bristol, Bristol, UK. matthew.hickman@bristol.ac.uk The objective of this study was to assess whether introducing dried blood spot testing can increase hepatitis C virus (HCV) diagnostic testing. A cluster randomized controlled trial was conducted. Sites were matched into pairs, with one site in each pair randomly allocated to receive the intervention (training and use of dried blood spot). Data were collected from all sites for 6 months before and 6 months after the start of the intervention. The participants were 22 specialist drug clinics and six prisons in England and Wales. The main outcome measure of this study was percentage point difference in individuals tested for HCV (the difference between the percentage of patients tested 6 months after and 6 months before the introduction of dried blood spot tests). Before the trial, 8% of patients at control and intervention sites had been tested for HCV, with 16 sites testing less than 5% of their caseload. The average percentage point difference between intervention and control sites was 14.5% (95% CI 1.3-28%, paired t-test, P = 0.03); with 13 of the 14 pairs contributing to the positive effect of the intervention (Wilcoxon matched-pairs signed-rank-test, P = 0.002). The size of the difference between intervention and control sites varied considerably. The study provides preliminary supporting evidence that dried blood spot testing may increase the uptake of HCV diagnostic testing, by increasing the opportunity for patients to be offered testing. Additional trials with a larger number of sites are justified, ideally in the context of drug and treatment policies that gave clearer priority (and targets) to infection control and testing. PMID: 18086182 [PubMed - indexed for MEDLINE] 162. Gastroenterol Clin Biol. 2007 Aug-Sep;31(8-9 Pt 1):657-8. [Why treat hepatitis C in prisons?]. [Article in French] Remy AJ. Unit de Consultations et de Soins Ambulatoires, Service

d'Hpato-Gastroentrologie et de Cancrologie Digestive, Hpital Saint-Jean, Perpignan. andre.remy@ch-perpignan.fr PMID: 17925762 [PubMed - indexed for MEDLINE] 163. Clin Infect Dis. 2007 Oct 15;45(8):1047-55. Epub 2007 Sep 6. Infection control in jails and prisons. Bick JA. California Medical Facility, California Department of Corrections and Rehabilitation, Vacaville, CA 95696, USA. joseph.bick@cdcr.ca.gov At the end of 2005, approximately 7 million people (or 1 of every 33 American adults) were either in jail, in prison, or on parole. Compared with the general public, newly incarcerated inmates have an increased prevalence of human immunodeficiency virus infection, hepatitis B virus infection, hepatitis C virus infection, syphilis, gonorrhea, chlamydia, and Mycobacterium tuberculosis infection. While incarcerated, inmates are at an increased risk for the acquisition of blood-borne pathogens, sexually transmitted diseases, methicillin-resistant Staphylococcus aureus infection, and infection with airborne organisms, such as M. tuberculosis, influenza virus, and varicella-zoster virus. While incarcerated, inmates interact with hundreds of thousands of correctional employees and millions of annual visitors. Most inmates are eventually released to interact with the general public. Tremendous opportunities exist for infectious diseases specialists and infection-control practitioners to have an impact on the health of correctional employees, the incarcerated, and the communities to which inmates return. This article presents a brief review of some of the most important infection-control challenges and opportunities within the correctional setting. PMID: 17879924 [PubMed - indexed for MEDLINE] 164. Int J Drug Policy. 2007 Oct;18(5):444-6. Epub 2007 Aug 8. The Jailbreak Health Project--incorporating a unique radio programme for prisoners. Minc A, Butler T, Gahan G. Community Restorative Centre, Broadway, NSW, Australia. ariane@crcnsw.org.au <ariane@crcnsw.org.au>

Several studies in NSW have identified prisoners to be at high risk for blood borne viruses. The prevalence of hepatitis C among men in NSW correctional centres is 40% and over 60% among women. It is even higher among those with histories of injecting drug use. As part of the state's strategy to minimise the spread of blood borne viruses and promote healthy lifestyles among prisoners, the Community Restorative Centre broadcasts a weekly half hour radio programme to prisoners and the community. The project is funded through the NSW Health Department and aims to provide support to prisoners, ex-prisoners and their families. Jailbreak's success hinges on the participation of the very people [prisoners] the show wishes to target. The radio show is aimed specifically at broadcasting health promotion and harm-minimisation messages to prisoners and their supporters although this is not obvious. When you tune in to Jailbreak you will hear a diverse range of opinion, music and poetry from people caught up in the criminal justice system. Nevertheless at the heart of this exciting and challenging project is the delivery of engaging, relevant and clear health messages to prison inmates, ex-inmates and families in relation to HIV, hepatitis and sexual health. Since 2002, valuable health information, often in the form of personal stories, vignettes and quiz questions, can be heard in and around Sydney on 2SER 107.3 FM or online at http://www.2ser.com. Jailbreak has not been without controversy and has to balance the security focus of correctional authorities and the illegality of substance use in correctional centres with the need to convey messages to prisoners in relation to harm-minimisation. PMID: 17854735 [PubMed - indexed for MEDLINE] 165. Int J Drug Policy. 2007 Oct;18(5):359-63. Epub 2007 Apr 30. Prevalence and correlates of hepatitis C virus infection among injecting drug users in Tehran. Zamani S, Ichikawa S, Nassirimanesh B, Vazirian M, Ichikawa K, Gouya MM, Afshar P, Ono-Kihara M, Ravari SM, Kihara M. Department of Global Health and Socio-epidemiology, Kyoto University School of Public Health, Kyoto, Japan. szamani@pbh.med.kyoto-u.ac.jp <szamani@pbh.med.kyoto-u.ac.jp> This study aimed to investigate the prevalence and correlates of hepatitis C virus infection among injecting drug users in a community-based setting in Tehran, Iran. In October 2004, injecting drug users were recruited from a drop-in centre and neighboring parks and streets in a drug-populated neighborhood in Tehran. Participants were interviewed using a structured questionnaire, and a sample of oral mucosal transudate was collected for detection of HIV and HCV antibodies. Overall, 105 of 202 participants (52.0%) were found to be positive for HCV-antibody testing. After adjustment for the basic demographic

characteristics, the prevalence of HCV infection was found to be associated with length of drug injection (more than 10 years) [odds ratio (OR), 3.25; 95% confidence interval (CI), 1.43-7.38], length of lifetime incarcerations (more than a year) (OR, 3.44; 95% CI, 1.68-7.06), and a history of being tattooed inside prison (OR, 1.96; 95% CI, 1.06-3.62). High prevalence of HCV infection and its association with incarceration-related exposures are important implications for harm reduction initiatives for drug using inmates in Iran. While prevention interventions for drug using inmates are being expanded in Iran, it is important that high prevalence of HCV infection be taken into consideration in order to control further transmission of this infection. PMID: 17854723 [PubMed - indexed for MEDLINE] 166. Am J Infect Control. 2007 Sep;35(7):477-80. Tattooing in prisons--not such a pretty picture. Hellard ME, Aitken CK, Hocking JS. Centre for Epidemiology and Population Health Research, Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, Victoria, Australia. hellard@burnet.edu.au BACKGROUND: Tattooing in prison represents a unique combination of risk factors for blood borne virus (BBV) transmission because it is illicitly performed by untrained operators with homemade, unsterile, and frequently-shared equipment. It occurs in a setting where a high proportion of people are already infected with hepatitis C virus (HCV) and other BBVs. OBJECTIVES: This study measured the frequency of tattoo acquisition by prisoners inside and outside prison, and the associations between tattooing, injecting drug use, and HCV infection risk. METHODS: A cross-sectional survey was conducted in correctional facilities in Victoria, Australia. Participants completed a questionnaire that asked about injecting drug use and tattooing and provided a finger-prick blood sample that was tested for HCV antibody. RESULTS: Six hundred and forty-two prisoners participated in the study; 449 had ever been tattooed, of whom 182 (41%) had been tattooed in adult or juvenile prison. Of the participants who were not tattooed professionally, 27% reported someone using the same needle, and 42% reported someone had used the ink before them. Prisoners with a history of drug injection were more likely to have a tattoo and to have acquired a tattoo in prison (OR 3.0; CI 1.7-5.4). The HCV antibody-positive prisoners were more likely to have acquired a tattoo in prison compared with HCV antibody-negative prisoners. CONCLUSIONS: Acquiring a tattoo in prison was common and the reports of sharing the tattooing needle and ink was high, placing prisoners at risk of acquiring HCV

through tattooing in prison. Trials need to be undertaken that evaluate the risk and benefits of legal tattoos in prison. PMID: 17765561 [PubMed - indexed for MEDLINE] 167. J Viral Hepat. 2007 Sep;14(9):645-52. Hepatitis C virus (HCV) prevalence, and injecting risk behaviour in multiple sites in England in 2004. Hickman M, Hope V, Brady T, Madden P, Jones S, Honor S, Holloway G, Ncube F, Parry J. Social Medicine, University of Bristol, Bristol, UK. matthew.hickman@bristol.ac.uk We sought to corroborate geographical differences in hepatitis C virus (HCV) prevalence and assess whether these can be explained by differences in injecting risk behaviour. A community recruited interview survey of 1058 injecting drug users (IDU) - including a blood spot specimen for antibody testing - was undertaken in seven cities in England. HCV prevalence varied from 27% to 74% across sites (chi(2)(6) = 115.3, P < 0.001). There was a significant variation in crack-injection, prison history, injecting frequency, homelessness, groin injecting, syringe reuse and sharing between the sites. Adjustment for clustering by site and other covariates attenuated the odds ratios (OR) for most variables: e.g. crack injection changed from an unadjusted OR of >2 to an adjusted OR of 1.4 (95% CI 0.9-2.0). Remaining significant covariates included: homelessness (OR 2.2; 1.4-3.6); ever imprisonment (OR 1.7; 1.2-2.5); syringe sharing >18 months ago (OR 2.0; 1.3-3.0); injecting duration and age. Introducing site as a second level variable did not reach significance (P = 0.10). HCV prevalence among IDU reporting 'never sharing' was 48%. Geographical variation in HCV prevalence remains poorly explained, but should be the key focus of our surveillance effort. Measures of sharing and their interpretation require greater scrutiny. PMID: 17697017 [PubMed - indexed for MEDLINE] 168. World J Gastroenterol. 2007 Aug 21;13(31):4168-76. Controversies in and challenges to our understanding of hepatitis C. Batey RG. Drug and Alcohol Clinical Services, Hunter New England Area Health Services, Newcastle, New South Wales, Australia. rbate@doh.health.nsw.gov.au

Discovered in 1989, the hepatitis C virus (HCV) continues to cause significant morbidity and mortality world-wide despite a huge research commitment to defining and understanding the virus and the disease it causes. This paper discusses a number of areas where progress in the management of the HCV have not kept pace with the scientific understanding of the HCV. It is suggested that in the fields of HCV prevention and providing access to treatment, practice falls short of what could be achieved. The role of alcohol in the pathogenesis of HCV liver injury is discussed. Discrimination against those with HCV infection and particularly those in prison settings fails to match good clinical practice. The complicated processes of sharing information between specialty groups is also discussed in an attempt to optimise knowledge dissemination in this field. PMID: 17696244 [PubMed - indexed for MEDLINE] 169. Ann Epidemiol. 2007 Oct;17(10):808-13. Epub 2007 Aug 6. End-stage liver disease in a state prison population. Baillargeon J, Soloway RD, Paar D, Giordano TP, Murray O, Grady J, Williams B, Pulvino J, Raimer BG. Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX 77555, USA. jbaillar@utmb.edu OBJECTIVES: Information on the epidemiology of end-stage liver disease (ESLD) in US correctional populations is limited. We examined the prevalence, mortality and clinical characteristics of ESLD in the nation's second largest state prison system. METHODS: We collected and analyzed medical and demographic data from 370,511 offenders incarcerated in Texas' prison system during a 3.5-year period. RESULTS: ESLD was diagnosed in 484 inmates (131/100,000); 213 (57/100,000) died of ESLD. Offenders who were Hispanic, 30-49 years of age, > or =50 years of age, HIV monoinfected, hepatitis C virus (HCV) monoinfected, or HIV/HCV coinfected had elevated ESLD prevalence and mortality rates. CONCLUSIONS: ESLD mortality in Texas' prison population is approximately 3 times higher than that of the general population, reflecting elevated rates of HCV and HIV/HCV coinfection among prisoners. Ultimately, the only viable treatment option for many prisoners with ESLD will be liver transplantation. The enormous costs of organ transplantation and immunosuppressive therapy are staggering and have the potential to decimate the healthcare budgets of most prison systems. Consequently, it is imperative that correctional healthcare programs expand HCV treatment and prevention strategies. PMID: 17689260 [PubMed - indexed for MEDLINE]

170. East Mediterr Health J. 2007 Mar-Apr;13(2):250-6. Prevalence of hepatitis C virus infection and risk factors of drug using prisoners in Guilan province. Mohtasham Amiri Z, Rezvani M, Jafari Shakib R, Jafari Shakib A. Department of Community Medicine, Guilan University of Medical Sciences, Rasht, Islamic Republic of Iran. mohtashamaz@yahoo.com This was a cross-sectional prevalence study to determine the prevalence of hepatitis C virus (HCV) and high-risk behaviours in drug abusers admitted to prison in Guilan province, northern Islamic Republic of Iran. Subjects were asked about risk behaviours for acquiring HCV and blood was drawn for HCV antibody testing using ELISA techniques. Of 460 inmates, the mean duration of drug use was 8.9 years; 51.7% were opium users and 18.3% heroin users. HCV risk behaviours were common in this population and 209 inmates (45.4%) were HCV antibody positive (88.9% of intravenous drug abusers). HCV-positive status was significantly associated with intravenous drug use, having skin tattoos and number of times in prison. PMID: 17684845 [PubMed - indexed for MEDLINE] 171. CMAJ. 2007 Jul 31;177(3):262-4. Deadly disregard: government refusal to implement evidence-based measures to prevent HIV and hepatitis C virus infections in prisons. Elliott R. Canadian HIV/AIDS Legal Network, Toronto, Ont. relliott@aidslaw.ca Erratum in CMAJ. 2007 Sep 11;177(6):606. Comment on CMAJ. 2007 Jul 31;177(3):257-61. CMAJ. 2007 Jul 31;177(3):252-6. PMCID: PMC1930184 PMID: 17664450 [PubMed - indexed for MEDLINE]

172. CMAJ. 2007 Jul 31;177(3):257-61. Prevalence of HIV and hepatitis C virus infections among inmates of Ontario remand facilities. Calzavara L, Ramuscak N, Burchell AN, Swantee C, Myers T, Ford P, Fearon M, Raymond S. HIV Social, Behavioural and Epidemiological Studies Unit, Faculty of Medicine, University of Toronto, Toronto, Ont. liviana.calzavara@utoronto.ca Erratum in CMAJ. 2007 Aug 28;177(5):489. Comment in CMAJ. 2007 Jul 31;177(3):262-4. BACKGROUND: Each year more than 56 000 adult and young offenders are admitted to Ontario's remand facilities (jails, detention centres and youth centres). The prevalence of HIV infection in Ontario remand facilities was last measured over a decade ago, and no research on the prevalence of hepatitis C virus (HCV) infection has been conducted in such facilities. We sought to determine the prevalence of HIV infection, HCV infection and HIV-HCV coinfection among inmates in Ontario's remand facilities. METHODS: A voluntary and anonymous cross-sectional prevalence study of HIV and HCV infections was conducted among people admitted to 13 selected remand facilities across Ontario between Feb. 1, 2003, and June 20, 2004. Data collection included a saliva specimen for HIV and HCV antibody screening and an interviewer-administered survey. Prevalence rates and 95% confidence intervals were calculated and examined according to demographic characteristics, region of incarceration and self-reported history of injection drug use. RESULTS: In total, 1877 participants provided both a saliva specimen and survey information. Among the adult participants, the prevalence of HIV infection was 2.1% among men and 1.8% among women. Adult offenders most likely to have HIV infection were older offenders (> or = 30 years) and injection drug users. The prevalence of HCV infection was 15.9% among men, 30.2% among women and 54.7% among injection drug users. Adult offenders most likely to have HCV infection were women, older offenders (> or = 30 years) and injection drug users. The prevalence of HCV-HIV coinfection was 1.2% among men and 1.5% among women. It was highest among older inmates and injection drug users. Among the young offenders, none was HIV positive and 1 (0.4%) was HCV positive. On the basis of the study results, we estimated that 1079 HIV-positive adults and 9208 HCV-positive adults were admitted to remand facilities in Ontario from Apr. 1, 2003, to Mar. 31, 2004. INTERPRETATION: Adult offenders entering Ontario remand facilities have a

considerably higher prevalence of HIV and HCV infections than the general population. PMCID: PMC1930192 PMID: 17664449 [PubMed - indexed for MEDLINE] 173. CMAJ. 2007 Jul 31;177(3):252-6. Prevalence of HIV and hepatitis C virus infections among inmates of Quebec provincial prisons. Poulin C, Alary M, Lambert G, Godin G, Landry S, Gagnon H, Demers E, Morarescu E, Rochefort J, Claessens C. Unit de recherche en sant des populations, Centre hospitalier universitaire de Qubec, Qubec, Que. Comment in CMAJ. 2007 Jul 31;177(3):262-4. BACKGROUND: To determine the prevalence of HIV and hepatitis C virus (HCV) infections and examine risk factors for these infections among inmates in Quebec provincial prisons. METHODS: Anonymous cross-sectional data were collected from January to June 2003 for men (n = 1357) and women (n = 250) who agreed to participate in the study and who completed a self-administrated questionnaire and provided saliva samples. RESULTS: The prevalence of HIV infection was 2.3% among the male participants and 8.8% among the female participants. The corresponding prevalence of HCV infection was 16.6% and 29.2%, respectively. The most important risk factor was injection drug use. The prevalence of HIV infection was 7.2% among the male injection drug users and 0.5% among the male non-users. Among the women, the rate was 20.6% among the injection drug users, whereas none of the non-users was HIV positive. The prevalence of HCV infection was 53.3% among the male injection drug users and 2.6% among the male non-users; the corresponding values among the women were 63.6% and 3.5%. INTERPRETATION: HIV and HCV infections constitute an important public health problem in prison, where the prevalence is affected mainly by a high percentage of injection drug use among inmates. PMCID: PMC1930200 PMID: 17664448 [PubMed - indexed for MEDLINE] 174. Int J Infect Dis. 2008 Jan;12(1):51-6. Epub 2007 Jul 23.

Risk factors and algorithms to identify hepatitis C, hepatitis B, and HIV among Georgian tuberculosis patients. Kuniholm MH, Mark J, Aladashvili M, Shubladze N, Khechinashvili G, Tsertsvadze T, del Rio C, Nelson KE. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Suite E7133, 615 N. Wolfe St., Baltimore, MD 21205, USA. mkunihol@jhsph.edu OBJECTIVES: To determine prevalence, risk factors, and simple identification algorithms for HIV, hepatitis B, and hepatitis C co-infection; factors that may predispose for anti-tuberculosis therapy-induced hepatotoxicity. METHODS: We recruited 300 individuals at in-patient tuberculosis hospitals in three cities in Georgia, administered a behavioral questionnaire, and tested for antibody to HIV, hepatitis C (HCV), hepatitis B core antigen (anti-HBc), and the hepatitis B surface antigen (HBsAg). RESULTS: Of the individuals tested, 0.7% were HIV positive, 4.3% were HBsAg positive, 8.7% were anti-HBc positive, and 12.0% were HCV positive. In multivariable analysis, a history of blood transfusion, injection drug use, and prison were significant independent risk factors for HCV, while a history of blood transfusion, injection drug use, younger age at sexual debut, and a high number of sex partners were significant risk factors for HBV. Three-questionnaire item algorithms predicted HCV serostatus 74.1% of the time and HBV serostatus 85.2% of the time. CONCLUSIONS: Treatment of tuberculosis patients in resource-limited countries with concurrent epidemics of HCV, HBV, and HIV may be associated with significant hepatotoxicity. Serologic screening of tuberculosis patients for HBV, HCV, and HIV or using behavioral algorithms to identify patients in need of intensive monitoring during anti-tuberculosis therapy may reduce this risk. PMCID: PMC2649965 PMID: 17644020 [PubMed - indexed for MEDLINE] 175. Clin Infect Dis. 2007 Aug 1;45(3):370-6. Epub 2007 Jun 19. Survival of HIV-infected injection drug users (IDUs) in the highly active antiretroviral therapy era, relative to sex- and age-specific survival of HIV-uninfected IDUs. Muga R, Langohr K, Tor J, Sanvisens A, Serra I, Rey-Joly C, Muoz A. Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain. rmuga.germanstrias@gencat.net Comment in

Clin Infect Dis. 2007 Aug 1;45(3):377-80. BACKGROUND: In the era of highly active antiretroviral therapy (HAART), it remains unclear whether human immunodeficiency virus (HIV)-infected injection drug users (IDUs) have durations of survival similar to those for comparable HIV-uninfected IDUs. The goal of this study was to compare survival durations of HIV-infected and HIV-uninfected IDUs for the period 1987-2004.Methods. Demographic data, drug use characteristics, and biological markers were obtained at the time of admission to a substance abuse treatment program. The outcome of interest was the duration of survival after admission, and the primary exposure was HIV infection. Vital status was ascertained by means of the mortality register by the end of 2004. Three calendar periods, which were defined on the basis of use of specific therapies, were considered: 1987-1991 (the antiretroviral monotherapy era), 1992-1996 (the dual combination therapy era and the era when methadone was introduced in Spain), and 1997-2004 (the era of HAART and of established methadone programs). We used Cox regression methods allowing for late entries to handle the contribution of persons who survived a given period and entered the following period with nonzero time. We compared HIV-uninfected and HIV-infected IDUs with adjustments for age, sex, and duration of follow-up after admission. RESULTS: A total of 1209 IDUs were admitted to the hospital during the period from January 1987 through December 2004, and 1181 were eligible for the study. The majority (81.3%) of patients were men. The mean age (+/- standard deviation) at admission was 27.8+/-5.6 years, and the mean duration of injection drug use (+/- standard deviation) was 7.6+/-5.0 years. The prevalences of HIV and hepatitis C virus infections were 59.0% and 92.3%, respectively, and the total duration of follow-up was 10.116 person-years. Although survival duration for HIV-uninfected IDUs in 1997-2004 was similar to the duration in earlier periods, the duration for HIV-infected IDUs improved significantly since 1997 (P<.01). Furthermore, among patients admitted in the last period, the survival durations for HIV-uninfected and HIV-infected IDUs was virtually the same (relative hazard, 0.89; 95% confidence interval, 0.44-1.81). CONCLUSIONS: The duration of survival of HIV-infected IDUs has improved substantially since 1997, reaching rates similar to the rates for HIV-seronegative IDUs who accessed the health care system in the era of HAART. PMID: 17599317 [PubMed - indexed for MEDLINE] 176. J Formos Med Assoc. 2007 Jun;106(6):467-74. Gender difference in the clinical and behavioral characteristics of human immunodeficiency virus-infected injection drug users in Taiwan. Cheng SH, Chiang SC, Hsieh YL, Chang YY, Liu YR, Chu FY.

Yangmei Township Public Health Center, Public Health Bureau, Taoyuan County Government, Taoyuan, Taiwan. BACKGROUND/PURPOSE: Injection drug users (IDUs) have become the major contributors to the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome epidemic in Taiwan, accounting for more than 60% of new cases in 2005. In Taiwan, gender difference in risk factors for HIV among IDUs has not been reported before. We studied the clinical and sociodemographic characteristics, sexual behaviors, drug use histories and criminal records of male and female HIV-infected IDUs. METHODS: A total of 100 male and 25 female HIV-infected inmates from two prisons were included. An individually structured interview was conducted with each inmate. Serostatus of hepatitis B virus (HBV) and hepatitis C virus (HCV) were tested. CD4+ T cell count and HIV viral load were also evaluated. RESULTS: The mean age of the HIV-infected inmates was 31.7 +/- 6.4 years. All inmates were co-infected with HCV and 20% were HBV carriers. The mean CD4+ T cell count was 498 cells/microL, and the mean viral load was 20,119 copies/mL. Heroin use history averaged 6.3 +/- 5.1 years, and 84.8% of patients had a previous criminal offense prior to current conviction. Female inmates were significantly younger, had more sexual partners, had more drug-using family members or sexual partners, shared injection paraphernalia more frequently, and started using methamphetamine and heroin at younger ages (p < 0.05). Male inmates tended to be single, had less parental support, had been more frequently convicted of non drug-related crimes, started using non-illicit substances more frequently at younger ages and had sex with prostitutes more frequently (p < 0.05). CONCLUSION: The results of this study suggest that drug injection risks and sexual behavior related risks are equally important in determining the risk of HIV infection among IDUs. Gender-specific approaches to prevention which reflect differences in gender-related patterns of risk are also needed. PMID: 17588840 [PubMed - indexed for MEDLINE] 177. Med J Aust. 2007 Jun 18;186(12):647-9. Prisons, hepatitis C and harm minimisation. Levy MH, Treloar C, McDonald RM, Booker N. School of Public Health, University of Sydney, Sydney, NSW, Australia. mrya@tpg.com.au Australian prisons have been identified as a focus of the ongoing hepatitis C epidemic. Harm minimisation is the major strategy directed to community-based public health measures to control hepatitis C. Harm-minimisation strategies to protect inmates and workers are incompletely and inconsistently applied in

Australian prisons. Overseas experience has demonstrated that introducing injecting-equipment exchange programs and professional tattoo parlours in prisons could at least partially reduce the risks of ongoing hepatitis C transmission, and would support prevention and treatment programs. A two-stage approach is suggested: firstly, implementing programs of proven effectiveness consistently across the eight Australian jurisdictions, and, secondly, expanding current initiatives in the light of international "best practice". PMID: 17576183 [PubMed - indexed for MEDLINE] 178. BMC Public Health. 2007 Jun 7;7:98. 'I just keep thinking I haven't got it because I'm not yellow': a qualitative study of the factors that influence the uptake of Hepatitis C testing by prisoners. Khaw FM, Stobbart L, Murtagh MJ. North East Health Protection Unit, Health Protection Agency, Institute of Pathology, Newcastle General Hospital, Westgate Road, Newcastle upon Tyne, UK. f.m.khaw@ncl.ac.uk BACKGROUND: Hepatitis C viral (HCV) infection is a significant public health problem. In the UK, an estimated 200,000 individuals have active HCV infection, most of whom are injecting drug users (IDUs). Many IDUs spend time within the prison system therefore screening for HCV infection in this setting is important. However, uptake of testing within prisons is very low. METHODS: Qualitative interview study. 30 interviews with 25 male and 5 female prisoners with a history of injecting drug use. RESULTS: Personal and institutional barriers to uptake of testing for HCV were identified. Personal barriers included: prisoners' fears and lack of knowledge about HCV, low motivation for testing, lack of awareness about the testing procedure, and concerns about confidentiality and stigma. Institutional barriers included: the prisons' applications procedure for testing, inadequate pre- and post-test discussion, lack of pro-active approaches to offering testing, and lack of continuity of care on discharge and transfer. CONCLUSION: This study highlights potential areas of development in the management of HCV in prisons. Further research is needed to evaluate care pathways for HCV in the prison setting and to develop and assess interventions to improve the uptake of testing for HCV by prisoners. PMCID: PMC1906754 PMID: 17555573 [PubMed - indexed for MEDLINE]

179. Int J Sports Med. 2007 Dec;28(12):1046-52. Epub 2007 Jun 1. Benefits of exercise training in Spanish prison inmates. Prez-Moreno F, Cmara-Snchez M, Tremblay JF, Riera-Rubio VJ, Gil-Paisn L, Lucia A. Centro Mdico, Centro Penitenciario de Soto del Real, Madrid, Spain. Prison populations are growing in Western countries. Imprisoned people usually have a poor health status and an increased risk to suffer chronic debilitating conditions as coinfection with the HIV and hepatitis C virus (HCV) and/or opioid dependency. We studied the effects of a 4-month concurrent cardiorespiratory and resistance training program on the cardiorespiratory fitness, lower and upper body dynamic strength endurance (6-RM test for bench press and knee-extensor exercise, respectively), muscle mass and quality of life (QOL) of adult prison inmates who are HIV/HVC co-infected and enrolled in a methadone maintenance program (n = 9; mean [SD] age: 37 [3] yrs). We also evaluated a control group (n = 10; 37 [2] yrs). A significant combined effect of group and time was found for peak completed workload (W) (p < 0.01), peak heart rate (HR (peak)) (p < 0.05) and rate of HR decrease at 1-min postexercise compared to HR (peak) (p < 0.05), respectively, in a gradual cycle ergometer test. A significant combined effect of group and time was also found for both bench press and knee-extensor 6-RM tests, respectively (p < 0.05). Supervised exercise training can improve the overall physical fitness of incarcerated people. Our results suggest that this type of intervention could be applied in prisons of Western societies. PMID: 17549659 [PubMed - indexed for MEDLINE] 180. Public Health Rep. 2007;122 Suppl 2:89-90. A community experience responding to hepatitis C. Rude EJ, Weisfuse I. New York City Department of Health and Mental Hygiene, Hepatitis C Program, New York, NY, USA. erude@health.nyc.gov PMCID: PMC1831803 PMID: 17542461 [PubMed - indexed for MEDLINE] 181. Public Health Rep. 2007;122 Suppl 2:83-8. Promoting HCV treatment completion for prison inmates: New York State's hepatitis

C continuity program. Klein SJ, Wright LN, Birkhead GS, Mojica BA, Klopf LC, Klein LA, Tanner EL, Feldman IS, Fraley EJ. New York State Department of Health AIDS Institute, Albany, NY, USA. sjk06@health.state.ny.us This article describes the development of a statewide program providing continuity of hepatitis C virus (HCV) treatment to prisoners upon release to the community. We discussed length of stay as a barrier to treatment with key collaborators; developed protocols, a referral process, and forms; mobilized staff; recruited heath-care facilities to accept referrals; and provided short-term access to HCV medications for inmates upon release. The Hepatitis C Continuity Program, including 70 prisons and 21 health-care facilities, is a resource for as many as 130 inmates eligible to start treatment annually. Health-care facilities provide fairly convenient access to 87.1% of releasees, and 100% offer integrated HCV-human immunodeficiency virus/acquired immunodeficiency syndrome care. As of March 2006, 24 inmates had been enrolled. The program was replicated in the New York City Rikers Island jail. The program is operational statewide, referrals sometimes require priority attention, and data collection and other details are still being addressed. PMCID: PMC1831802 PMID: 17542460 [PubMed - indexed for MEDLINE] 182. Public Health Rep. 2007;122 Suppl 2:74-7. Project ECHO: linking university specialists with rural and prison-based clinicians to improve care for people with chronic hepatitis C in New Mexico. Arora S, Thornton K, Jenkusky SM, Parish B, Scaletti JV. University of New Mexico School of Medicine, Albuquerque, NM 87131-0001, USA. SArora@salud.unm.edu Project Extension for Community Healthcare Outcomes (Project ECHO) is a telemedicine and distance-learning program designed to improve access to quality health care for New Mexicans with hepatitis C. Project ECHO links health-care providers from rural clinics, the Indian Health Service, and prisons with specialists at the University of New Mexico. At weekly clinics, partners present and discuss patients with hepatitis C with specialists. Partners can receive continuing education credits for participating. Since June 2003, 173 hepatitis C clinics have been conducted with 1,843 case presentations. Partners have received 390 hours of training and 2,997 hours of continuing education credits. And in

2006, the State Legislature approved $1.5 million in annual funding for the project. Project ECHO has increased access to state-of-the art hepatitis C virus care for patients living in rural areas or prisons. Because of its success with hepatitis C, this project is being expanded to other chronic medical conditions. PMCID: PMC1831800 PMID: 17542458 [PubMed - indexed for MEDLINE] 183. Rev Esp Sanid Penit. 2007 Jun;9(1):21-32. doi: 10.4321/S157506202007000100005. [Expert recommendations for the diagnosis and treatment of chronic hepatitis C infection in the prison setting]. [Article in Spanish] Saiz de la Hoya-Zamcola P, Marco-Tourio A, Clemente-Ricote G, Portilla-Sogorb J, Boix-Martnez V, Nez-Martnez O, Reus-Bauls S, Teixid I Prez N. Servicios Mdicos, Centro Penitenciario Alicante I, Alicante, Espaa. The prevalence of HCV infection in Spanish prisons is very high (38.5%). The characteristics of the infected patients, particularly the high rate of HIV coinfection, makes it very likely that the morbidity and mortality produced by serious liver disease secondary to this infection will increase considerably in the coming years. A group of Spanish experts with experience in patients who are inmates has been invited to establish a series of recommendations for the diagnosis and treatment of chronic hepatitis C infection in Spanish prisons. PMID: 23128612 [PubMed] 184. Int J STD AIDS. 2007 Apr;18(4):228-30. Experience of setting up a genitourinary medicine in-reach clinic in a male prison. Sherrard J, Boss I, Law L. Department of Genitourinary Medicine, Churchill Hospital, Old Road, Headington, Oxford OX3 7LJ, UK. jackiesherrard@doctors.org.uk A fortnightly in-reach genitourinary (GU) medicine Service to a medium security male prison has been provided since April 2004. Patients are seen either by referrals from the prison general practitioner (GP), or at an individual's

request. Problems have arisen due to a lack of space and time - the health adviser and doctor have to share a room. Since the prisoners have to leave Health Care by 1130 hours, if one inmate has complicated issues, it can result in these not being dealt with, or in patients not being seen as there is no flexibility. There has been an unexpectedly high DNA rate, which is multifactorial. Some prisoners have been moved to another prison since the request to be seen was made, some are on court attendances or have legal visits. Additionally some men choose not to come when sent for on the day. A few men who attend do so mistakenly, thinking that GUM is the dentist. This is particularly a problem where English is not the first language. The attendance of prisoners at the GU medicine service is noted in their prison health record, with relevant information, such as referral for management of hepatitis C. Of the 219 men seen in the first year, 55% had a GU medicine screen. The most common infections were chlamydia 10.5%, warts 12.1% and HCV 9%. The clinic has been well supported by patients and prison staff. High rates of infections are being detected and managed. The men have been happy to be screened, and despite initial concerns all are happy to provide urine specimens for chlamydia screening. PMID: 17509170 [PubMed - indexed for MEDLINE] 185. N Engl J Med. 2007 Apr 26;356(17):1785; author reply 1786-7. Mortality after release from prison. Spaulding AC, Allen SA, Stone A. Comment on N Engl J Med. 2007 Jan 11;356(2):157-65. PMID: 17460238 [PubMed - indexed for MEDLINE] 186. Intern Med J. 2007 Jul;37(7):472-7. Epub 2007 Apr 16. Viral hepatitis among male amphetamine-inhaling abusers. Lai SW, Chang WL, Peng CY, Liao KF. Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan. BACKGROUND: Few studies have focused on the clandestinely consumed amphetamine as a primary drug. The purpose of this study was to estimate the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection and the related

factors in male amphetamine-inhaling abusers. METHODS: This was a cross-sectional study. From November 2004 to February 2005, 285 amphetamine-inhaling male subjects at one prison in Taiwan and 285 age-matched healthy men without history of using illicit drugs or tattooing were enrolled. A face-to-face interview focusing on amphetamine-addicted history and sociodemographic information was used. Hepatitis B surface antigen (HBsAg) and anti-HCV were tested. RESULTS: The mean age of the subjects was 34.1 +/- 8.6 years (range 17-75 years). Among 285 subjects, 13.3% were positive for HBsAg, 20.0% positive for anti-HCV and 2.5% positive for combined HBsAg and anti-HCV. Multivariate logistic regression analysis showed that tattoo (odds ratio (OR) 2.97, 95% confidence interval (CI) 1.37-6.43) and elevated alanine aminotransferase (ALT) (OR 3.15, 95% CI 1.49-6.66) were independently related to persons being anti-HCV positive. Elevated ALT was related to persons being HBsAg positive (OR 2.60, 95% CI 1.15-5.89). CONCLUSION: Screening of HBV and HCV infection among amphetamine-inhaling abusers remains necessary. Tattoo and elevated ALT are identified as the related factors for being anti-HCV positive. Elevated ALT is the related factor for being HBsAg positive. PMID: 17445007 [PubMed - indexed for MEDLINE] 187. HIV AIDS Policy Law Rev. 2006 Dec;11(2-3):23-4. Federal prison guards call for power to test prisoners for HIV. Betteridge G. The union representing federal prison guards is lobbying the government to amend the Corrections and Conditional Release Act (CCRA) to permit prison staff to apply for orders to test prisoners for HIV and the hepatitis B and C viruses. This article summarizes the union's proposal and the Legal Network's response. PMID: 17373062 [PubMed - indexed for MEDLINE] 188. Euro Surveill. 2007 Jan 20;12(1). [Epub ahead of print] Hepatitis and HIV in Northern Ireland prisons: a cross-sectional study. Danis K, Doherty L, McCartney M, McCarrol J, Kennedy H. EPIET fellow, Communicable Disease Surveillance Centre-Northern Ireland.

A study was undertaken in Northern Ireland (NI) prisons to (i) determine prevalence of bloodborne viruses among inmates, (ii) estimate the extent of self-reported risk behaviours. All three prisons in NI were included in the study. Outcome measures included (i) antibodies to hepatitis C (HCV), hepatitis B (HBV) core antigen, HIV, (ii) self-reported risk behaviour. Five prisoners (0.75 %) tested positive for HBV, seven (1.1%) for HCV and none for HIV. Eleven per cent reported ever having injected drugs. Of these, 20% had started injecting while in prison, and 12% shared injecting equipment in prison. Two per cent had completed HBV immunisation. Injecting drugs was associated with HCV (adjusted prevalence ratio=5.2; 95% CI 0.9-16) and HBV infection (adjusted prevalence ratio=4.1; 95% CI 0.7-23). The low prevalence of bloodborne viruses within NI prisons is not consistent with findings of studies in other countries, possibly reflecting the unique sociopolitical situation in NI. In spite of knowledge of the risks of transmission of bloodborne viruses in prison, high-risk practices are occurring. Preventing risk behaviours and transmission of infection in prisons now poses a challenge for health services in the United Kingdom. PMID: 17370979 [PubMed - as supplied by publisher] 189. Aust N Z J Public Health. 2007 Feb;31(1):44-50. The 2004 Australian prison entrants' blood-borne virus and risk behaviour survey. Butler T, Boonwaat L, Hailstone S, Falconer T, Lems P, Ginley T, Read V, Smith N, Levy M, Dore G, Kaldor J. Centre for Health Research in Criminal Justice and School of Public Health and Community Medicine, University of New South Wales, Eastgardens. tony.butler@justicehealth.nsw.gov.au OBJECTIVES: To assess the prevalence of blood-borne viruses and associated risk factors among prison entrants at seven Australian prisons across four States. DESIGN: Consecutive cross-sectional design. Voluntary confidential testing of all prison entrants for serological markers of human immunodeficiency virus (HIV), hepatitis C (HCV) and hepatitis B (HBV) over 14 consecutive days in May 2004. Demographic data and data related to risks for blood-borne virus transmission, such as sexual activity, body piercing, tattooing, and injecting drug use, were collected. RESULTS: National prevalence for HIV was 1%, hepatitis B core antibody 20%, and hepatitis C antibody 34%. Fifty-nine per cent of participants had a history of injecting drug use. Among injecting drug users, the prevalence of HIV was 1%, hepatitis C antibody 56%, and hepatitis B core antibody 27%. Forty-one per cent of those screened reported a previous incarceration. In the multivariate model, Queensland and Western Australian (WA) prison entrants were significantly less likely to test positive to HCV than those in New South Wales (NSW). Amphetamine

was the most commonly injected drug in Queensland, Tasmania and WA. In NSW, heroin was the most common drug injected. In the multivariate analysis a history of injecting drug use, being aged 30 years or more, and a prior incarceration were positively associated with hepatitis C infection. For hepatitis B core antibody, age over 30 years and a history of injecting drug use were associated with an increased risk. CONCLUSIONS: The findings support the view that prisoner populations are vulnerable to blood-borne virus infection, particularly hepatitis B and C. Prisoner populations should be included in routine surveillance programs so as to provide a more representative picture of blood-borne virus epidemiology in Australia. PMID: 17333608 [PubMed - indexed for MEDLINE] 190. J Med Microbiol. 2007 Mar;56(Pt 3):391-7. Correlates of hepatitis C virus infection among incarcerated Ghanaians: a national multicentre study. Adjei AA, Armah HB, Gbagbo F, Ampofo WK, Quaye IK, Hesse IF, Mensah G. Department of Pathology, University of Ghana Medical School, College of Health Sciences, University of Ghana, Korle-Bu, Accra, Ghana. andrewadjei50@hotmail.com A national multicentre cross-sectional study was undertaken on the correlates of hepatitis C virus (HCV) infection in a sample of inmates from eight Ghanaian prisons. A total of 1366 inmates from eight of the ten regional central prisons in Ghana were enrolled between May 2004 and December 2005. Subjects voluntarily completed a risk-factor questionnaire and provided blood specimens for unlinked anonymous testing for the presence of antibodies to HCV. These data were analysed using both univariate and multivariate techniques. The median age of participants was 36.5 years (range 16-84 years). Of the 1366 inmates tested, HCV seroprevalence was 18.7%. On multivariate analysis, the independent determinants of HCV infection were being incarcerated for longer than the median time served of 36 months [odds ratio (OR) 5.8; 95% confidence interval (95% CI) 5.0-6.9], history of intravenous drug use (OR 4.5; 95% CI 3.8-5.4) and homosexuality (OR 3.1; 95% CI 2.5-3.9). Consistent with similar studies worldwide, the prevalence of HCV in prison inmates was higher than the general population in Ghana, suggesting probable transmission in prisons in Ghana through intravenous drug use and unsafe sexual behaviour. PMID: 17314372 [PubMed - indexed for MEDLINE] 191. Braz J Infect Dis. 2006 Aug;10(4):274-8.

Combined pegylated interferon and ribavirin for the management of chronic hepatitis C in a prison setting. Sabbatani S, Giuliani R, Manfredi R. Department of Clinical and Experimental Medicine, Division of Infectious Diseases, University of Bologna Alma Mater Studiorum, S. Orsola Hospital, Bologna, Italy. The elevated frequency of chronic hepatitis C virus (HCV) infection found among prison inmates, and the availability of improved pharmacological cure for this potentially life-threatening disorder, make investigations conducted in this somewhat neglected area very relevant, since only a few, open-label experiences have been reported till now. In the metropolitan prison of Bologna (Italy), HCV seroprevalence was found to be over 31% in 2003, so that a pilot feasibility study based on treatment with pegylated interferon plus ribavirin was initiated, after careful counseling carried out by a joint commission of health care personnel of the correctional facility and infectious diseases consultants. Thirty-nine patients were enrolled, and despite expected dropouts due to difficulty in maintaining the same level of counseling pressure over time, and the particularly unfavorable climatic conditions during Summer 2003, a sustained virological response was obtained for 8 out of the 21 patients who remained evaluable after the first three month follow-up, although we need to take into account that a high percentage of subjects (67%) were selected for therapy due to their favorable HCV genotypes (types 2 and 3). Our preliminary experience shows that an intrinsically complicated therapy, such as the administration of pegylated interferon plus ribavirin, can attain a relatively high success rate, even in a very unfavorable and uncomfortable context, such as a prison, where only enforced counseling, active participation of institutional health care operators, and patient's willingness to maintain an elevated level of co-operation and adherence, can overcome most structural and relational difficulties. PMID: 17293911 [PubMed - indexed for MEDLINE] 192. Enferm Infecc Microbiol Clin. 2007 Feb;25(2):91-7. Factors associated with reported hepatitis C and HIV among injecting drug users in ten European cities. March JC, Oviedo-Joekes E, Romero M. Escuela Andaluza de Salud Pblica, Granada, Espaa.

BACKGROUND: To analyze self-reported prevalence of HCV and HIV in a sample of socially excluded injecting drug users, as well as factors associated with the presence of these diseases. METHODS: Cross-sectional study. Data were collected with a structured, face-to-face questionnaire by outreach workers and privileged access interviewers in 1131 participants who had injected heroin and/or cocaine over the past year (71.5% men; mean age, 30 years) from Seville and Granada, Spain; Cologne, Germany; Vienna, Austria; Brussels, Belgium; Athens, Greece; Dublin, Ireland; London, England; Lisbon, Portugal and Perugia, Italy. RESULTS: Among the total sample, 595 (52.6%) participants reported HCV-positive status and 143 (12.6%) HIV-positive status. Multivariate analysis for HCV showed that women are at less risk than men, and that longer drug use, injecting while in prison, sharing needles, and reported positive status for tuberculosis, HBV, HIV or sexually-transmitted disease are positively associated with HCV. Participants reporting positive HIV status were generally older, had injected drugs while in prison, had completed less than 8 years of schooling, were divorced, had no regular employment, and declared infection with tuberculosis, sexually-transmitted disease and HCV. CONCLUSIONS: The highest incidences of HCV and HIV were reported by participants in a poorer social and health situation. Drug addicts must cope not only with their addiction but also with the process of social exclusion they are immersed in. To the greatest extent possible, any course of action for this group should be built into integrated, coordinated plans that take a broad approach to the main issues involved. PMID: 17288906 [PubMed - indexed for MEDLINE] 193. Infect Control Hosp Epidemiol. 2007 Jan;28(1):24-30. Epub 2006 Dec 29. Prevalence and risk factors for bloodborne exposure and infection in correctional healthcare workers. Gershon RR, Sherman M, Mitchell C, Vlahov D, Erwin MJ, Lears MK, Felknor S, Lubelczyk RA, Alter MJ. Mailman School of Public Health, Columbia University, New York, NY 10032, USA. rg405@columbia.edu OBJECTIVE: To determine the prevalence and risk factors for bloodborne exposure and infection in correctional healthcare workers (CHCWs).Design. Cross-sectional risk assessment study with a confidential questionnaire and serological testing performed during 1999-2000. SETTING: Correctional systems in 3 states. RESULTS: Among 310 participating CHCWs, the rate of percutaneous injury (PI) was 32 PIs per 100 person-years overall and 42 PIs per 100 person-years for CHCWs

with clinical job duties. Underreporting was common, with only 25 (49%) of 51 PIs formally reported to the administration. Independent risk factors for experiencing PI included being age 45 or older (adjusted odds ratio [aOR], 2.41 [95% confidence interval (CI), 1.31-4.46]) and having job duties that involved needle contact (aOR, 3.70 [95% CI, 1.28-10.63]) or blood contact (aOR, 5.05 [95% CI, 1.45-17.54]). Overall, 222 CHCWs (72%) reported having received a primary hepatitis B vaccination series; of these, 150 (68%) tested positive for anti-hepatitis B surface antigen, with negative results significantly associated with receipt of last dose more than 5 years previously. Serologic markers of hepatitis B virus infection were identified in 31 individuals (10%), and the prevalence of hepatitis C virus infection was 2% (n=7). The high hepatitis B vaccination rate limited the ability to identify risk factors for infection, but hepatitis C virus infection correlated with community risk factors only. CONCLUSION: Although the wide coverage with hepatitis B vaccination and the decreasing rate of hepatitis C virus infection in the general population are encouraging, the high rate of exposure in CHCWs and the lack of exposure documentation are concerns. Continued efforts to develop interventions to reduce exposures and encourage reporting should be implemented and evaluated in correctional healthcare settings. These interventions should address infection control barriers unique to the correctional setting. PMID: 17230384 [PubMed - indexed for MEDLINE] 194. J Law Med Ethics. 2006 Winter;34(4):831-2. Recent developments in health law. Civil rights: prisoners' right to treatment information under Pabon v. Wright. Wilansky DP. PMID: 17199828 [PubMed - indexed for MEDLINE] 195. Cad Saude Publica. 2007 Jan;23(1):197-205. [Behavior associated with HIV and HCV infection in female prison inmates in So Paulo, Brazil]. [Article in Portuguese] Strazza L, Massad E, Azevedo RS, Carvalho HB. Departamento de Medicina Legal, Faculdade de Medicina, Universidade de So Paulo, So Paulo, Brasil. strazza@usp.br

An increase has been observed in AIDS and hepatitis C cases in women, including female prison inmates. This study focused on inmates' behavioral factors associated with risk of HIV and HCV transmission in a women's detention facility in So Paulo, Brazil. Behavioral questionnaires were applied and HIV and HCV serology were performed. The selected measure of association was odds ratio for both the bi and multivariate logistic regression analyses. 290 inmates participated in the study. HIV and HCV prevalence rates were 13.9% and 16.2%, respectively. Statistically significant associations were observed (p < 0.05) between HIV and the following variables: partner with AIDS OR = 6.9 (2.7-35.2); injection drug users (IDU) OR = 3.3 (1.6-14.7); regular partner OR = 3.7 (1.5-8.3), and between HCV and: IDU OR = 13.7 (4.4-42.7); IDU partner OR = 4.9 (1.9-12.2); previous arrest OR = 2.8 (1.2-6.5) adjusted for: partner with AIDS, IDU, IDU partner, drug user, and previous arrest. In conclusion, parenteral risk was associated with HIV and HCV infection and sexual risk with HIV. Appropriate and continuous preventive programs are recommended in the prison. PMID: 17187118 [PubMed - indexed for MEDLINE] 196. AIDS Policy Law. 2006 Nov 17;21(21):6. Prisons. 11th Circuit: prison is properly giving inmate's HIV drugs. [No authors listed] PMID: 17162767 [PubMed - indexed for MEDLINE] 197. Addiction. 2006 Dec;101(12):1787-96. Drug injecting and syringe use in the HIV risk environment of Russian penitentiary institutions: Qualitative study. Sarang A, Rhodes T, Platt L, Kirzhanova V, Shelkovnikova O, Volnov V, Blagovo D, Rylkov A. Russian Harm Reduction Network, Moscow, Russia. BACKGROUND: Evidence highlights the prison as a high risk environment in relation to human immunodeficiency virus (HIV) and hepatitis C virus (HCV) transmission associated with injecting drug use. METHODS: We undertook qualitative studies among 209 injecting drug users (IDUs) in three Russian cities: Moscow (n = 56), Volgograd (n = 83) and Barnaul in western Siberia (n = 70). RESULTS: Over three-quarters (77%) reported experience of police arrest related to their drug use, and 35% (55% of men) a history of imprisonment or detention.

Findings emphasize the critical role that penitentiary institutions may play as a structural factor in the diffusion of HIV associated with drug injection in the Russian Federation. While drugs were perceived to be generally available in penitentiary institutions, sterile injection equipment was scarce and as a consequence routinely shared, including within large groups. Attempts to clean borrowed needles or syringes were inadequate, and risk reduction was severely constrained by a combination of lack of injecting equipment availability and punishment for its possession. Perceptions of relative safety were also found to be associated with assumptions of HIV negativity, resulting from a perception that all prisoners are HIV tested upon entry with those found HIV positive segregated. CONCLUSION: This study shows an urgent need for HIV prevention interventions in the Russian penitentiary system. PMID: 17156178 [PubMed - indexed for MEDLINE] 198. Health Hum Rights. 2005;8(2):46-74. Prisoners who inject drugs: public health and human rights imperatives. Jrgens R, Betteridge G. Canadian HIV/AIDS Legal Network. rjurgens@sympatico.ca This article examines the human rights and public health implications of injection drug use in prisons with a specific focus on HIV and hepatitis C (HCV) viruses. The authors argue that prisoners who inject drugs have a right to access harm reduction measures--those that reduce the harmful consequences of drug use without necessarily reducing drug consumption. Moreover, states that fulfill their obligation to provide prisoners with harm reduction measures such as access to bleach, substitution therapy, and sterile injection equipment implement sound public health policy with a positive impact for a population particularly vulnerable to HIV and HCV. Ultimately, this approach benefits not only prisoners but also prison staff and the public, and does not entail lessening of the safety and security of prisons. PMID: 17136903 [PubMed - indexed for MEDLINE] 199. Gastroenterol Hepatol. 2006 Nov;29(9):551-9. [Expert recommendations for the diagnosis and treatment of chronic hepatitis C infection in the prison setting]. [Article in Spanish]

Saiz de la Hoya-Zamcola P, Marco-Mourio A, Clemente-Ricote G, Portilla-Sogorb J, Boix-Martnez V, Nez-Martnez O, Reus-Bauls S, Teixid i Prez N; Grupo de expertos para las recomendaciones sobre diagnostico y tratamiento de la hepatitis C en el medio penitenciario. Servicios Mdicos. Centro Penitenciario Alicante I. Espaa. pabloshz@coma.es The prevalence of HCV infection in Spanish prisons is very high (38.5%). The characteristics of the infected patients, particularly the high rate of HIV coinfection, makes it very likely that the morbidity and mortality produced by serious liver disease secondary to this infection will increase considerably in the coming years. A group of Spanish experts with experience in patients who are inmates has been invited to establish a series of recommendations for the diagnosis and treatment of chronic hepatitis C infection in Spanish prisons. PMID: 17129550 [PubMed - indexed for MEDLINE] 200. Enferm Infecc Microbiol Clin. 2006 Nov;24(9):568-75. [Expert recommendations for the diagnosis and treatment of chronic hepatitis C infection in the prison setting]. [Article in Spanish] Saiz de la Hoya-Zamcola P, Marco-Mourio A, Clemente-Ricote G, Portilla-Sogorb J, Boix-Martnez V, Nez-Martnez O, Reus-Bauls S, Teixid i Prez N. Servicios Mdicos, Centro Penitenciario Alicante I, Alicante, Espaa. pabloshz@coma.es The prevalence of HCV infection in Spanish prisons is very high (38.5%). The characteristics of the infected patients, particularly the high rate of HIV coinfection, makes it very likely that the morbidity and mortality produced by serious liver disease secondary to this infection will increase considerably in the coming years. A group of Spanish experts with experience in patients who are inmates has been invited to establish a series of recommendations for the diagnosis and treatment of chronic hepatitis C infection in Spanish prisons. PMID: 17125677 [PubMed - indexed for MEDLINE] 201. J Urban Health. 2006 Nov;83(6):1105-13. Prevalence and correlates of hepatitis C virus infection among street-recruited

injection drug users in San Juan, Puerto Rico. Reyes JC, Coln HM, Robles RR, Rios E, Matos TD, Negrn J, Marrero CA, Caldern JM, Shepard E. Center for Addiction Studies, Institute of Addiction, Universidad Central del Caribe, PO Box 60327, Bayamn, 00960, Puerto Rico. jcreyes@uccaribe.edu Throughout the world, injection drug users (IDUs) are the group at highest risk for hepatitis C virus (HCV) infection. IDUs residing in the island of Puerto Rico and Puerto Rican IDUs residing in the U.S. mainland have been shown to be at very high risk of infection with HIV. However, the extent to which HCV infection has spread among IDUs in Puerto Rico is not yet known. The aims of this study were to estimate seroprevalence of HCV and to identify the correlates associated with HCV transmission. The sample was drawn through street outreach strategies and was comprised of 400 injection drug users not in treatment, living in the San Juan metropolitan area. HCV and HIV infection were detected by enzyme-linked immunosorbent assay and the results were confirmed by Western blot. Information on sociodemographics, drug use patterns, and risk behaviors was obtained through structured interviews. Bivariate analyses and multivariate logistic regression were used to assess covariates of infection with HCV. The prevalence of HCV infection was 89%. After controlling for sociodemographic characteristics, HCV infection was positively associated with increasing years of injection, injecting in a shooting gallery, tattooing in prison, and self-reported STD infection. Notably, IDUs who had initiated drug injection within the year prior to the study interview had an HCV infection rate of 57%. This study indicates that more aggressive educational programs are urgently needed to reduce the spread of HCV infection among IDUs in Puerto Rico. PMCID: PMC3261284 PMID: 17075726 [PubMed - indexed for MEDLINE] 202. Sex Transm Dis. 2007 Jun;34(6):367-70. Prevalence of risk factors for hepatitis C virus in HIV-infected and HIV/hepatitis C virus-coinfected patients. Bollepalli S, Mathieson K, Bay C, Hillier A, Post J, Van Thiel DH, Nadir A. Maricopa Medical Center (MMC), Phoenix, Arizona, USA. METHODS: A sample of patients with HIV completed a questionnaire identifying their demographic characteristics and risk factors for hepatitis C virus (HCV). A chart review was conducted to confirm the information obtained using the questionnaire. Risk factors associated with coinfection status at alpha level of

0.1 in univariate analysis were entered into a multivariate Cox regression model. RESULTS: Of the 242 HIV-positive patients analyzed, 168 were HIV-infected and 74 were HIV/HCV-coinfected. Risk factors that were significantly different between HIV-monoinfected and HIV/HCV-coinfected subjects included intravenous drug use, snorting drugs, sharing razors or toothbrushes, being in prison, the presence of one or more tattoos, sex for money or drugs, sex with an intravenous drug user and man who has sex with men. In a multivariate regression model, only intravenous drug use remained as a significant risk factor/predictor of HCV/HIV coinfection. A subanalysis identified risk factors more prevalent among coinfected men who have sex with men, including intravenous drug use, sharing razors/toothbrushes, tattoos, sex for money or drugs, sex with an intravenous drug user, and a history of having 11 or more sexual partners. A history of having had a sexually transmitted disease and 11 or more sex partners was more prevalent among HIV-monoinfected men who have sex with men. CONCLUSIONS: HIV/HCV coinfection was associated with intravenous drug use but not with sexual risk factors. PMID: 17016234 [PubMed - indexed for MEDLINE] 203. World J Gastroenterol. 2006 Sep 7;12(33):5272-80. Screening in liver disease. Del Poggio P, Mazzoleni M. A disease is suitable for screening if it is common, if the target population can be identified and reached and if both a good screening test and an effective therapy are available. Of the most common liver diseases only viral hepatitis and genetic hemochromatosis partially satisfy these conditions. Hepatitis C is common, the screening test is good and the therapy eliminates the virus in half of the cases, but problems arise in the definition of the target population. In fact generalized population screening is not endorsed by international guidelines, although some recommend screening immigrants from high prevalence countries. Opportunistic screening (case finding) of individuals with classic risk factors, such as transfusion before 1992 and drug addiction, is the most frequently used strategy, but there is disagreement whether prison inmates, individuals with a history of promiscuous or traumatic sex and health care workers should be screened. In a real practice setting the performance of opportunistic screening by general practitioners is low but can be ameliorated by training programs. Screening targeted to segments of the population or mass campaigns are expensive and therefore interventions should be aimed to improve opportunistic screening and the detection skills of general practitioners. Regarding genetic hemochromatosis there is insufficient evidence for population screening, but individual physicians can decide to screen racial groups with a

high prevalence of the disease, such as people in early middle age and of northern European origin. In the other cases opportunistic screening of high risk individuals should be performed, with a high level of suspicion in case of unexplained liver disease, diabetes, juvenile artropathy, sexual dysfunction and skin pigmentation. PMID: 16981254 [PubMed - indexed for MEDLINE] 204. Presse Med. 2006 Sep;35(9 Pt 1):1249-54. [Hepatitis C in prison settings: screening and therapy are improving. Comparative survey between 2000 and 2003]. [Article in French] Remy AJ; UCSA de France. Unit de Consultations et de Soins Ambulatoires (UCSA), Service d'Hpato-Gastroentrologie et de Cancrologie Digestive, Rseau Hpatite C de Catalogne et du Pays d'Oc, Centre Hospitalier Saint-Jean Roussillon, Perpignan. andre.remy@ch-perpignan.fr OBJECTIVE: To determine the real frequency of hepatitis C (HCV) in French prisons. AIMS AND METHODS: To evaluate the changes in HCV screening and therapeutic practices in prisons between 2000 and 2003 by comparing results of mail surveys of prison medical units both years (* if p<0.01). RESULTS: 88 units (51%) responded to both surveys. In 2003, HCV serologic screening was routinely performed in 28% (36%* in 2000) of prisons and routinely offered in 66% (35%*). Mean HCV prevalence was 6.9% in 2003 and 6.7% in 2003. There were 534 liver biopsies in 2003 and 545 in 2003, that is, an average of 6 biopsies per unit per year both years. Treatment was provided to 297 patients in 2003 and 164 in 2000, but 29% of prisons offered no treatment in 2003, and 44% (*) in 2000. Overall 14% of HCV-infected prisoners received therapy. CONCLUSION: The prisons participating in this study and the inmates they include were representative of the French prison population. HCV prevalence in French prisons appears stable. Routinely suggested or conducted screening is widespread. The number of liver biopsies is stable but low, and the number of patients receiving treatment has increased significantly. PMID: 16969313 [PubMed - indexed for MEDLINE] 205. Harm Reduct J. 2006 Sep 6;3:27.

A review of the evidence for the effectiveness of primary prevention interventions for hepatitis C among injecting drug users. Wright NM, Tompkins CN. Her Majesty's Prison Leeds, Leeds, UK. n.wright@leeds.ac.uk BACKGROUND: Hepatitis C (HCV) prevalence is most common amongst injecting drug users where up to 98% of the population can be infected despite a low prevalence of HIV. This review considers the evidence for the effectiveness of primary prevention interventions to reduce incidence or prevalence of hepatitis C. METHODS: Systematic review of the major electronic medical databases: Medline, EMBASE, PsycINFO, CINAHL and the Cochrane Library (Evidence Based Health). Either intervention or observational studies were included if they described an intervention targeting injecting drug using populations with the outcome to reduce either the prevalence or incidence of hepatitis C infection. RESULTS: 18 papers were included in the final review from 1007 abstracts. Needle exchange programmes reduce the prevalence of HCV though prevalence remains high. Similarly the effectiveness of methadone maintenance treatment is only marginally effective at reducing HCV incidence. There is limited evidence evaluating either the effectiveness of behavioural interventions, bleach disinfectants, or drug consumption rooms. CONCLUSION: Primary prevention interventions have led to a reduction in HIV incidence, have been less effective at reducing HCV incidence. Global prevalence of HCV remains disturbingly high in injecting drug users. A robust response to the global health problem of HCV will require provision of new interventions. Behavioural interventions; distribution of bleach disinfectant; other injecting paraphernalia alongside sterile needle distribution; and evaluation of drug consumption rooms merit further expansion internationally and research activity to contribute to the emerging evidence base. Whilst the prevalence of HCV remains high, nevertheless many current interventions aimed at primary HCV prevention have been shown to be cost-effective due to their significant positive impact upon prevalence of HIV. PMCID: PMC1569828 PMID: 16956393 [PubMed] 206. Health Technol Assess. 2006 Sep;10(32):iii-iv, ix-xii, 1-93. The cost-effectiveness of testing for hepatitis C in former injecting drug users. Castelnuovo E, Thompson-Coon J, Pitt M, Cramp M, Siebert U, Price A, Stein K.

Peninsular Technology Assessment Group, Peninsular Medical School, Universities of Exeter and Plymouth, UK. OBJECTIVES: To evaluate the effectiveness and cost-effectiveness of testing for hepatitis C (HCV) among former injecting drug users (IDUs). DATA SOURCES: Electronic databases 1996-October 2004. Trent Regional Database Study. Routine UK mortality data. REVIEW METHODS: A decision analytic model was developed to investigate the impact of case-finding and treatment on progression of HCV disease in a hypothetical cohort of 1000 people. This was compared with a cohort in whom no systematic case-finding is implemented but spontaneous presentation for testing is allowed to occur. A group of epidemiological and clinical experts informed the structure of the model, which has three main components: (1) testing and diagnosis, (2) treatment, and (3) long-term consequences of infection. A fourth component, case-finding strategies, examines the potential impact of case-finding in three settings: prisons, general practice and drug services. RESULTS: Case-finding for HCV is likely to prevent, for 1000 people approached, three cases of decompensated cirrhosis, three deaths due to HCV and one case of hepatocellular cancer (at 30 years). Twenty-five additional people are likely to undergo combination therapy as a result of initial case-finding. One liver transplant is likely to be prevented for 10,000 people included in case-finding. Case-finding is likely to cost, in the general case, around pounds sterling 760,000 more than a policy of not case-finding. The total cost of either strategy is high and driven predominantly by the cost of treatment with combination therapy (the costs of long-term consequences are heavily discounted owing to the duration of the model). Systematically offering testing to 1000 people would cost around pounds sterling 70,000. In terms of life-years gained, case-finding is likely to result in an additional life-year gained for an investment of pounds sterling 20,084. Taking impacts on quality of life into account gives an estimate for the cost-utility of case-finding as pounds sterling 16,514 per QALY. The probabilistic sensitivity analysis shows that, if NHS policy makers view pounds sterling 30,000 per QALY as an acceptable return on investment, there is a 74% probability that case-finding for HCV would be considered cost-effective. At pounds sterling 20,000 per QALY, the probability that case-finding would be considered cost-effective is 64%. In all analyses, the probability of case-finding being considered cost-effective at a level of pounds sterling 30,000 per QALY was high. Case-finding in drug services is likely to be the most expensive, owing to the high prevalence of cases in the tested population. Correspondingly, benefits are highest for this strategy and cost-effectiveness is similar, in average terms, to the general case. Case-finding in general practice by offering testing to the whole population aged 30-54 years is, paradoxically, estimated to be the least expensive option as only a small number of people accept the offer of testing and HCV prevalence in this group is much higher than would be expected from the general population. Two approaches to case-finding in prison were considered, based on the results of studies in Dartmoor and the Isle

of Wight prisons. These differed substantially in the prevalence of cases identified in the tested populations. The analysis based on data from Dartmoor prison had the least favourable average cost-effectiveness of the strategies considered (pounds sterling 20,000 per QALY). Subgroup analyses based on duration of infection show that case-finding is likely to be most cost-effective in people whose infection is more long-standing and who are consequently at greater risk of progression. In people who were infected more than 20 years previously, case-finding yields benefits at around pounds sterling 15,000 per QALY. Treatment effectiveness was modelled using estimates from randomised controlled trials and lower rates of viral response may be seen in practice. However, estimates of cost-effectiveness remained below pounds sterling 30,000 for all levels of treatment effectiveness above 58% of those shown in the relevant trials. The value of information analysis, based on assumptions that 10,000 people might be eligible for case-finding and that programmes would run for 15 years, suggests that the maximum value of further research into case-finding is in excess of pounds sterling 19 million. Partial expected value of perfect information (EVPI) analysis shows that the utility estimates used in the model eclipse all other factors in terms of importance to parameter uncertainty. This is not surprising, since the point estimates for differences in utility between states and across the arms of the model are small. CONCLUSIONS: Case-finding for hepatitis C is likely to be considered cost-effective by NHS commissioners. Although there remains considerable uncertainty, it appears unlikely that cost-effectiveness would exceed the levels considered acceptable. Further improvements in the effectiveness of treatments to slow or halt disease progression are likely to improve the cost-effectiveness of case-finding. Case-finding is likely to be most cost-effective if targeted at people whose HCV disease is probably more advanced. Further empirical work is required to specify, in practice, different approaches to case-finding in appropriate settings and to evaluate their effectiveness and cost-effectiveness directly. PMID: 16948891 [PubMed - indexed for MEDLINE] 207. Harm Reduct J. 2006 Aug 15;3:25. Reconsidering the public health failings of the criminal justice system: a reflection on the case of Scott Ortiz. Kerr T. Throughout most of the world, the primary response to the health and social impacts of illicit drug use has been to intensify the enforcement of drug laws. The consequences of this policy approach include an unprecedented growth in prison populations and increasing concerns regarding drug-related harms within prisons and without, including increased risk of HIV and hepatitis C (HCV)

infection. This has led to calls from public health and prisoner advocacy groups to prison authorities to improve health services available in the community and those available to prisoners. While considerable progress has been made with respect to the growing implementation of HIV and HCV prevention measures within some nations' prisons, the case of Scott Ortiz illuminates a new set of challenges for prisoners and their advocates as judges often have a faulty understanding of public health arguments and data. In this case we see one such instance where a judge acts in ways not rooted in sound public health evidence or practice to produce a perverse outcome that violates both sound medical and judicial objectives. PMCID: PMC1559689 PMID: 16911792 [PubMed] 208. Epidemiol Infect. 2007 Feb;135(2):274-80. Epub 2006 Jul 7. Prevalence of hepatitis C in a German prison for young men in relation to country of birth. Meyer MF, Wedemeyer H, Monazahian M, Dreesman J, Manns MP, Lehmann M. Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Germany. A high prevalence of hepatitis C (HCV) virus infection of up to 80% has been reported for injecting drug users (IDUs) in prison communities. However, there are only very limited data available on the prevalence and course of HCV in young offenders. We performed a study on hepatitis C markers in the largest German Young Offenders' Institution (YOI), a prison for men (aged 16-24 years). In 2002, all 1176 incoming offenders were asked to participate in the study of whom >95% agreed. Ninety-seven inmates (8.6%) tested positive for anti-HCV or HCV RNA, 79% of whom were viraemic. None of the patients had evidence of cirrhosis at presentation. Interestingly, six individuals (6%) tested positive for HCV RNA in the absence of anti-HCV antibodies, four of whom cleared HCV spontaneously during follow-up without either clinical signs of acute hepatitis or developing HCV antibodies. Hepatitis C markers were significantly more prevalent among immigrants from the former Soviet Union (NIS) than among German inmates (31% vs. 6% respectively, P<0.0001). HIV co-infection was found in five individuals, all of whom were German. In contrast, hepatitis B surface antigen (HBsAg) was detected in five NIS immigrants, one Lebanese and one German inmate. HCV genotypes 2 and 3 were more prevalent in immigrants than in German inmates, while biochemical parameters did not differ significantly between the two groups. In conclusion, the prevalence of hepatitis C was relatively low among inmates of German YOIs although there were significant differences in relation to the country of birth. Our data highlight the need for educational programmes for

young offenders in order to prevent the further spread of HCV. PMCID: PMC2870573 PMID: 16824250 [PubMed - indexed for MEDLINE] 209. HIV AIDS Policy Law Rev. 2006 Apr;11(1):34, 36. Australia: ACT considers prison needle exchange program. Franklin T. PMID: 16805021 [PubMed - indexed for MEDLINE] 210. HIV AIDS Policy Law Rev. 2006 Apr;11(1):34, 36. UK: groups call for comprehensive response to HIV and hepatitis in prison. Betteridge G. PMID: 16805020 [PubMed - indexed for MEDLINE] 211. Scand J Gastroenterol. 2006 Aug;41(8):969-73. Screening for viral hepatitis among male non-drug-abuse prisoners. Liao KF, Lai SW, Chang WL, Hsu NY. Department of Internal Medicine, Taichung Prison, and Department of Surgery, China Medical University Hospital, Taiwan. OBJECTIVE: To describe the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection and the associated risk factors in a prison population. MATERIAL AND METHODS: In this cross-sectional study, from November 2004 to February 2005, all 297 newly sentenced prisoners (mean age 37.5+/-11.7 years, age range 16-69 years), who had never used illicit drugs received routine blood check-ups and completed a face-to-face interview. Hepatitis B surface antigen (HBsAg) and anti-HCV antibodies were tested using the t-test, chi-square test, and logistic regression. RESULTS: Among the 297 subjects, 13.1% were positive for HBsAg, 8.4% were positive for anti-HCV, and 1.7% were positive for combined HBsAg and anti-HCV. Logistic regression analysis demonstrated that tattooing (odds ratio=2.24, 95% CI=1.03-4.88) and an elevated alanine aminotransferase (ALAT) level (odds ratio=4.10, 95% CI=1.61-10.40) were independently related to HCV infection.

CONCLUSIONS: Screening of HBV and HCV infection in prison populations remains necessary. Tattooing and elevated ALAT level are identified as the related factors of HCV infection. PMID: 16803696 [PubMed - indexed for MEDLINE] 212. BMC Public Health. 2006 Jun 27;6:170. Estimating the cost-effectiveness of detecting cases of chronic hepatitis C infection on reception into prison. Sutton AJ, Edmunds WJ, Gill ON. Health Protection Agency, Centre for Infections, 61 Colindale Ave, London NW9 5EQ, UK. andrew.sutton@hpa.org.uk BACKGROUND: In England and Wales where less than 1% of the population are Injecting drug users (IDUs), 97% of HCV reports are attributed to injecting drug use. As over 60% of the IDU population will have been imprisoned by the age of 30 years, prison may provide a good location in which to offer HCV screening and treatment. The aim of this work is to examine the cost effectiveness of a number of alternative HCV case-finding strategies on prison reception METHODS: A decision analysis model embedded in a model of the flow of IDUs through prison was used to estimate the cost effectiveness of a number of alternative case-finding strategies. The model estimates the average cost of identifying a new case of HCV from the perspective of the health care provider and how these estimates may evolve over time. RESULTS: The results suggest that administering verbal screening for a past positive HCV test and for ever having engaged in illicit drug use prior to the administering of ELISA and PCR tests can have a significant impact on the cost effectiveness of HCV case-finding strategies on prison reception; the discounted cost in 2017 being pound2,102 per new HCV case detected compared to pound3,107 when no verbal screening is employed. CONCLUSION: The work here demonstrates the importance of targeting those individuals that have ever engaged in illicit drug use for HCV testing in prisons, these individuals can then be targeted for future intervention measures such as treatment or monitored to prevent future transmission. PMCID: PMC1543636 PMID: 16803622 [PubMed - indexed for MEDLINE] 213. Subst Use Misuse. 2006;41(8):1095-109. Alcohol use and risk taking among regular ecstasy users.

Breen C, Degenhardt L, Kinner S, Bruno R, Jenkinson R, Matthews A, Newman J. National Drug and Alcohol Research Centre, University of NSW, Sydney, New South Wales, Australia. Courtney.breen@unsw.edu.au We examine alcohol use in conjunction with ecstasy use and risk-taking behaviors among regular ecstasy users in every capital city in Australia. Data on drug use and risks were collected in 2004 from a national sample of 852 regular ecstasy users (persons who had used ecstasy at least monthly in the preceding 6 months). Users were grouped according to their typical alcohol use when using ecstasy: no use, consumption of between one and five standard drinks, and consumption of more than five drinks ("binge" alcohol use). The sample was young, well educated, and mainly working or studying. Approximately two thirds (65%) of the regular ecstasy users reported drinking alcohol when taking ecstasy. Of these, 69% reported usually consuming more than five standard drinks. Those who did not drink alcohol were more disadvantaged, with greater levels of unemployment, less education, higher rates of drug user treatment, and prison history. They were also more likely than those who drank alcohol when using ecstasy to be drug injectors and to be hepatitis C positive. Excluding alcohol, drug use patterns were similar between groups, although the no alcohol group used cannabis and methamphetamine more frequently. Binge drinkers were more likely to report having had three or more sexual partners in the past 6 months and were less likely to report having safe sex with casual partners while under the influence of drugs. Despite some evidence that the no alcohol group were more entrenched drug users, those who typically drank alcohol when taking ecstasy were as likely to report risks and problems associated with their drug use. It appears that regular ecstasy users who binge drink are placing themselves at increased sexual risk when under the influence of drugs. Safe sex messages should address the sexual risk associated with substance use and should be tailored to reducing alcohol consumption, particularly targeting "heavy" alcohol users. The study's limitations are noted. PMID: 16798678 [PubMed - indexed for MEDLINE] 214. AIDS Policy Law. 2006 May 19;21(10):3. Exposure. Inmate's sentence doubled for exposing officer to HIV. [No authors listed] PMID: 16791921 [PubMed - indexed for MEDLINE] 215. J Addict Dis. 2006;25(2):25-32.

Hepatitis and human immunodeficiency virus co-infection among injection drug users in Los Angeles County, California. Fisher DG, Reynolds GL, Jaffe A, Perez MJ. Center for Behavioral Research and Services, California State University, Long Beach, CA 90813, USA. fisher@csulb.edu This study examined the prevalence of hepatitis A (HAV), B (HBV), C (HCV), and Human Immunodeficiency Virus (HIV) co-infection among Injection Drug Users (IDUs) in Los Angeles County, California, and predictors of multiple infections in this population. Six hundred seventy-nine IDUs were recruited from October 2002 through June 2004. Participants completed questionnaires to elicit demographic, drug and sex risk information, and were tested for hepatitis A, B, C and HIV.A linear regression model predicting the total number of infections (0 to 4 possible) was constructed. Significant associations were found between HAV and HBV infection, HAV and HCV infection, and HBV and HCV infection. Predictors of total co-infections included age of first injection, lifetime years in jail, and Hispanic ethnicity. Latinos had the highest proportion of HAV and HBV co-infection with HCV. The total number of co-infections, especially those co-infected with all three of the hepatitis infections, was unexpectedly high. PMID: 16785216 [PubMed - indexed for MEDLINE] 216. Eur Addict Res. 2006;12(3):151-60. Hepatitis C virus infection among injecting drug users in the Czech Republic -prevalence and associated factors. Zabransky T, Mravcik V, Korcisova B, Rehak V. Czech National Focal Point for Drugs and Drug Addiction, Praha-Mala Strana, Czech Republic. tomas@zabransky.cz AIM: To determine the prevalence of, and factors associated with, hepatitis C virus (HCV) infection in the population of Czech injecting drug users (IDUs). DESIGN: Multicentric cross-sectional study. SETTING: A convenience sample of injecting drug users was recruited using the snowball sampling method. PARTICIPANTS: Sample of 760 IDUs from 9 different Czech regions. MEASUREMENT: We used one-drop instant blood tests to determine the anti-HCV antibodies status; a structured questionnaire was completed during the interview with the researcher. We calculated the ratio of positive findings and performed univariate analyses of correlations between predictors and independent variables. Finally, we created a logistic regression model that controlled for age, region

of residence, reported sharing of injection paraphernalia, and length of injection drug use and for the interaction between length of injection use and imprisonment in order to assess the predictive value of imprisonment in an individual's history. FINDINGS: 226 participants (29.74% of the tested sample) were found to be anti-HCV positive. After adjusting for the sensitivity of the test, the 'true proportion' was 34.97% (95% CI: 31.56-38.35). Many correlated independent variables were found in the univariate analyses. In our logistic regression model, we have found that imprisonment increases the odds of being anti-HCV positive by a factor of 4.3. CONCLUSION: Anti-HCV seroprevalence remains relatively low in the Czech IDUs population compared to similar populations in the developed countries. Regional differences exist in anti-HCV prevalence within the Czech Republic. The strong association of anti-HCV prevalence with imprisonment history when controlled for other potentially clinically important factors suggests the need for more effective preventive measures in Czech prisons. PMID: 16778436 [PubMed - indexed for MEDLINE] 217. Eur J Epidemiol. 2006;21(5):383-7. Epub 2006 Jun 9. Surveillance of HIV and viral hepatitis by analysis of samples from drug related deaths. Christensen PB, Kringsholm B, Banner J, Thomsen JL, Cowan S, Stein GF, Jrgensen GW, Grasaasen K, Georgsen J, Pedersen C. Department of Infectious Diseases, Odense University Hospital, Odense C, DK5000, Denmark. peer.christensen@dadlnet.dk OBJECTIVES: To determine the prevalence of antibodies against HIV, hepatitis B (HBV) and hepatitis C (HCV) in postmortem samples from drug related deaths (DRDs) in Denmark. DESIGN: Prospective cohort study. Postmortem samples tested for anti-HIV, anti-HCV anti-HBc and anti-HBs. Comparison to pre-mortem testing when possible. DRDs were searched for in the national register of drug treatment, national prison registers, and the national infectious disease register. SETTING: National level. PARTICIPANTS: Drug related deaths admitted to Danish Institutes of Forensic Medicine during 2004. MAIN OUTCOME MEASURES: Prevalence of antibodies, injection drug use, drug treatment experience and prevalence of cirrhosis. RESULTS: Samples for analysis were obtained from 78% (233/299) of DRDs. The prevalences of anti-HIV, anti-HCV and anti-HBc were 4% (9/214), 51% (110/215), and 35% (74/209), indicating a persisting low prevalence of HIV and a declining

prevalence of HCV and HBV. Injecting ever was detected among 45% of DRDs and this was associated with a significantly higher prevalence of hepatitis B and C. Among the DRDs 56% received drug treatment and 12% had cirrhosis at autopsy. Evidence of vaccination against HBV was found among 16% (21/128). CONCLUSIONS: Monitoring of viral hepatitis and HIV among DRDs is feasible, and our survey indicates a falling prevalence among Danish drug users. Surveillance based on drug users in treatment may overestimate the true prevalence. PMID: 16763882 [PubMed - indexed for MEDLINE] 218. J Urban Health. 2006 Mar;83(2):275-88. The effect of hepatitis C virus infection on health-related quality of life in prisoners. Thein HH, Butler T, Krahn M, Rawlinson W, Levy MH, Kaldor JM, Dore GJ. National Centre in HIV Epidemiology and Clincal Research, The University of New South Wales, Sydney, NSW, Australia. Hepatitis C virus (HCV) infection in prisoners represents an important public health problem. However, there is very little information about HCV-related health-related quality of life (HRQOL). We examined the effect of HCV antibody positivity, HCV viremia, and being a prisoner on prisoners'' HRQOL. Population-based health surveys incorporating HCV screening were conducted among prisoners at New South Wales (NSW), Australia, correctional centers in 1996 and 2001. HCV antibody and HCV RNA status were determined from venous blood sampling. HRQOL and mood status were assessed using the Short Form-36 (SF-36) Health Survey and Beck Depression Inventory (BDI). Comparison of HRQOL scores between HCV antibody negative, HCV antibody positive/non-viremic, and HCV antibody positive/viremic and assessment of temporal change in HRQOL between 1996 and 2001 within groups were made using ANCOVA adjusting for confounders. Factors associated with HRQOL were determined in linear regression models. Analyses between HCV antibody negative (n = 423), HCV positive/non-viremic (n = 89), and HCV positive/viremic (n = 178) prisoners found no measurable effect of HCV on HRQOL, including that attributable to HCV viremia. Compared to uninfected Australian population norms, prisoners had lower HRQOL irrespective of HCV status. The prevalence of 'moderate' to 'severe' depressive symptoms was greater in the HCV antibody positive/viremic group than the HCV antibody positive/non-viremic group or the HCV antibody negative group. Selected demographic factors (age), co-morbidity, severity of depressive symptoms and medical care utilization influenced HRQOL. There was evidence to support the effect of knowledge of HCV status on HRQOL. In conclusion, our findings contrast with previous studies in non-prisoner groups in which HCV infection appears to

decrease overall HRQOL. Non-HCV factors may override HCV-specific HRQOL impairment in this population. Targeted management strategies are required to improve HRQOL of prisoners. PMCID: PMC2527173 PMID: 16736376 [PubMed - indexed for MEDLINE] 219. Clin Infect Dis. 2006 Jun 15;42(12):1663-70. Epub 2006 May 11. Acute hepatitis C virus infection in incarcerated injection drug users. McGovern BH, Wurcel A, Kim AY, Schulze zur Wiesch J, Bica I, Zaman MT, Timm J, Walker BD, Lauer GM. Lemuel Shattuck Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. bmcgovern@tufts-nemc.org Comment in Clin Infect Dis. 2006 Jun 15;42(12):1671-3. BACKGROUND: The Centers for Disease Control and Prevention has emphasized the need for interventional programs regarding hepatitis C virus (HCV) infection for injection drug users, the group of persons who are at highest risk of acquiring acute infection. METHODS: We designed a pilot study to assess the feasibility of identifying injection drug users with acute HCV infection in correctional and detoxification facilities. On-site medical providers were educated regarding risk factors and signs and symptoms of infection and were instructed to refer all patients with hepatitis to our specialty clinic. RESULTS: Over a 30-month period, 21 patients received a diagnosis of acute hepatitis C, 3 received a diagnosis of hepatitis B, and 1 received a diagnosis of hepatitis A. Of the 21 patients with acute hepatitis C, 19 were identified in the prison setting shortly after incarceration. Of the 17 patients who were observed serially (mean duration of observation, 6.3 months), 8 had spontaneous virologic clearance. Early therapy with pegylated interferon was initiated for 5 patients with persistent viremia and led to a sustained virologic response in 2 individuals. All patients agreed to undergo human immunodeficiency virus counseling and testing, as well as to receive immunization for hepatitis A and B. CONCLUSIONS: Incarceration presents a unique opportunity to identify injection drug users with acute HCV infection, to initiate counseling regarding other bloodborne pathogens, and to facilitate immunizations and HCV treatment. PMID: 16705568 [PubMed - indexed for MEDLINE]

220. Ann Intern Med. 2006 May 16;144(10):762-9. A framework for management of hepatitis C in prisons. Spaulding AC, Weinbaum CM, Lau DT, Sterling R, Seeff LB, Margolis HS, Hoofnagle JH. Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. aspauld@emory.edu The prevalence of chronic hepatitis C virus (HCV) infection in prisons ranges from 12% to 31%. There are generally accepted--albeit still evolving--guidelines for identification and treatment of hepatitis C in the community. However, there is less agreement among health professionals caring for prisoners about best practices for identification, medical management, and treatment of hepatitis C. Inmates often lack health care before incarceration. In prisons, infected persons could be identified and the management of infection initiated; however, the high prevalence of HCV infection among prisoners would impose a disproportionate cost for hepatitis C care on the correctional system. The optimal solution is for prison and public health systems in the United States to jointly provide targeted HCV testing and standard-of-care hepatitis C medical management, treatment, and prevention programs to prison inmate populations. The authors report on a January 2003 meeting of experts in prison health, public health, hepatology, and infectious diseases and explore the clinical care, prevention, and collaboration needed to provide hepatitis C management in prisoners. PMID: 16702592 [PubMed - indexed for MEDLINE] 221. South Med J. 2006 Apr;99(4):348-51. Descriptive epidemiology of hepatitis C virus among male heroin abusers in Taiwan. Liao KF, Peng CY, Lai SW, Chang WL, Hsu NY. Department of Internal Medicine, Family Medicine, and Surgery, China Medical University Hospital, Taichung, Taiwan. BACKGROUND: The purpose of this study was to explore the epidemiology of hepatitis C virus (HCV) infection and to determine the risk factors for HCV infection among heroin abusers in Taiwan. METHODS: This was a cross-sectional study. From November 2004 to February 2005, 577 subjects, including 423 subjects (73.3%) using injectable heroin and 154 subjects (26.7%) using smoked heroin from one male prison located in Taiwan, were enrolled in this study. The mean age was 33.3 +/- 7.9 years (age range 19-65

years). Anti-HCV antibody was tested. A face-to-face interview focusing on sociodemographic information and risk behaviors was addressed. The t test, chi-squared test, and multivariate logistic regression were used. RESULTS: The overall prevalence of anti-HCV antibody positivity was 74.9%, with 89.8% among injecting heroin abusers and 33.8% among smoking heroin abusers (P < 0.0001). The multivariate logistic regression analysis demonstrated that needle sharing was independently related to HCV infection (odds ratio = 5.25, 95% confidence interval = 2.48-11.12). CONCLUSIONS: The prevalence of anti-HCV antibody positivity among male injecting drug abusers is high in Taiwan. Needle sharing is identified as a potential risk factor for HCV infection. PMID: 16634243 [PubMed - indexed for MEDLINE] 222. Cad Saude Publica. 2006 Apr;22(4):861-70. Epub 2006 Apr 5. "The first shot": the context of first injection of illicit drugs, ongoing injecting practices, and hepatitis C infection in Rio de Janeiro, Brazil. Oliveira ML, Hacker MA, Oliveira SA, Telles PR, O KM, Yoshida CF, Bastos FI. Instituto Oswaldo Cruz, Fundao Oswaldo Cruz, Rio de Janeiro, Brazil. mlaoliveira@fiocruz.br The context of first drug injection and its association with ongoing injecting practices and HCV (hepatitis C virus) infection were investigated. Injection drug users (IDUs) (N = 606) were recruited in "drug scenes" (public places, bars) in Rio de Janeiro, Brazil, interviewed, and tested for HCV. Sharing of needles/syringes was more prevalent at the first injection (51.3%) than at the baseline interview (36.8%). Those who shared syringes/needles at first injection were more likely to be currently engaged in direct/indirect sharing practices. Among young injectors (< 30 years), those reporting sharing of needles/ syringes at the first injection were about four times more likely to have been infected by HCV. Hepatitis C virus prevalence among active IDUs (n = 272) was 11%. Prison history and longer duration of drug injection were identified as independent predictors of HCV infection. To effectively curb HCV transmission among IDUs and minimize harms associated with risk behaviors, preventive strategies should target individuals initiating drug injection beginning with their very first injection and discourage the transition from non-injecting use to the self-injection of illicit drugs. PMID: 16612439 [PubMed - indexed for MEDLINE] 223. J Viral Hepat. 2006 Apr;13(4):264-71.

Clinical pathways for patients with newly diagnosed hepatitis C - what actually happens. Irving WL, Smith S, Cater R, Pugh S, Neal KR, Coupland CA, Ryder SD, Thomson BJ, Pringle M, Bicknell M, Hippisley-Cox J. Division of Microbiology and Infectious Diseases, School of Molecular Medical Sciences, University of Nottingham, UK. will.irving@nottingham.ac.uk Management of hepatitis C virus (HCV)-infected individuals requires referral to specialist care. To determine whether patients newly diagnosed as anti-HCV positive are appropriately referred for further investigation and management, and if not, to determine why not. We studied patients tested for antibodies to HCV by Nottingham Public Health Laboratory in a 2-year period (2000-2002). The progress of newly diagnosed anti-HCV positive patients into specialist clinics for further management was documented. For patients not referred for specialist care, a questionnaire was sent to the clinician requesting the initial anti-HCV test, to identify reasons for nonreferral. Eleven thousand one hundred and seventy-seven patients were tested for anti-HCV. Two hundred and fifty-six (2.3%) were newly diagnosed as being anti-HCV positive. Two per cent of samples sent from primary care were anti-HCV positive, compared to 18.8, 18.9 and 1.3% sent from prison, drug and alcohol units, and secondary care, respectively. About 64.3% of positive patients diagnosed in primary care were referred to specialist care, compared to 18.4, 42.4 and 62.6% of patients diagnosed in the other three settings. One hundred and twenty-five (49%) newly diagnosed patients were referred appropriately for further management. 68 of these attended clinic, 45 underwent liver biopsy and 26 (10%) began treatment. One hundred and thirty-one patients (51%) were not referred. In 54 cases, there was no evidence that the anti-HCV positive result reached the patient. In 15, referral was considered but rejected, and 20 patients were referred to non-HCV-specialists (their general practitioners or to genito-urinary medicine). Hence less than 50% of newly diagnosed anti-HCV positive patients are referred to an appropriate clinic for further investigation and management. Reasons for this are multifarious and complex, reflecting both systems failure and patient choice. Unless these are understood and addressed, the Department of Health Hepatitis C Strategy (2002) and Action Plan for England (2004) will fail to achieve their intended objectives. PMID: 16611193 [PubMed - indexed for MEDLINE] 224. N S W Public Health Bull. 2005 Sep-Oct;16(9-10):166-7. Bug Breakfast in the Bulletin: Blood-borne viruses in correctional facilities. Wallace C, Hailstone S, Lloyd A.

NSW Public Health Officer Training Program, NSW Department of Health. PMID: 16596152 [PubMed - indexed for MEDLINE] 225. J Med Microbiol. 2006 May;55(Pt 5):593-7. Prevalence of human immunodeficiency virus, hepatitis B virus, hepatitis C virus and syphilis among prison inmates and officers at Nsawam and Accra, Ghana. Adjei AA, Armah HB, Gbagbo F, Ampofo WK, Quaye IK, Hesse IF, Mensah G. Department of Pathology, University of Ghana Medical School, College of Health Sciences, Korle-Bu, Accra, Ghana. andrewadjei50@hotmail.com Comment in J Med Microbiol. 2006 May;55(Pt 5):481-2. Although the high prevalence of blood-borne viral infections and syphilis in correctional facilities has been well documented globally, such data are sparse from Africa, and there has been no such data from Ghana. This study sought to estimate the prevalence of human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) and syphilis among prison inmates and officers at prisons in Nsawan and Accra, Ghana. Prisoners and officers in 3 of the 46 prisons in Ghana were surveyed from May 2004 to May 2005. Subjects voluntarily completed a risk-factor questionnaire and provided blood specimens for unlinked anonymous testing for the presence of antibodies to HIV, HCV and Treponema pallidum, the causative agent of syphilis, and the surface antigen of hepatitis B virus (HBsAg). Almost 16% (3770) of the total of 23,980 prison inmates in Ghana were eligible, and 281 (7.5%) of those eligible took part, whilst almost 23% (1120) of the total of 4910 prison officers were eligible, and 82 (7.3%) of those eligible took part. For the 281 inmates tested, HIV seroprevalence was 19.2%, 17.4% had HBsAg, HCV seroprevalence was 19.2% and reactive syphilis serology was noted in 11%. For the 82 officers tested, HIV seroprevalence was 8.5%, 3.7% had HBsAg, HCV seroprevalence was 23.2% and reactive syphilis serology was noted in 4.9%. The data indicate a higher prevalence of HIV and HCV in correctional facilities (both prison inmates and officers) than in the general population in Ghana, suggesting their probable transmission in prisons in Ghana through intravenous drug use, unsafe sexual behaviour and tattooing as pertains to prisons worldwide. PMID: 16585647 [PubMed - indexed for MEDLINE] 226. Drug Alcohol Depend. 2006 Sep 15;84(2):160-6. Epub 2006 Feb 17.

Value for money in drug treatment: economic evaluation of prison methadone. Warren E, Viney R, Shearer J, Shanahan M, Wodak A, Dolan K. Centre for Health Economics Research and Evaluation, CHERE, University of Technology, Sydney, Australia. BACKGROUND: Although methadone maintenance treatment in community settings is known to reduce heroin use, HIV infection and mortality among injecting drug users (IDU), little is known about prison methadone programs. One reason for this is the complexity of undertaking evaluations in the prison setting. This paper estimates the cost-effectiveness of the New South Wales (NSW) prison methadone program. METHODS: Information from the NSW prison methadone program was used to construct a model of the costs of the program. The information was combined with data from a randomised controlled trial of provision of prison methadone in NSW. The total program cost was estimated from the perspective of the treatment provider/funder. The cost per heroin free day, compared with no prison methadone, was estimated. Assumptions regarding resource use were tested through sensitivity analysis. RESULTS: The annual cost of providing prison methadone in NSW was estimated to be 2.9 million Australian dollars (or 3,234 Australian dollars per inmate per year). The incremental cost effectiveness ratio is 38 Australian dollars per additional heroin free day. CONCLUSIONS: From a treatment perspective, prison methadone is no more costly than community methadone, and provides benefits in terms of reduced heroin use in prisons, with associated reduction in morbidity and mortality. PMID: 16487668 [PubMed - indexed for MEDLINE] 227. Addiction. 2006 Feb;101(2):252-66. Prevalence of HIV, hepatitis C and syphilis among injecting drug users in Russia: a multi-city study. Rhodes T, Platt L, Maximova S, Koshkina E, Latishevskaya N, Hickman M, Renton A, Bobrova N, McDonald T, Parry JV. Centre for Research on Drugs and Health Behaviour and Unit for International Public Health and Development, Imperial College London, UK. t.rhodes@imperial.ac.uk OBJECTIVES: To estimate the prevalence of HIV, hepatitis C virus (HCV) and syphilis in injecting drug users (IDUs) in Russia. METHODS: Unlinked anonymous cross-sectional survey of 1473 IDUs recruited from

non-treatment settings in Moscow, Volgograd and Barnaul (Siberia), with oral fluid sample collection for HIV, HCV antibody (anti-HIV, anti-HCV) and syphilis testing. RESULTS: Prevalence of antibody to HIV was 14% in Moscow, 3% in Volgograd and 9% in Barnaul. HCV prevalence was 67% in Moscow, 70% in Volgograd and 54% in Barnaul. Prevalence of positive syphilis serology was 8% in Moscow, 20% in Volgograd and 6% in Barnaul. Half of those HIV positive and a third of those HCV positive were unaware of their positive status. Common risk factors associated with HIV and HCV infection across the cities included both direct and indirect sharing of injecting equipment and injection of home-produced drugs. Among environmental risk factors, we found increased odds of anti-HIV associated with being in prison in Moscow, and some association between official registration as a drug user and anti-HIV and anti-HCV. No associations were found between sexual risk behaviours and anti-HIV in any city. CONCLUSIONS: HIV prevalence among IDUs was markedly higher than city routine surveillance data suggests and at potentially critical levels in terms of HIV prevention in two cities. HCV prevalence was high in all cities. Syphilis prevalence highlights the potential for sexual risk and sexual HIV transmission. Despite large-scale testing programmes, knowledge of positive status was poor. The scaling-up of harm reduction for IDUs in Russia, including sexual risk reduction, is an urgent priority. PMID: 16445554 [PubMed - indexed for MEDLINE] 228. Harm Reduct J. 2006 Jan 24;3:2. Patterns of drug use among a sample of drug users and injecting drug users attending a General Practice in Iran. Day C, Nassirimanesh B, Shakeshaft A, Dolan K. National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Level 2, 376 Victoria Street, Darlinghurst, NSW 2010, Australia. cday@nchecr.unsw.edu.au AIM: This study aimed to examine drug use, drug treatment history and risk behaviour among a sample of Iranian drug users seeking treatment through a general practice clinic in Iran. METHODS: Review of medical records and an intake questionnaire at a large general practice in Marvdasht, Iran, with a special interest in drug dependence treatment. Records from a random sample of injecting drug users (IDU), non-injecting drug users (DU) and non-drug using patients were examined. RESULTS: 292 records were reviewed (34% IDU, 31% DU and 35% non-drug users). Eighty-three percent were males; all females were non-drug users. The mean age of

the sample was 30 years. Of the IDU sample, 67% reported sharing a needle or syringe, 19% of these had done so in prison. Of those who had ever used drugs, being 'tired' of drug use was the most common reason for seeking help (34%). Mean age of first drug use was 20 years. The first drugs most commonly used were opium (72%), heroin (13%) and hashish/ other cannabinoids (13%). Three quarters reported having previously attempted to cease their drug use. IDU were more likely than DU to report having ever been imprisoned (41% vs 7%) and 41% to have used drugs in prison. CONCLUSION: This study has shown that there is a need for general practice clinics in Iran to treat drug users including those who inject and that a substantial proportion of those who inject have shared needles and syringes, placing them at risk of BBVI such as HIV and hepatitis C. The expansion of services for drug users in Iran such as needle and syringe programs and pharmacotherapies are likely to be effective in reducing the harms associated with opium use and heroin injection. PMCID: PMC1397809 PMID: 16433914 [PubMed] 229. Epidemiol Infect. 2006 Aug;134(4):814-9. Epub 2005 Dec 22. A syringe exchange programme in prison as prevention strategy against HIV infection and hepatitis B and C in Berlin, Germany. Stark K, Herrmann U, Ehrhardt S, Bienzle U. Robert Koch Institute, Department of Infectious Disease Epidemiology, Berlin, Germany. starkk@rki.de In two prisons in Berlin, Germany, provision of sterile injection equipment for injecting drug users (IDUs) started in 1998. To assess the programme's impact, the frequency of injecting drug use and syringe sharing, and the incidence of HIV, HBV, and HCV infection were determined in a follow-up study. Of all IDUs (n=174), 75% continued to inject. After the project start the level of syringe sharing declined from 71% during a 4-month period of previous imprisonment to 11% during the first 4 months of follow-up, and to virtually zero thereafter. Baseline seroprevalences for HIV, HBV, and HCV were 18, 53, and 82%. HIV and HCV seroprevalence at baseline was significantly associated with drug injection in prison prior to the project start. No HIV and HBV seroconversions, but four HCV seroconversions occurred. The provision of syringes for IDUs in appropriate prison settings may contribute to a substantial reduction of syringe sharing. However, the prevention of HCV infection requires additional strategies. PMCID: PMC2870452 PMID: 16371183 [PubMed - indexed for MEDLINE]

230. HIV AIDS Policy Law Rev. 2005 Aug;10(2):51. UK: legal action on needle exchange programs in prisons dismissed. Valette D. In April 2005, a judicial review application against the UK Home Secretary for his failure to introduce needle exchange programs in prisons in England and Wales was dismissed by a judge at the Royal Courts of Justice (Administrative Court Division). PMID: 16365988 [PubMed - indexed for MEDLINE] 231. HIV AIDS Policy Law Rev. 2005 Aug;10(2):37-8. Scottish Prison Service to halt mandatory drug testing. [No authors listed] PMID: 16365978 [PubMed - indexed for MEDLINE] 232. Eur Addict Res. 2006;12(1):33-41. Drugs and social exclusion in ten European cities. March JC, Oviedo-Joekes E, Romero M. Andalusian School of Public Health, Campus Universitario de Cartuja, Granada, Spain. AIM: To describe social characteristics seen among socially excluded drug users in 10 cities from 9 European countries, and identify which social exclusion indicators (i.e. housing, employment, education) are most closely linked to intravenous drug use. DESIGN: Cross-sectional survey. SETTING: Interviews were held in social services centers, town halls, streets, squares and other usual meeting points of the target population. PARTICIPANTS: The sample comprises 1,879 participants who have used heroin and/or cocaine and certain derivatives (92.3%) over the last year. Males accounted for 69.7% of the sample, and the mean age was 30.19 years. Participants were recruited in 10 cities: Seville and Granada, Spain; Cologne, Germany; Vienna, Austria; Brussels, Belgium; Athens, Greece; Dublin, Ireland; London, England;

Lisbon, Portugal, and Perugia, Italy. MEASUREMENTS: Structured face-to-face questionnaire, conducted by privileged access interviewers. RESULTS: Cannabis, heroin and cocaine are the most widely used substances. In the total sample, 60.2% injected drugs during the last year, 45.9% reported having hepatitis C; 54.9% have been in prison; 14.2% are homeless; 11.3% have a regular job, and 35.2% are involved in illegal activities. Hierarchical logistic regression analysis (injectors and non-injectors) showed that older participants have a greater likelihood of injecting than younger ones. Social exclusion variables associated with intravenous drug use are incarceration, homelessness, irregular employment, and delinquency. Participants who abandoned or were expelled from a drug treatment program are at greater risk of injecting drugs than participants who have never had treatment, are currently in treatment or have been released. CONCLUSION: Personal, social, and economic conditions are all linked in a process of social exclusion that compounds problem drug misuse. Given the findings of this study, we believe that there is a clear need for specific programs targeting specific groups, i.e., distinct strategies must be set in place, in line with the profile and needs of the patient in each context. Copyright (c) 2006 S. Karger AG, Basel. PMID: 16352901 [PubMed - indexed for MEDLINE] 233. Drug Alcohol Depend. 2006 Jul 27;83(3):210-7. Epub 2005 Dec 15. Prevalence of injecting drug use and associated risk behavior among regular ecstasy users in Australia. White B, Day C, Degenhardt L, Kinner S, Fry C, Bruno R, Johnston J. National Drug and Alcohol Research Centre, University of New South Wales, NSW 2052, Australia. Bethany@burnet.edu.au BACKGROUND: The aim of the study was to investigate the prevalence of injecting drug use and associated risk behaviour among a sentinel sample of ecstasy users. METHODS: Cross-sectional surveys were conducted with regular ecstasy users as part of an annual monitoring study of ecstasy and related drug markets in all Australian capital cities. RESULTS: Twenty-three percent of the sample reported having ever injected a drug and 15% reported injecting in the 6 months preceding interview. Independent predictors of lifetime injection were older age, unemployment and having ever been in prison. Completion of secondary school and identifying as heterosexual was associated with a lower likelihood of having ever injected. Participants who had recently injected typically did so infrequently; only 9% reported daily

injecting. Methamphetamine was the most commonly injected drug. Prevalence of needle sharing was low (6%), although half (47%) reported sharing other injecting equipment in the preceding 6 months. CONCLUSIONS: Ecstasy users who report having injected a drug at some time appear to be demographically different to ecstasy users who have not injected although neither are they typical of other drug injectors. The current investigation suggests that ongoing monitoring of injecting among regular ecstasy users is warranted. PMID: 16343810 [PubMed - indexed for MEDLINE] 234. J Infect. 2006 Aug;53(2):125-30. Epub 2005 Nov 28. The prevalence of HCV antibody in South Australian prisoners. Miller ER, Bi P, Ryan P. Department of Public Health, University of Adelaide, Adelaide, South Australia 5005, Australia. emma.miller@adelaide.edu.au OBJECTIVES: The study was aimed at identifying the hepatitis C virus (HCV)-antibody status of prisoners incarcerated in South Australia in order to develop an HCV prevalence estimate for the whole prison system. METHODS: The health records of persons incarcerated within eight prisons (accommodating approximately 93% of the jurisdiction's adult incarcerated population) were audited for evidence of HCV infection, age, sex, Indigenous status (Australian Aboriginal or Torres Strait Islander) and date of entry to prison. These data were analysed using both univariate and multivariate techniques. RESULTS: Among 1347 prisoners (1254 males and 93 females), 30.2% were HCV-antibody positive. After excluding those with no history of testing, HCV-antibody prevalence rose to 41.3% (males 39.8%, females 66.1%). HCV-antibody positivity was significantly associated with age, sex and Indigenous status in both univariate and multivariate analyses. CONCLUSIONS: Consistent with the literature, the prevalence of HCV infection in the SA prison system appears to be extremely high. This study suggests that HCV prevention efforts in prison settings should be considered as an important priority. PMID: 16313963 [PubMed - indexed for MEDLINE] 235. Epidemiol Infect. 2005 Dec;133(6):1146-8. Tattoos, incarceration and hepatitis B and C among street-recruited injection

drug users in New Mexico, USA: update. Samuel MC, Bulterys M, Jenison S, Doherty P. 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]. PMCID: PMC2870351 PMID: 16274514 [PubMed - indexed for MEDLINE] 236. Clin Infect Dis. 2005 Jul 1;41 Suppl 1:S56-62. Delivering therapy for hepatitis C virus infection to incarcerated HIV-seropositive patients. McGovern B, Fiore J, Wurcel A, Taglienti P, Bradley M, Galvin S, Libone G, Ramsey J, Molinaro-Gudas V, Drewniak S, Amick C, Andalkar A, Scheft H, Bica I. Division of Infectious Diseases, Lemuel Shattuck Hospital, Jamaica Plain, MA 02130, USA. bmcgovern@tufts-nemc.org The increase in morbidity and mortality due to end-stage liver disease has fueled recent guidelines that recommend consideration of treatment for hepatitis C in human immunodeficiency virus (HIV)-infected patients. Unfortunately, studies indicate that few patients coinfected with HIV and hepatitis C virus (HCV) are treated for their underlying hepatitis because of ongoing substance abuse, depression, chaotic lifestyles, homelessness, and perceived nonadherence. The structured environment of the prison system enables clinicians to provide complicated therapies for HCV to HIV-infected patients in combination with substance abuse programs. Furthermore, adherence to and adverse effects of therapy can be closely monitored. Offering treatment for HCV infection during incarceration to HIV-seropositive persons is highly efficient and targets

underserved minority patients who have limited access to care in the community. PMID: 16265615 [PubMed - indexed for MEDLINE] 237. J Viral Hepat. 2005 Nov;12(6):655-62. Prevalence of, and risk factors for, hepatitis C virus infection among recent initiates to injecting in London and Glasgow: cross sectional analysis. Judd A, Hutchinson S, Wadd S, Hickman M, Taylor A, Jones S, Parry JV, Cameron S, Rhodes T, Ahmed S, Bird S, Fox R, Renton A, Stimson GV, Goldberg D. Department of Primary Care and Social Medicine, Centre for Research on Drugs and Health Behaviour, Imperial College London, London. a.judd@imperial.ac.uk Our aim was to compare the prevalence of antibody to hepatitis C virus (anti-HCV) among recently initiated injecting drug users (IDUs) in London and Glasgow, and to identify risk factors which could explain differences in prevalence between the cities. Complementary studies of community recruited IDUs who had initiated injection drug use since 1996 were conducted during 2001-2002. Data on HCV risk behaviours were gathered using structured questionnaires with identical core questions and respondents were asked to provide an oral fluid specimen which was tested anonymously for anti-HCV but was linked to the questionnaire. Sensitivities of the anti-HCV assays for oral fluid were 92-96%. Prevalence of anti-HCV was 35% (122/354) in London and 57% (207/366) in Glasgow (P < 0.001). Multifactorially, factors significantly associated with raised odds of anti-HCV positivity were increasing length of injecting career, daily injection, polydrug use, having had a needlestick injury, and having served a prison sentence. In addition lower odds of anti-HCV positivity were associated with non-injection use of crack cocaine and recruitment from drug agencies. After adjustment for these factors, the increased odds of anti-HCV associated with being a Glasgow IDU were diminished but remained significant. HCV continues to be transmitted among the IDU population of both cities at high rates despite the availability of syringe exchange and methadone maintenance. Effectiveness of harm reduction interventions may be compromised by inadequate coverage and failure to reduce sufficiently the frequency of sharing different types of injecting equipment, as well as the high background prevalence of HCV, and its high infectivity. Comprehensive action is urgently required to reduce the incidence of HCV among injectors. PMID: 16255768 [PubMed - indexed for MEDLINE] 238. AIDS. 2005 Oct;19 Suppl 3:S41-6. Hepatitis B, hepatitis C, and HIV in correctional populations: a review of

epidemiology and prevention. Weinbaum CM, Sabin KM, Santibanez SS. Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. cweinbaum@cdc.gov The 2 million persons incarcerated in US prisons and jails are disproportionately affected by hepatitis B virus (HBV), hepatitis C virus (HCV) and HIV, with prevalences of infection two to ten times higher than in the general population. Infections are largely due to sex- and drug-related risk behaviors practised outside the correctional setting, although transmission of these infections has also been documented inside jails and prisons. Public health strategies to prevent morbidity and mortality from these infections should include hepatitis B vaccination, HCV and HIV testing and counseling, medical management of infected persons, and substance abuse treatment in incarcerated populations. PMID: 16251827 [PubMed - indexed for MEDLINE] 239. Acta Med Port. 2004 Sep-Oct;17(5):381-4. Epub 2004 Dec 20. [Prevalence infections and risk factors due to HIV, Hepatitis B and C in a prison establishment in Leiria]. [Article in Portuguese] Passadouro R. Centro de Sade Dr. Arnaldo Sampaio, Leiria. The present study emerged due to HIV, Hepatitis B and C test samples that have been taking place in a prison establishment in Leiria. The samples were taken from 788 (77%) of the 1019 prisoners that entered the prison during the periods between February of 1999 to September 2003. A questionnaire was carried to the transmission of HIV, Hepatitis B and C infections and blood samples were also taken to determine the immunologic situation in relationship to the same viruses. Of the 788 prisoners that participated, 699 (89%) were male and 89(11%) were female. The average age was 32.3, the oldest person was 70 and the youngest was 16 years old. 294 (40%) prisoners admitted using injectable drugs and 606 (84%) confirmed they had more than one sexual partner. HIV infection were found in 47 (6%) of the prisoners, HCV infection in 326 (42%), HBsAg in 21 (3%), HBsAc in 309 (40%) and HBcAc in 312 (40%) of the prisoners. Statistics confirm a significant relationship between injectable drugs and the presence of HIV infection and HBcAc and between sexual relationships with an infected partner and the presence of HBcAc, anti-HCV and HIV infection. The prevalence of infected prisoners with HIV

was 6%, with HBV 40% and with HCV 42%. Hepatitis B and C infected 70% of the prisoner who used injectable drugs. The prevalence of hepatitis B and C and HIV infection that were found compel for the continuation of prevention. PMID: 16197845 [PubMed - indexed for MEDLINE] 240. Body Posit. 2005;18(1):34-5. Tattooing in prison: an innocuous practice or a conduit for hep C? Day RF. PMID: 16193570 [PubMed - indexed for MEDLINE] 241. Am J Gastroenterol. 2005 Oct;100(10):2180-5. Risk factors for hepatitis C on the Texas-Mexico border. Hand WL, Vasquez Y. Department of Research Development, Texas Tech University Health Sciences Center, El Paso, Texas 79905, USA. OBJECTIVES: Our clinical experience suggested that hepatitis C virus (HCV) infection in this Texas-Mexico border area might have features, especially risk factors, that differ from some other areas of the United States. Therefore, we conducted a prospective analysis to investigate the epidemiology, risk factors, and certain other characteristics of HCV infection in the El Paso region. METHODS: During a 2-yr period, individuals with a positive HCV serology were considered as "patients" and those with a negative hepatitis serology panel were "controls." A questionnaire survey was conducted in person or by telephone with individuals (patients and controls) who agreed to participate in the interview process. RESULTS: We identified and interviewed 320 patients and 307 controls. All of the contacted patients and controls agreed to be interviewed. Many established and potential risk factors for HCV transmission were documented in the patients. Furthermore, multiple potential risk factors were often present in individual patients. However, on multivariate analysis only injection drug use, blood transfusion, and tattooing were found to be significant independent risk factors for HCV infection. In the great majority of patients, tattoos were applied by friends (including gang members), inmates in jail/prison, or self, rather than commercial parlors. CONCLUSIONS: Tattooing is an independent risk factor for HCV infection in this United States-Mexico border area. The role of nonsterile tattooing practices in

HCV transmission merits additional examination in regard to precise risk settings, frequency, and mechanisms of infection. PMID: 16181366 [PubMed - indexed for MEDLINE] 242. J Clin Virol. 2006 Mar;35(3):244-9. Epub 2005 Sep 6. HTLV infection among young injection and non-injection heroin users in Spain: prevalence and correlates. de la Fuente L, Toro C, Soriano V, Brugal MT, Vallejo F, Barrio G, Jimnez V, Silva T; Project Itnere Working Group. Centro Nacional de Epidemiologa, Instituto de Salud Carlos III, C/Sinesio Delgado 6, 28029 Madrid, Spain. lfuente@isciii.es BACKGROUND: Although some studies have described the epidemiology of infection with HIV or hepatitis B and C in young users in Spain - one of the European countries with the highest prevalences - there are no studies of the prevalence of HTLV infection and the most important associated factors. OBJECTIVES: To evaluate the prevalence and main determinants of HTLV-1 and HTLV-2 infection in young heroin users (including both injection (IDUs) and non-injection drug users (NIDUs)) recruited outside health care services in three of Spain's principal cities. STUDY DESIGN: Cross-sectional cohort study. All participants (981) were street-recruited by chain referral procedures between April 2001 and December 2003. Face-to-face interviews were conducted using a structured questionnaire and dried blood spot samples were collected for serological testing. RESULTS: No sample was positive for HTLV-1 and 27 samples were positive for HTLV-2; all of these were found only in Spanish IDUs in the cities of Madrid (17, 6.2%) and Barcelona (10, 3.5%). The only two factors significantly associated with HTLV infection in the logistic regression analysis were HIV infection (OR 5.7; 95% CI 2.2-14.8) and having injected in the last 30 days (OR 6.5; 95% CI 1.4-29.8). Having been in prison (OR 2.4; 95% CI 0.9-6.4) and HCV infection (OR 3.8; 95% CI 0.5-30.7), which were strongly and significantly associated in the bivariate analysis, were no longer significant in the logistic analysis. Almost the same variables were selected in the tree analysis, in which subjects could be classified into three groups: high prevalence (28.5%, HIV+ and HBV+ who had injected in the last 30 days), medium prevalence (17.8%) and low (<3%) or zero prevalence (HIV-, HCV- and HBV-). CONCLUSIONS: HTLV-1 was not detected among young Spanish heroin users. HTLV2 was not found in NIDUs (perhaps due to the low rate of sexual transmission); it was found only in IDUs from Madrid and Barcelona, but not in those from Seville. Its

prevalence is very low and the main correlates of infection were HIV infection and injection as the usual route of heroin administration. PMID: 16143565 [PubMed - indexed for MEDLINE] 243. Clin Infect Dis. 2005 Oct 1;41(7):998-1002. Epub 2005 Aug 30. Community incidence of hepatitis B and C among reincarcerated women. Macalino GE, Vlahov D, Dickinson BP, Schwartzapfel B, Rich JD. Department of Medicine, Tufts-New England Medical Center, Boston, MA, USA. BACKGROUND: The incarceration rate has increased 239% in the United States over the past 2 decades. This increase in incarceration has been fueled by the movement towards a criminal, rather than medical, response to the problem of drug dependence. For women in particular, incarceration and drug use are interdependent epidemics. Given that incarceration is common among drug-dependent persons, infectious diseases--including hepatitis B virus (HBV) and hepatitis C virus (HCV) infection--are prevalent among incarcerated persons. We sought to determine the incidence of HBV and HCV infection among recidivist women prisoners. METHODS: From 1996 through 1997, excess from serum samples collected during HIV testing of female admittees to a state Department of Corrections facility were tested for HBV and HCV. Multiple samples obtained from women incarcerated multiple times during the study period were compared for incidence. RESULTS: Baseline prevalences of markers of HBV and HCV were 36% and 34%, respectively. Incidence rates for HBV and HCV infection among reincarcerated women were 12.2 and 18.2 per 100 person-years, respectively. The majority of the time spent between serial intakes was not spent in the correctional facility; thus, incident infections likely occurred in the community. CONCLUSIONS: Incidences of HBV and HCV infection among reincarcerated women were high. Prisons and jails can be efficient locations for the diagnosis, treatment, and prevention of hepatitis B and C through programs such as testing, counseling, education, vaccination, and linkage to medical and drug treatment services. PMID: 16142665 [PubMed - indexed for MEDLINE] 244. AIDS. 2005 Sep 23;19(14):1535-40. High HIV, hepatitis C and sexual risks among drug-using men who have sex with men in northern Thailand.

Beyrer C, Sripaipan T, Tovanabutra S, Jittiwutikarn J, Suriyanon V, Vongchak T, Srirak N, Kawichai S, Razak MH, Celentano DD. Department of Epidemiology, Bloomberg School of Public Health, The Johns Hopkins University, 615 North Wolfe Street (E-7152), Baltimore, MD 21205, USA. cbeyrer@jhsph.edu BACKGROUND: Men who have sex with men (MSM) and who use drugs have shown high HIV risks in Europe, and the Americas. We investigated MSM-drug user demographics, HIV sexual and drug use risks and behaviors in Chiang Mai, northern Thailand to identify prevention targets. METHODS: A total of 2005 males aged 13 years and older were enrolled during inpatient drug treatment from 1999-2000 and assessed for HIV, hepatitis C virus (HCV), syphilis, and for demographics and risks by questionnaire. Data were analyzed using chi and multiple logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Of 2005 males in treatment, 1752 (87.4%) had ever had sex, and 66 of 1752 (3.8%) reported ever having sex with another man; mostly Katoey (transgendered male) partners. MSM had higher HIV rates (OR, 2.32; 95% CI, 1.36-3.96) and were younger (P = 0.002); more likely to be Thai (P < 0.0001); better educated (P < 0.0001); had more lifetime sex partners (P < 0.0001), more female partners (P = 0.002), more female paid partners (P < 0.0001), and been paid for sex (P < 0.0001). MSM were more likely to have ever injected (P < 0.0001), sold drugs, been in prison, injected in prison, used heroin, and to have HCV (OR, 2.59; 95% CI, 1.55-4.34). CONCLUSIONS: Northern Thai MSM-drug users are at high HIV and HCV risk. In addition to sex risks with men, they have more sex with women and sex workers than other men, which fits Thai MSM patterns but not Western ones. Prevention must take into account their high rates of substance use and multiple partner types. PMID: 16135908 [PubMed - indexed for MEDLINE] 245. Am J Public Health. 2005 Oct;95(10):1737-9. Epub 2005 Aug 30. Feasibility and outcome of HCV treatment in a Canadian federal prison population. Farley J, Vasdev S, Fischer B, Haydon E, Rehm J, Farley TA. University of British Columbia, Vancouver, BC, Canada. We assessed feasibility and outcome of hepatitis C virus (HCV) treatment in male correctional inmates in British Columbia, Canada. We reviewed the medical charts of 114 treated inmates; 80 had complete data for treatment outcome. Approximately

4 of 5 inmates completed treatment (78.8%); 66.3% achieved sustained virological response. Those who completed treatment, those with injection drug use as a risk factor, and those with genotypes 2 and 3 were significantly more likely to achieve sustained virological response. HCV treatment in correctional inmates is feasible and effective. PMCID: PMC1449428 PMID: 16131642 [PubMed - indexed for MEDLINE] 246. J Urban Health. 2005 Sep;82(3 Suppl 4):iv101-12. Marginalized and socially integrated groups of IDUs in Hungary: potential bridges of HIV infection. Gyarmathy VA, Neaigus A. Institute for International Research on Youth at Risk, National Development and Research Institutes, 71 West 23rd Street, 8th Floor, New York, NY, USA. gyarmathy@ndri.org The discrepancy in HIV rates among Eastern and central European injecting drug users (IDUs) suggests that, in addition to risk behaviors, social contact patterns also play an important role. We identify two groups of IDUs in Budapest, Hungary, marginalized IDUs (M-IDUs) and socially integrated IDUs (SI-IDUs) and compare their HIV/hepatitis B virus (HBV)/hepatitis C virus (HCV) social and risk network characteristics, risk behaviors, and travel patterns. Between May 2003 and January 2004, 29 nontreatment-recruited young IDUs in Budapest participated in ethnographic interviews and focus groups. The mean age was 23.6 years (SD=3.6); eight were female and two Roma/Gypsy. Most injected heroin (n=23) and/or amphetamines (n=10) in the past 30 days. M-IDUs had no legal employment, injected heroin and sniffed glue, and stopped using drugs in treatment/prison. SI-IDUs had regular jobs or were students, injected heroin and sniffed cocaine, and stopped using drugs before exams/tests. Both M-IDUs and SI-IDUs shared injecting equipment on occasion and used condoms rarely. M-IDUs had a large social network of "buddies" and a small risk network of "friends". SI-IDUs had two separate large social networks of "buddies": a M-IDU and a non-IDU network; and a small risk network of "friends". Both groups reported monogamous sexual relationships. M-IDUs traveled within Hungary, whereas SI-IDUs traveled to Western Europe. If an HIV epidemic among IDUs in Hungary is not prevented, SI-IDUs may form a potential "bridge" of HIV infection between high-risk IDU populations and the low-risk general population, whereas M-IDUs may become cores of infection. Different approaches may be appropriate for M-IDUs and SI-IDUs to prevent HIV. PMCID: PMC2656943

PMID: 16107433 [PubMed - indexed for MEDLINE] 247. Epidemiol Infect. 2005 Aug;133(4):679-85. Hepatitis virus and HIV infections in inmates of a state correctional facility in Mexico. Alvarado-Esquivel C, Sablon E, Martnez-Garca S, Estrada-Martnez S. Facultad de Medicina, Universidad Jurez del Estado de Durango, Mxico. alvaradocosme@yahoo.com We sought to determine the prevalence and associated characteristics of hepatitis A, B, C and D viruses and HIV infections in a prison in Durango, Mexico. Sera from 181 inmates were analysed for HAV antibody, hepatitis B core antibody (HBcAb), hepatitis B surface antigen (HBsAg), HCV antibody, HDV antibody, HIV antibody and HCV genotypes. Prevalence of HAV antibody, HBcAb, HBsAg, HCV antibody, HDV antibody and HIV antibody were 99.4, 4.4, 0.0, 10.0, 0.0 and 0.6% respectively. HCV genotype 1a predominated in HCV-infected inmates (62.5%), followed by HCV genotype 1b (25%) and HCV genotype 3 (12.5%). An association between HBV infection and age > 30 years was found. HCV infection was associated with being born in Durango City, history of hepatitis, ear piercing, tattooing, drug abuse history, intravenous drug use and lack of condom use. We concluded that the prevalence of HAV, HBV, HDV and HIV infections in inmates in Durango, Mexico were comparable to those of the Mexican general population and blood donors, but lower than those reported in other prisons around the world. However, HCV infection in inmates was higher than that reported in Mexican blood donors but lower than those reported in other prisons of the world. These results have implications for the optimal planning of preventive and therapeutic measures. PMCID: PMC2870296 PMID: 16050514 [PubMed - indexed for MEDLINE] 248. World J Gastroenterol. 2005 Jul 14;11(26):4085-9. Prevalence of hepatitis C virus infection and its related risk factors in drug abuser prisoners in Hamedan--Iran. Mohammad Alizadeh AH, Alavian SM, Jafari K, Yazdi N. Research Center for Gastroenterology and Liver Disease, Shaheed Beheshti University of Medical Sciences, 7th Floor, Taleghani Hospital, Yaman Str., Evin, Tehran 19857, Iran. article@rcgld.org

AIM: Recent studies in Iran has shown that prevalence of hepatitis C virus (HCV) infection among Iranian prisoners is high, in spite of low HCV seroprevalence in general population. METHODS: This study was carried out in the central prison of Hamedan--Iran, in year 2002. Inmates were interviewed using a standard questionnaire including demographic, imprisonment history and HCV-related risk behaviors items. Thereafter, the sera drawn from the participants were tested for anti-HIV and anti-HCV antibodies. RESULTS: A total number of 427 drug abuser inmates participated in our study. Three hundred and ninety-seven (93%) were men and 30 (7%) were women. Total number of IV drug abusers (IDA) and non-IV drug abusers (NIDA) was 149 (34.9%) and 278 (65.1%), respectively. The overall rate of antibody positivity among inmates was 0.9% for HIV and 30% for HCV. Of all IDAs, 31.5% and of NIDAs, 29.1% had serological evidence of HCV infection. CONCLUSION: The seroprevalence of HCV infection among drug abuser prisoners in comparison with the general population in Iran, is very high (30% vs in italics 0.2%). Our results indicate the importance of policies to prevent transmission of HCV infection during and following incarceration. PMID: 15996035 [PubMed - indexed for MEDLINE] 249. Clin Infect Dis. 2005 Jul 15;41(2):177-86. Epub 2005 Jun 9. Hepatitis C virus infection among prisoners in the California state correctional system. Fox RK, Currie SL, Evans J, Wright TL, Tobler L, Phelps B, Busch MP, Page-Shafer KA. Division of General Internal Medicine, University of California-San Francisco, 94105, USA. BACKGROUND: Incarcerated populations are at high risk for hepatitis C virus (HCV) infection, yet prisoners are not routinely screened or treated for HCV infection. Understanding the risk factors of HCV infection among prisoners could help improve HCV interventions. METHODS: Prevalence and risk of HCV infection among 469 prisoners entering California State correctional facilities were assessed using HCV antibody screening, HCV RNA measurement, and structured interviews. Multivariate logistic regression analysis was used to identify independent correlates of HCV infection. RESULTS: The prevalence of HCV infection was 34.3% overall (95% confidence interval [CI], 30%-38%) and was 65.7% among those with a history of injection drug use (IDU), compared with 10.2% among those with no history of IDU (odds ratio [OR], 17.24; 95% CI, 10.52-28.25). Significant differences in HCV antibody positivity were found in association with age at first detention but not with the

nature of the crime. Independent correlates of HCV infection included age, history of IDU, cumulative time of incarceration, biological sex (OR for females subjects compared with males subjects, 0.35; 95% CI, 0.13-0.96), and a history of having sex with a male IDU (OR, 4.42; 95% CI, 1.46-13.37). We identified significant differences in risk factors between male and female subjects--notably, that the risk of HCV infection was significantly elevated among female non-IDUs who reported having sexual partners with a history of IDU. Among non-IDUs, correlates of HCV infection included history of receipt of blood products and cumulative years of incarceration. CONCLUSIONS: HCV infection is pervasive among the California prison population, including prisoners who are non-IDUs and women with high-risk sexual behavior. These results should promote consideration of routine HCV antibody screening and behavioral interventions among incarcerated men and women. PMID: 15983913 [PubMed - indexed for MEDLINE] 250. Lancet. 2004 Dec;364 Suppl 1:s32-3. Carandiru. Varella D. Clinical Oncology Department, Hospital Sirio-Libanes, Avenue Higienopolis, 101, Apt 141, So Paulo, Brazil. drvarella@yahoo.com.br PMID: 15967144 [PubMed - indexed for MEDLINE] 251. J Clin Forensic Med. 2005 Aug;12(4):196-8. Patterns of illicit drug use of prisoners in police custody in London, UK. Payne-James JJ, Wall IJ, Bailey C. Forensic Healthcare Services Ltd., 19 Speldhurst Road, London E9 7EH, UK. jasonpaynejames@aol.com AIMS AND METHODS: The aims of the study were to explore the current characteristics of drug misusers seen in police custody and identify trends or changes that have taken place in the last decade. A prospective, anonymised, structured questionnaire survey was undertaken of consenting consecutive, self-admitted illicit drug users seen by forensic physicians in police custody within the Metropolitan Police Service in London, UK in 2003. RESULTS: 30% of detainees were dependent on heroin or crack cocaine. Drug users (n=113) were studied in 2003. 95.4% completed the questionnaire. 82% were male,

18% female. Mean age was 28.5 y (range 18-49). 80% were unemployed; significant mental health issues (e.g., schizophrenia) were present in 18%; 15% had alcohol dependence; heroin was the most frequently used drug (93%); crack cocaine -- 87%; mean daily cost of drugs -- heroin GBP 76 (range 20-240), crack GBP 81 (range 20-300). >50% users inject crack and heroin simultaneously. 56% used the intravenous route; 25% had shared needles; 100% had accessible sources of clean needles; 6.4% were hepatitis B positive; 42% were aware of hepatitis prophylaxis; hepatitis C positive -- 20.2%; 3.6% were HIV positive. Mean length of time of drug use was 7.5 y (range 1 month -- 20 years); 82% had served a previous prison sentence; 54% had used drugs in prison; 11% had used needles in prison; 3% of users stated they had started using in prison. 38% had been on rehabilitation programs; 11% had been on Drug Treatment and Testing; Orders (DTTO); 32% had used the services of Drug Arrest Referral Teams in police stations; 10% were in contact with Drug Teams at the time of assessment. CONCLUSIONS: In the last decade, there appears to be a substantial increase in the prevalence of drug use in this population -- particularly of crack cocaine. Treatment interventions are either not readily available, or not followed through. In very general terms, the illicit drug use problem appears to have significantly worsened in the population seen in police custody in London, UK, in the last decade although there is evidence that health education and harm reduction messages appear to have had some positive effects. PMID: 15950514 [PubMed - indexed for MEDLINE] 252. Eur Respir J. 2005 Jun;25(6):1070-6. Correlates of Mycobacterium tuberculosis infection in a prison population. Carbonara S, Babudieri S, Longo B, Starnini G, Monarca R, Brunetti B, Andreoni M, Pastore G, De Marco V, Rezza G; GLIP (Gruppo di Lavoro Infettivologi Penitenziari). Clinica Malattie Infettive, Universit di Bari, Piazza G. Cesare 11, 70124 Bari, Italy. s_carbonara@yahoo.it Prisons represent a crucial setting for tuberculosis control. Currently, there is scarce information concerning Mycobacterium tuberculosis (MT) infection in European prisons, and no data are available for Italy. This study aims to describe the prevalence and correlates of MT infection in an Italian prison population. In this multicentre cross-sectional study, 1,247 inmates from nine prisons were recruited and asked to undergo questioning regarding socio-economic and demographic variables, tuberculin skin testing (TST), chest radiographs and testing for HIV, hepatitis B and hepatitis C virus infection. TST was positive in 17.9% of the 448 evaluable subjects. With multivariate logistic regression (performed among male inmates), MT infection was correlated with age (adjusted

odds ratio (OR) 4.12 for inmates aged 31-40 yrs; 3.78 for those aged >40 yrs), being foreign-born (OR = 4.9), education < or =5 yrs (OR = 1.88) and length of detention (increased risk per yr: 11%). As with elsewhere in the world, the prison system in Italy features a population with an increased rate of Mycobacterium tuberculosis infection and at-risk rate for Mycobacterium tuberculosis transmission. Improved tuberculosis surveillance and control measures are deemed necessary in correctional facilities nationwide, especially for subjects with the above risk factors and those who are HIV infected, in whom the tuberculin skin testing can be misleading. The screening of entrants is particularly important to avoid undiagnosed smear-positive tuberculosis cases. PMID: 15929964 [PubMed - indexed for MEDLINE] 253. Addiction. 2005 Jun;100(6):820-8. Four-year follow-up of imprisoned male heroin users and methadone treatment: mortality, re-incarceration and hepatitis C infection. Dolan KA, Shearer J, White B, Zhou J, Kaldor J, Wodak AD. National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia. k.dolan@unsw.edu.au AIMS: To examine the long-term impact of methadone maintenance treatment (MMT) on mortality, re-incarceration and hepatitis C seroconversion in imprisoned male heroin users. DESIGN, SETTING AND PARTICIPANTS: The study cohort comprised 382 imprisoned male heroin users who had participated in a randomized controlled trial of prison-based MMT in 1997/98. Subjects were followed-up between 1998 and 2002 either in the general community or in prison. MEASUREMENTS: All-cause mortality, re-incarceration, hepatitis C and HIV serostatus and MMT retention. FINDINGS: There were no deaths recorded while subjects were enrolled in MMT. Seventeen subjects died while out of MMT, representing an untreated mortality rate of 2.0 per 100 person-years (95% CI, 1.2-3.2). Re-incarceration risk was lowest during MMT episodes of 8 months or longer (adjusted hazard ratio 0.3 (95% CI, 0.2-0.5; P < 0.001), although MMT periods 2 months or less were associated with greatest risk of re-incarceration (P < 0.001). Increased risk of hepatitis C seroconversion was significantly associated with prison sentences of less than 2 months [adjusted hazard ratio 20 (95% CI, 5-76; < P = 0.001)] and MMT episodes less than 5 months [adjusted hazard ratio 4.2 (95% CI, 1.4-12.6; P = 0.01)]. Subjects were at greatest risk of MMT dropout during short prison sentences of 1 month or less (adjusted hazard ratio 10.4 (95% CI, 7.0-15.7; P < 0.001). HIV

incidence was 0.3 per 100 person-years (95% CI, 0.03-0.99). CONCLUSIONS: Retention in MMT was associated with reduced mortality, re-incarceration rates and hepatitis C infection. Prison-based MMT programmes are integral to the continuity of treatment needed to ensure optimal outcomes for individual and public health. PMID: 15918812 [PubMed - indexed for MEDLINE] 254. Women Health. 2004;40(4):57-73. Harm reduction and women in the Canadian national prison system: policy or practice? Rehman L, Gahagan J, DiCenso AM, Dias G. School of Health and Human Performance, Dalhousie University, 6230 South St, Halifax, NS, B3H 3J5, Canada. Laurene.Rehman@dal.ca Applying the principles of harm reduction within the context of incarcerated populations raises a number of challenges. Although some access to harm reduction strategies has been promoted in general society, a divide between what is available and what is advocated continues to exist within the prison system. This paper explores the perceptions and lived experiences of a sample of nationally incarcerated women in Canada regarding their perceptions and experiences in accessing HIV and Hepatitis C prevention, care, treatment and support. In-depth interviews were conducted with 156 women in Canadian national prisons. Q.S.R. Nudist was used to assist with data management. A constant comparison method was used to derive categories, patterns, and themes. Emergent themes highlighted a gap between access to harm reduction in policy and in practice. Despite the implementation of some harm reduction techniques, women in Canadian prisons reported variable access to both education and methods of reducing HIV/HCV transmission. Concerns were also raised about pre-and post-test counseling for HIV/HCV testing. Best practices are suggested for implementing harm reduction strategies within prisons for women in Canada. PMID: 15911510 [PubMed - indexed for MEDLINE] 255. J Med Virol. 2005 Jul;76(3):311-7. Correlates of HIV, HBV, and HCV infections in a prison inmate population: results from a multicentre study in Italy. Babudieri S, Longo B, Sarmati L, Starnini G, Dori L, Suligoi B, Carbonara S, Monarca R, Quercia G, Florenzano G, Novati S, Sardu A, Iovinella V, Casti A,

Romano A, Uccella I, Maida I, Brunetti B, Mura MS, Andreoni M, Rezza G. Istituto Malattie Infettive, Universit di Sassari, Sassari, Italy. babuder@uniss.it A cross-sectional study was undertaken on the correlates of infection for the human immunodeficiency virus (HIV) and hepatitis viruses B and C (HBV and HCV) in a sample of inmates from eight Italian prisons. A total of 973 inmates were enrolled [87.0% males, median age of 36 years, 30.4% intravenous drug users (IDUs), 0.6% men who have sex with men (MSWM)]. In this sample, high seroprevalence rates were found (HIV: 7.5%; HCV: 38.0%; anti-HBc: 52.7%; HBsAg: 6.7%). HIV and HCV seropositivity were associated strongly with intravenous drug use (OR: 5.9 for HIV; 10.5 for HCV); after excluding IDUs and male homosexuals, the HIV prevalence remained nonetheless relatively high (2.6%). HIV prevalence was higher for persons from Northern Italy and Sardinia. The age effect was U-shaped for HIV and HCV infections; HBV prevalence increased with age. Tattoos were associated with HCV positivity (OR: 2.9). The number of imprisonments was associated with HIV infection, whereas the duration of imprisonment was only associated with anti-HBc. The probability of being HIV-seropositive was higher for HCV-seropositive individuals, especially if IDUs. In conclusion, a high prevalence of HIV, HCV, and HBV infections among inmates was observed: these high rates are in part attributable to the high proportion of IDUs. Frequency of imprisonment and tattoos were associated, respectively, with HIV and HCV positivity. Although it is possible that the study population is not representative of Italy's prison inmate population, the results stress the need to improve infection control measures users was prisons. Copyright (c) 2005 Wiley-Liss, Inc. PMID: 15902712 [PubMed - indexed for MEDLINE] 256. Mod Healthc. 2005 Apr 25;35(17):34. A retro disease on the loose. Rise of hepatitis C in prisons may fuel outbreak in general population. Knapp A. New York University School of Medicine, USA. PMID: 15876002 [PubMed - indexed for MEDLINE] 257. Can J Public Health. 2005 Mar-Apr;96(2):97-101.

Drug use and risk of bloodborne infections: a survey of female prisoners in British Columbia. Martin RE, Gold F, Murphy W, Remple V, Berkowitz J, Money D. Department of Family Practice, University of British Columbia, Vancouver. remartin@interchange.ubc.ca Comment in Can J Public Health. 2005 Mar-Apr;96(2):93-6. BACKGROUND: Clinicians working in a women's prison in British Columbia observed hepatitis C sero-conversion among inmates, prompting this study to determine: the characteristics of women who do and do not report illicit drug use in prison; patterns of drug use inside prison; factors associated with illicit drug use that might contribute to bloodborne transmission inside prison. METHODS: A cross-sectional observational data set was created using an anonymous 61-item self-administered survey. RESULTS: Eighty-three percent (104/126) of eligible inmates participated. Seventy-four percent (77/104) reported their current prison sentence was related to illicit drug use and 25% (26/104) reported their ethnicity as Aboriginal. Ninety-three percent (97/104) reported a prior history of illicit drug use, of whom 70% (68/97) reported a history of injection drug use. Thirty-six percent (37/104) reported illicit drug use in prison, and 21% (22/104) reported injection drug use in prison. Fifty-two percent (54/104) reported hepatitis C sero-positivity, and 8% (8/104) reported HIV sero-positivity. Of the 22 women who reported prison injection drug use, 91% (20/22) reported hepatitis C infection and 86% (19/22) reported injecting with shared needles inside prison, with or without bleach cleaning. Women were more likely to report illicit drug use in prison if they had had illegal sources of income prior to incarceration (p=0.0081, OR 3.19), had previously injected drugs (p=0.036, OR 2.97), and had first injected drugs at a friend's house (p=0.066, OR 2.70). INTERPRETATION: The majority of women reporting prison injection drug use also reported hepatitis C sero-positivity and shared needle use. Canadian prisons are risk situations for transmission of bloodborne pathogens, and provide opportunities for harm reduction strategies. PMID: 15850026 [PubMed - indexed for MEDLINE] 258. Dig Dis Sci. 2005 Apr;50(4):714-8. Evaluation of The Federal Bureau of Prisons protocol for selection of which hepatitis C-infected inmates are considered for treatment. Pradhan MM, Horswell R, Jones G, Ramsey JL, Cassidy W.

Louisiana State University Health Sciences Center, Department of Medicine, Baton Rouge, Louisiana 70805, USA. The Federal Bureau of Prisons limits hepatitis C therapy to those inmates with certain biochemical abnormalities. To evaluate this protocol, an analysis was done on data collected on hepatitis C infected inmates in the Louisiana Department of Corrections. A quality assurance database of hepatitis C infected inmates evaluated in the Louisiana Department of Corrections was reviewed for liver biopsy and laboratory results. Patients were compared as to whether they would have been biopsied under the Federal Bureau of Prisons protocol and if there were histologic differences between those who would and those who would not have been biopsied. Of 490 inmates biopsied, 26% (129) had an alanine aminotransferase level between one and two times the upper limit of normal without other biochemical abnormalities. If treating stages 2-4, 48% of these would qualify for treatment (15% if treating stages 3-4). There was no statistical difference between this group and either the group with an alanine aminotransferase level between one and two times the upper limit of normal and with other laboratory abnormalities or the group with an alanine aminotransferase level greater than or equal to two times the upper limit of normal and without other abnormalities. In the Louisiana Department of Corrections, the Federal Bureau of Prisons protocol was neither sensitive nor specific enough at identifying those that should be considered for hepatitis C therapy. PMID: 15844707 [PubMed - indexed for MEDLINE] 259. Int J STD AIDS. 2005 Feb;16(2):117-22. Screening for sexually transmitted diseases and hepatitis in 18-29-year-old men recently released from prison: feasibility and acceptability. Sosman JM, MacGowan RJ, Margolis AD, Eldridge E, Flanigan T, Vardaman J, Fitzgerald C, Kacanek D, Binson D, Seal DW, Gaydos CA; Project START Study Group. Department of Medicine, University of Wisconsin Medical School, Madison, WI 53705, USA. jms@medicine.wisc.edu Men entering prisons have high rates of sexually transmitted disease (STD), hepatitis, and HIV. This study sought to determine the acceptability and feasibility of screening for STD and hepatitis in young men released from prison. Participants were interviewed six months after release and offered free screening. Of 42 (56%) eligible men who participated in the qualitative interview, 33 (79%) provided at least a blood or urine specimen. Eight of 33 (24%) men tested had chlamydia, trichomoniasis, hepatitis B or C virus (HBV or HCV). Three of 32 (9%) had chlamydia, three of 32 (9%) had trichomoniasis, two of

28 (7%) had prior syphilis, and two of 28 (7%) had HCV. Of 28 tested for HBV, six (21%) were immune, two (7%) had chronic infection, and 20 (71%) were susceptible. Barriers to screening included lack of forewarning, inconvenience, and insufficient incentive. In conclusion, screening for STD and hepatitis among former inmates can be acceptable and feasible. Forewarning, reducing the time burden, and providing monetary incentives may increase screening rates. PMID: 15825246 [PubMed - indexed for MEDLINE] 260. Clin Gastroenterol Hepatol. 2005 Apr;3(4):311-8. Management of hepatitis C virus in special populations: patient and treatment considerations. Gish RG, Afdhal NH, Dieterich DT, Reddy KR. Liver Transplant Program and Division of Hepatology and Complex GI, California Pacific Medical Center, 2340 Clay Street #232, San Francisco, CA 94115, USA. gishr@sutterhealth.org The most common chronic blood-borne infection in the United States is caused by hepatitis C virus. An estimated 3.9 million people (1.8%) in the United States have been infected with the hepatitis C virus, excluding certain subpopulations who are at high risk for hepatitis C virus infection. Among these subpopulations are an estimated 255,000 (15%) of prison inmates and 175,000 (22%) of homeless people. Prevalence of hepatitis C virus infection is also high among veterans (6.6% overall and even higher among homeless veterans). The single most important risk factor for hepatitis C virus infection is injection drug use; up to 90% of illicit injection drug users are infected with hepatitis C virus. This review describes the prevalence of hepatitis C virus in special populations and discusses the treatment options for patients with severe disease, transplant recipients, and patients at high risk for infection. Close monitoring and management of therapeutic side effects are required to assist these patients in adhering to therapy. PMID: 15822034 [PubMed - indexed for MEDLINE] 261. HIV AIDS Policy Law Rev. 2004 Dec;9(3):45-6. Canada: study provides further evidence of risk of hepatitis C and HIV transmission in prisons. [No authors listed]

In 2002, as part of a larger injection drug use social network study undertaken in Winnipeg, a study was undertaken at Stony Mountain Institution to obtain data on the social network interactions in the prison and the potential role these interactions have on facilitating or inhibiting the spread of bloodborne pathogens among injection drug users. The study, although small in size and largely exploratory, provides further evidence of the risk of HCV and HIV transmission in prisons and its potential public health implications. PMID: 15810133 [PubMed - indexed for MEDLINE] 262. HIV AIDS Policy Law Rev. 2004 Dec;9(3):41-3. Prison needle exchange programs work. [No authors listed] On 27 October 2004 the Canadian HIV/AIDS Legal Network and the Ontario Medical Association (OMA) released reports recommending that needle exchange programs (NEPs) be implemented in prisons, based on evidence that such programs promote and protect the health of both prisoners and prison staff. At the same time, the Scottish Prison Service announced that it was looking at providing such programs, and an Iranian physician reported on a pilot project in his country. PMID: 15810131 [PubMed - indexed for MEDLINE] 263. Rev Esp Salud Publica. 2005 Jan-Feb;79(1):35-46. [Perceived health and use of health care services in inmates of an Andalusian prison, 1999]. [Article in Spanish] Oviedo-Joekes E, March Cerd JC, Ramos Montserrat MJ, Ballesta Gmez R, Prieto Rodrguez MA. Escuela Andaluza de Salud Pblica, Cuesta del Observatorio 4, Campus Universitario de Cartuja, 18080, Granada. eugenia.oviedojoekes.easp@juntadeandalucia.es BACKGROUND: The study of the health condition of the populations under confinement in penitentiaries is based on the evidence of a more deteriorated health than the general population and a greater degree of social exclusion, which is associated with worse general health. This study is aimed at ascertaining how the inmates of an Andalusian penitentiary perceive their health

condition and the use made thereby of the healthcare services, as well as the factors associated with those variables. METHODS: Descriptive, cross-sectional study. The data was collected with a questionnaire. The sample size was 450 inmates, 90.4% of whom were males. RESULTS: Seventy-two percent of those taking part in the study considered their health to be good or very good, 32.7% stating having seen the doctor once a month or more often. A total 43.1% of the participants stated having chronic illnesses, mainly HIV (19.1%) and hepatitis C (18.2%); 40.9% stating that they take medication. Worse health was perceived among the older inmates, those who have to serve longer than a five-year sentence, those who are repeat offenders and those not having pending trials. Those perceiving their health to have deteriorated over the past year have chronic illnesses and take medication. The regression model for the use of healthcare services shows that they are used to a greater extent by those who are serving a longer than a 5-year sentence, those who have been in prison for less than a year and those who take medication. CONCLUSIONS: The results show the importance of increasing the monitoring of possible addictive disorders upon entering prison and of the trend and treatment of chronic diseases. PMID: 15794584 [PubMed - indexed for MEDLINE] 264. Can J Gastroenterol. 2005 Mar;19(3):153-6. Treatment of chronic hepatitis C in Canadian prison inmates. Farley JD, Wong VK, Chung HV, Lim E, Walters G, Farley TA, Yoshida EM. Department of Health Care & Epidemiology, University of British Columbia, Vancouver. drjohnfarley@shaw.ca PURPOSE: To assess sustained viral response rate and adherence to standard interferon alpha-2b and ribavirin therapy in inmates with chronic hepatitis C (HCV) in Canadian penitentiaries in the Pacific region. METHODS: A retrospective chart review of all inmates with chronic HCV who were treated with standard interferon alpha-2b and ribavirin therapy between March 2001 and October 2002. RESULTS: A total of 90 male inmates were treated. The mean age at time of treatment was 40 years. There were 49 inmates with HCV genotype 1, 11 with HCV genotype 2 and 30 with HCV genotype 3. Eight inmates discontinued treatment because of intolerance to side effects. Nine inmates were stopped by the physician because of nonresponse at an average of 27 weeks. All inmates achieved at least 80% adherence of interferon and ribavirin therapy. The overall sustained virological response (SVR) was 55.9%. SVR was 31.6% for genotype 1, 100% for genotype 2 and 71.4% for genotype 3. CONCLUSION: There was excellent SVR and adherence to treatment with interferon

and ribavirin. This experience highlights an important opportunity to treat a population with a high prevalence of HCV-positive persons who may otherwise not seek treatment. PMID: 15776135 [PubMed - indexed for MEDLINE] 265. Clin Infect Dis. 2005 Apr 15;40 Suppl 5:S367-72. Opportunities to address the hepatitis C epidemic in the correctional setting. Boutwell AE, Allen SA, Rich JD. Massachusetts General Hospital, Boston, Massachusetts, USA. An estimated 15%-40% of incarcerated persons in the United States are infected with hepatitis C virus (HCV). Approximately 1.4 million HCV-infected persons pass through the corrections system annually, accounting for one-third of the total number of HCV-infected persons in the United States. This high prevalence of HCV infection is due to the substantial increase in drug-related arrests over the past 2 decades. Although the hepatitis C epidemic in the corrections system may be viewed as a burden on correctional health systems, it is an important public health opportunity and an obligation. Research on the implementation of cost-effective HCV screening, prevention, and treatment programs among incarcerated persons is essential. Testing, education, and, when appropriate, treatment of prisoners should be a cornerstone of the public health response to the hepatitis C epidemic in the United States. PMID: 15768350 [PubMed - indexed for MEDLINE] 266. Enferm Infecc Microbiol Clin. 2005 Feb;23(2):53-7. [Predictive markers of HIV and HCV infection and co-infection among inmates in a Spanish prison]. [Article in Spanish] Siz de la Hoya P, Bedia M, Murcia J, Cebri J, Snchez-Pay J, Portilla J. Centro Penitenciario Alicante I, Hospital General Universitario de Alicante, Maestro Alonso 109, 03010 Alicante, Spain. Comment in Enferm Infecc Microbiol Clin. 2005 Feb;23(2):51-2.

OBJECTIVE: To study the prevalence and factors associated with HIV and HCV infection among inmates of a Spanish prison. METHOD: A cross-sectional study was carried out in July 2001. We determined HCV (ELISA and RIBA-3) and HIV (ELISA and Western-blot) serology in the prison population. Study variables included age, sex, nationality and previous intravenous drug use (IDU). In IDU inmates we analyzed the age when intravenous drug use was initiated, years of consumption, age at first admission in prison and syringe sharing with other inmates. The subpopulations of Arab and Romani (gypsy) inmates were studied differentially. RESULTS: A total of 800 inmates (mean age 34.2 6 6.2 years) were evaluated; 74.3% were Spanish and 33.6% IDU. HCV serology was obtained in 730 inmates and HIV serology in 773 with the following seroprevalence results: HCV 38.2%, HIV 19.1% and HCV-HIV co-infection 18.8%. The variables associated with HCV or HIV infection in the univariate analysis were Spanish nationality, previous IDU and coinfection by the other virus. In the multivariate analysis, only coinfection and, particularly, previous IDU (HCV infection: adjusted ORp 104.8 [95% CI: 49.4-222.2]) (HIV infection adjusted ORp 45.1 [95% CI: 14.0-144.9]) maintained an association with the two infections. CONCLUSIONS: The prevalence of HIV and HCV infection and coinfection is high in Spanish prisons. Infection by either of these viruses and previous IDU were independently associated with both infections. The percentage of non-Spanish inmates with these infections is low. PMID: 15743573 [PubMed - indexed for MEDLINE] 267. Enferm Infecc Microbiol Clin. 2005 Feb;23(2):51-2. [Hepatitis C and HIV in Spanish prisons]. [Article in Spanish] Soriano V, Gonzlez-Lahoz J. Comment on Enferm Infecc Microbiol Clin. 2005 Feb;23(2):53-7. PMID: 15743572 [PubMed - indexed for MEDLINE] 268. Health Soc Care Community. 2005 Jan;13(1):75-83. Exploring risk perception and behaviour of homeless injecting drug users diagnosed with hepatitis C. Wright NM, Tompkins CN, Jones L.

Centre for Research in Primary Care, Hallas Wing, 71-75 Clarendon Road, Leeds, LS2 9PL, UK. n.wright@leeds.ac.uk Injecting drug users (IDUs) are at the greatest risk of hepatitis C infection by using any item of injecting equipment that has come into contact with contaminated blood. Alongside this, homeless IDUs have been identified as being at increased risk of harm in their illicit drug taking behaviour. This study interviewed 17 hepatitis C positive homeless IDUs about their injecting practices. In-depth interviews explored the impact of a positive hepatitis C diagnosis on their injecting and identified their risk behaviours and perceptions. The interviews were tape-recorded, transcribed and analysed using the framework approach. Homeless IDUs engaged in both high risk and unhygienic injecting practices, such as using drugs outside and in public places, sharing injecting equipment and re-using cleaned needles. Excessive needle reuse whilst in prison was also identified. However, the findings were not universally bleak as a positive diagnosis of hepatitis C did lead to some behaviour change towards safer injecting and some adopted other lifestyle and behaviour changes. It was, however, common for homeless people to devolve responsibility for preventing hepatitis C transmission to their peers, especially when injecting with others. Knowledge regarding possible transmission through injecting paraphernalia appeared to make users more careful to reduce it through these routes. Placing a continuous emphasis on health promotion is therefore important in educating IDUs about the hepatitis C transmission risks associated with injecting drug use. Information regarding safer and hygienic use, including accurate information regarding the most effective methods to clean used equipment, must be re-enforced by people working with homeless injecting drug users. PMID: 15717909 [PubMed - indexed for MEDLINE] 269. AIDS Read. 2005 Feb;15(2):54-5. The role of prisons in dissemination of HIV and hepatitis. Laurence J. PMID: 15712392 [PubMed - indexed for MEDLINE] 270. Clin Microbiol Infect. 2005 Feb;11(2):86-94. Hepatitis C virus infection. Thomson BJ, Finch RG.

Department of Infectious Diseases, University of Nottingham, Nottingham, UK. brian.thomson@nottingham.ac.uk Hepatitis C virus (HCV) infection is a major public health problem. Up to 3% of the world's population is infected with HCV, and at least 200 000 adults in the UK carry the virus. Of those exposed to HCV, 80% become chronically infected, and at least 30% of carriers develop chronic liver disease, including cirrhosis and hepatocellular carcinoma. This review provides an overview of selected features of the molecular biology and pathogenesis of HCV infection, and thereafter discusses in detail the epidemiology of HCV, the hepatic and extra-hepatic diseases caused by the virus, and the current treatment options for both acute and chronic virus infection. The special cases of healthcare workers, prison inmates and individuals coinfected with human immunodeficiency virus and HCV are considered in detail. PMID: 15679481 [PubMed - indexed for MEDLINE] 271. Eur J Epidemiol. 2004;19(12):1119-22. Prisoners are at risk for hepatitis C transmission. Butler T, Kariminia A, Levy M, Kaldor J. Centre for Health Research in Criminal Justice, Sydney 2036, Australia. tony.butler@justicehealth.nsw.gov.au OBJECTIVE: Determine the incidence of hepatitis C virus antibodies among a cohort of prisoners. DESIGN: Follow-up study of a random sample of prisoners who participated in a cross-sectional survey in 1996. SETTING: 29 correctional centres in New South Wales (Australia). PARTICIPANTS: 181 adult prisoners (163 men and 18 women). RESULTS: The incidence of hepatitis C virus antibody among the 90 inmates who were seronegative at the first test in 1996 was 7.1 per 100 person-years (16 seroconverters). Among the 90 inmates, 37 had re-entered the prison system following release into the community and 53 had been continuously detained. The seroconversion rate was higher among the re-entrants compared with those who had been continuously incarcerated (10.8 vs. 4.5 per 100 person-years, p=0.07). However, when the data was stratified by injecting status, the serocon-version rate in the two groups was similar. Most of the seroconverters had histories of injecting drug users (14/16). The overall incidence among injectors was 19.3 per 100 person years (95% CI: 9.1-29.2). CONCLUSIONS: Hepatitis C transmission occurs inside the prison with injecting drug use the likely cause. Among non-injectors, tattooing was the most likely mode of transmission. Harm minimisation measures with proven effectiveness need

to be considered for this environment. PMID: 15678792 [PubMed - indexed for MEDLINE] 272. Hepatology. 2005 Jan;41(1):88-96. Elevated prevalence of hepatitis C infection in users of United States veterans medical centers. Dominitz JA, Boyko EJ, Koepsell TD, Heagerty PJ, Maynard C, Sporleder JL, Stenhouse A, Kling MA, Hrushesky W, Zeilman C, Sontag S, Shah N, Ona F, Anand B, Subik M, Imperiale TF, Nakhle S, Ho SB, Bini EJ, Lockhart B, Ahmad J, Sasaki A, van der Linden B, Toro D, Martinez-Souss J, Huilgol V, Eisen S, Young KA. Epidemiologic Research and Information Center VA Puget Sound Health Care System, Seattle, WA 98108-1597, USA. jason.dominitz@med.va.gov Several studies suggest veterans have a higher prevalence of hepatitis C virus infection than nonveterans, possibly because of military exposures. The purpose of this study was to estimate the prevalence of anti-hepatitis C antibody and evaluate factors associated with infection among users of Department of Veterans Affairs medical centers. Using a two-staged cluster sample, 1288 of 3863 randomly selected veterans completed a survey and underwent home-based phlebotomy for serological testing. Administrative and clinical data were used to correct the prevalence estimate for nonparticipation. The prevalence of antihepatitis C antibody among serology participants was 4.0% (95% CI, 2.6%-5.5%). The estimated prevalence in the population of Veterans Affairs medical center users was 5.4% (95% CI, 3.3%-7.5%) after correction for sociodemographic and clinical differences between participants and nonparticipants. Significant predictors of seropositivity included demographic factors, period of military service (e.g., Vietnam era), prior diagnoses, health care use, and lifestyle factors. At least one traditional risk factor (transfusion or intravenous drug use) was reported by 30.2% of all subjects. Among those testing positive for hepatitis C antibody, 78% either had a transfusion or had used injection drugs. Adjusting for injection drug use and nonparticipation, seropositivity was associated with tattoos and incarceration. Military-related exposures were not found to be associated with infection in the adjusted analysis. In conclusion, the prevalence of hepatitis C in these subjects exceeds the estimate from the general US population by more than 2-fold, likely reflecting more exposure to traditional risk factors among these veterans. PMID: 15619249 [PubMed - indexed for MEDLINE] 273. AIDS Treat News. 2004 Oct 29;(406):7.

Prison health care: activist campaign targets hepatitis, HIV care for prisoners, and continuity of care after release. McTighe L. A new activist group wants to force medical practices in prisons to meet national standards for treatment and care, especially for hepatitis C and HIV. PMID: 15614965 [PubMed - indexed for MEDLINE] 274. J Public Health (Oxf). 2004 Dec;26(4):372-5. Screening for hepatitis C virus in the Dartmoor prison population: an observational study. Horne JA, Clements AJ, Drennan P, Stein K, Cramp ME. South West Dorset PCT, Hillfort House, Poundbury Road, Dorchester DT1 2PN. jane.horne@nhs.net BACKGROUND: Prisons are a potential setting for hepatitis C screening. This study describes prisoner flows through such screening for all prisoners entering Dartmoor prison between 1 January 1998 and 30 June 2001. METHODS: We identified numbers at each step of the screening pathway, from screening to result, referral, biopsy and outcome. We describe the proportions of those screened who were seropositive; seropositives who were confirmed virus-positive; virus-positive cases attending for biopsy; and virus-positive cases eligible for treatment. RESULTS: Of 3034 entries into Dartmoor, 12 per cent were screened, with 16 per cent of these seropositive. Seventynine per cent of seropositive prisoners with a polymerase chain reaction result were confirmed virus-positive, and 27 per cent of these prisoners had a biopsy. Two prisoners were eligible for treatment. CONCLUSIONS: Screening uptake is low. Attrition rates are high, especially at the referral interface between the prison and specialist care. Finally, the yield of individuals eligible for treatment is low, at 7/1000 tested. PMID: 15598857 [PubMed - indexed for MEDLINE] 275. Epidemiol Prev. 2004 May-Jun;28(3):163-8. [HIVAb, HCVAb and HBsAg seroprevalence among inmates of the prison of Bologna and the effect of counselling on the compliance of proposed tests].

[Article in Italian] Sabbatani S, Giuliani R, Fulgaro C, Paolillo P, Baldi E, Chiodo F. UO malattie infettive, Policlinico S. Orsola di Bologna. sabbatani@med.unibo.it OBJECTIVES: The aims of the study were to evaluate the HIVAb, HCVAb and HBsAg seroprevalence among Italian and foreign inmates of the prison of Bologna, to evaluate if the extensive counselling of "new" inmates has significantly enhanced adherence to laboratory tests. DESIGN: The serological status was determined by a blood withdraw following the informed consent. Before asking their consent, patients were informed by cultural mediators who had been instructed about the aims of the study/exam during introductory meetings. The initial step managed by mediators was followed by further individual counselling interventions, carried out by hospital infective disease unit, prison and prison drug abuse service physicians. The laboratory tests were performed in an external structure. SETTING: Prison of Bologna. PARTICIPANTS: The study was conducted on 433 subjects among a whole population of 900 inmates in the local prison: 390 subjects were males (90.1%) and 43 were females (9.9%). The median age of the whole population was 34.86 years (+/- 9.9). The studied population counted 147 (33.9%) intravenous drug users (IDU) and 286 not addicts (66.1%). As regards nationality, 212 subjects were Italian (48.9%) and 221 (51.1%) foreigners. Among the total 433 inmates considered, 78 (18%) were known as previous IDU with conviction history or condemned to long term sentences, while 59 (13.6%) were inmates recently convicted active IDU assisted by the internal drug abusers service. The third group was composed by 296 inmates imprisoned during the summer (103 Italians and 193 foreigners) self declared not IDU. RESULTS: A. 12.5% of inmates were HIV positive, 8.1% HBV positive and 31.1% HCV positive. 25 subjects were found positive both to HIV and HCV; 1 both to HIV and HBV and 5 to HIV, HBV and HCV. HIV positivity is more common among Italian vs. foreigners inmates, among IDU vs. not IDU. HCV positivity is more common among Italian vs. foreigners inmates, and among IDU vs. not IDU. The distribution of HBV seropositivity among the different groups shows no statistically significant differences. All subjects receiving multi-focal counselling reached better compliance levels: 10% vs. 1% for HIV, 16% vs. 1% for HBV and 35% vs. 0.3% for HCV, with statistically significant coefficients of contingency. CONCLUSIONS: In the prison of Bologna drug addiction is prevalent in italian seropositive personers and it is often associated with HIV and HCV positivity. Foreign inmates, mostly in the not-IDU group, show a lower prevalence of these two infections. Multi-focal counselling before test increased significantly the adherence of inmates to the study.

PMID: 15532873 [PubMed - indexed for MEDLINE] 276. J Gastroenterol Hepatol. 2004 Oct;19(10):1114-20. Risk behaviors and antibody hepatitis B and C prevalence among injecting drug users in south-western Sydney, Australia. Maher L, Chant K, Jalaludin B, Sargent P. School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia. L.Maher@unsw.edu.au BACKGROUND AND AIM: Hepatitis C virus (HCV) infection is now the leading notifiable disease in Australia. The current study aimed to determine the prevalence of HCV and hepatitis B virus (HBV) infection and associated risk behaviors among injecting drug users (IDUs) screened in south-western Sydney as part of a multisite prospective cohort study. METHODS: Using a combination of snowball sampling and word-of-mouth recruitment strategies, 377 IDUs were interviewed using a structured questionnaire and tested for exposure to HCV and HBV. Entry criteria were injecting drug use in the previous 6 months and antibody HCV serostatus not known to be positive. RESULTS: More than one-third (36.6%) tested HCV antibody positive and one-quarter (28%) had been exposed to HBV. Independent predictors of HCV seropositivity were HBV core antibody positive serostatus, incarceration in the past year, injecting in public, Asian ethnicity and duration of injecting. Individual risk behaviors, including sharing needles and syringes, sharing other injecting equipment and being injected by others, were not significant in either bivariate or multivariate models. CONCLUSIONS: Results indicate an urgent need for structural interventions designed to reduce the exposure of IDUs, particularly indigenous Australian and Asian injectors, to risk environments. Structural interventions, including population-based hepatitis B immunization, expanded access to needle and syringe programs and drug treatment, prison diversion programs and medically supervised injecting facilities, should be incorporated into existing blood-borne virus prevention efforts. PMID: 15377287 [PubMed - indexed for MEDLINE] 277. Can Commun Dis Rep. 2004 Aug 15;30(16):141-8. Hepatitis C virus transmission in the prison/inmate population. [Article in English, French]

Skoretz S, Zaniewski G, Goedhuis NJ. University of Guelph, Canada. PMID: 15352686 [PubMed - indexed for MEDLINE] 278. J Int Assoc Physicians AIDS Care (Chic). 2004 Apr-Jun;3(2):45-8. The carceral limb of the public body: jail inmates, prisoners, and infectious disease. Comfort ML, Grinstead O. Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco 94105, USA. MComfort@psg.ucsf.edu Comment in J Int Assoc Physicians AIDS Care (Chic). 2004 Apr-Jun;3(2):44. PMID: 15346689 [PubMed - indexed for MEDLINE] 279. J Urban Health. 2004 Sep;81(3):448-52. Risk factors for hepatitis C infection and perception of antibody status among male prison inmates in the Hepatitis C Incidence and Transmission in Prisons Study cohort, Australia. Gates JA, Post JJ, Kaldor JM, Pan Y, Haber PS, Lloyd AR, Dolan KA; Hepatitis C Incidence and Transmission in Prison Study Group. National Drug and Alcohol Research Centre, UNSW, Sydney, 2052, Australia. j.gates@unsw.edu.au The objective of this study was to compare the prevalence of risk factors for hepatitis C virus (HCV) infection among male prison inmates enrolling into a prospective cohort in Australia. We tested 121 inmates who were previously untested or were previously known to be anti-HCV antibody negative for anti-HCV antibodies by enzyme-linked immunosorbent assay. HCV-positive inmates were classified as cases (n = 25) and HCV-negative inmates as controls (n = 96). The study found that cases were less educated than controls and confirmed that prior imprisonment, drug injection, and a longer duration of injecting were risk factors for HCV infection. More than half of those who tested HCV positive perceived that they did not have HCV infection, and 44% were unsure of their HCV status. Those inmates who were incorrect about their HCV status tended to be less

educated and were more likely to have been previously imprisoned than those who were correct about their HCV status. Inmates who were unsure of their HCV status were less likely to have been tested for HCV than those who had a clear perception of their HCV status, even if incorrect. Three (12%) inmates who tested positive denied injecting drug use, but reported other risk factors. Prisons are likely to remain an important site for the diagnosis of HCV infection and targeted interventions aimed at risk reduction among inmates with low education levels and a previous imprisonment history. PMCID: PMC3455941 PMID: 15273267 [PubMed - indexed for MEDLINE] 280. Am J Public Health. 2004 Jul;94(7):1218-23. Prevalence and incidence of HIV, hepatitis B virus, and hepatitis C virus infections among males in Rhode Island prisons. Macalino GE, Vlahov D, Sanford-Colby S, Patel S, Sabin K, Salas C, Rich JD. Brown University Medical School, Providence, RI 02912, USA. grace_macalino@brown.edu Erratum in Am J Public Health. 2004 Nov;94(11):1847. 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. PMCID: PMC1448424 PMID: 15226146 [PubMed - indexed for MEDLINE] 281. Drug Alcohol Depend. 2004 Jul 15;75(1):89-95.

Correlates of hepatitis C virus infection in homeless men: a latent variable approach. Stein JA, Nyamathi A. Department of Psychology, 1282 Franz Hall, University of California, Los Angeles, CA 90095-1563, USA. jastein@ucla.edu Homeless individuals are at risk for numerous health problems including Hepatitis C virus (HCV). HCV is primarily caused by sharing of equipment associated with injection drug use (IDU). In the current study, we assessed differences among HCV-negative and HCV-positive homeless men residing in Los Angeles (N = 198; about 50% HCV positive) on a number of risk factors and behaviors. Findings revealed several significant correlates of HCV-positive status. HCV-positivity was significantly and positively associated with a history of substance use (IDU and non-IDU), recent IDU-related behaviors including equipment sharing, other forms of sharing (e.g., toothbrushes, razors), homelessness severity, tattoos, sexually transmitted diseases, a jail/prison history, and greater age. Lifetime alcohol problems were not associated with HCV. Although associations of HCV with current IDU-related behaviors are not surprising, it is alarming that these behaviors were recent. Those who work among homeless populations should be aware not only of the high likelihood of HCV infection in this population but also of the transmission risk due to continued IDU sharing behaviors. Substance abuse treatment should be implemented to hinder the spread of HCV in this vulnerable population. Also, needle exchange and provision of clean ancillary IDU equipment should be encouraged in areas where homeless people are known to congregate. PMID: 15225892 [PubMed - indexed for MEDLINE] 282. Can HIV AIDS Policy Law Rev. 2004 Apr;9(1):51. Australia: hepatitis C "sweeps" prisons. Jrgens R. PMID: 15216834 [PubMed - indexed for MEDLINE] 283. Can HIV AIDS Policy Law Rev. 2004 Apr;9(1):47-8. Canadian Human Rights Commission recommends prison needle exchange programs. Jrgens R. In a report released on 28 January 2004, the Canadian Human Rights Commission

recommended that the Correctional Service of Canada (CSC) implement a pilot needle exchange program in three or more correctional facilities, at least one of them a women's facility, by June 2004. PMID: 15216829 [PubMed - indexed for MEDLINE] 284. Can HIV AIDS Policy Law Rev. 2004 Apr;9(1):40. Dublin Declaration on HIV/AIDS in prisons launched. Jrgens R. On 23 February 2004, the Dublin Declaration on HIV/AIDS in Prisons in Europe and Central Asia was launched. The Declaration focuses on prisons in Europe and Central Asia, but it is also relevant for prisons in other countries, including Canada, which are still far from having adopted a comprehensive approach, based on public health and human rights principles, to HIV/AIDS and hepatitis C in prisons. PMID: 15216826 [PubMed - indexed for MEDLINE] 285. Epidemiol Infect. 2004 Jun;132(3):409-15. The prevalence and the risk behaviours associated with the transmission of hepatitis C virus in Australian correctional facilities. Hellard ME, Hocking JS, Crofts N. Epidemiology and Social Research Program, Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, Victoria, Australia. 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.

PMCID: PMC2870120 PMID: 15188710 [PubMed - indexed for MEDLINE] 286. Clin Gastroenterol Hepatol. 2004 Jun;2(6):469-73. A comparison of the spectrum of chronic hepatitis C virus between Caucasians and African Americans. Sterling RK, Stravitz RT, Luketic VA, Sanyal AJ, Contos MJ, Mills AS, Shiffman ML. Division of Gastroenterology, Virginia Commonwealth University Medical Center, Richmond 23298-0341, USA. rksterli@hsc.vcu.edu Comment in Clin Gastroenterol Hepatol. 2004 Jun;2(6):456-8. BACKGROUND & AIMS: Differences in hepatitis C virus (HCV)-related liver disease between Caucasians and African Americans remain controversial. METHODS: We performed a retrospective analysis of 302 consecutive inmates in the Virginia Department of Corrections evaluated for HCV between October 1998 and July 2002. All subjects were anti-HCV positive, HCV treatment naive, human immunodeficiency virus and HBV negative, and had compensated liver disease. RESULTS: The mean age of the cohort was 41 years; they were 91% male and 51% Caucasian. The mean ALT level was 94 U/L, 49% had a normal ALT level, and 80% were genotype 1. The mean Knodell histologic activity index (HAI) was 7.03, with bridging fibrosis in 18% and cirrhosis in 6%. When analyzed by race, the mean ALT level (106 vs. 79 U/L; P = 0.01), proportion with normal ALT level (46% vs. 57%; P = 0.06), and proportion with genotype 1 (67% vs. 94%; P < 0.001) were different between Caucasians and African Americans, respectively. Although the HAI and proportion with bridging fibrosis/cirrhosis were similar between groups, African Americans had lower piecemeal necrosis (1.41 vs. 1.72; P = 0.034) and fibrosis (1.12 vs. 1.40; P = 0.047) scores compared to Caucasians. Multivariate analysis demonstrated that age, ALT, and race were significant independent variables associated with total HAI, piecemeal necrosis, and fibrosis scores. CONCLUSIONS: Although the overall spectrum of liver disease is similar, African Americans have less piecemeal necrosis and lower fibrosis scores independent of age and ALT compared with Caucasians. PMID: 15181614 [PubMed - indexed for MEDLINE] 287. J Med Virol. 2004 Jul;73(3):387-91.

High rate of spontaneous clearance of acute hepatitis C virus genotype 3 infection. Lehmann M, Meyer MF, Monazahian M, Tillmann HL, Manns MP, Wedemeyer H. Jugendanstalt Hameln, Hameln, Germany. Treating acute hepatitis C with interferon alpha prevents chronicity in nearly all cases when therapy is initiated within 3 months after infection. However, 15-50% of untreated patients may clear the hepatitis C virus (HCV) spontaneously. Therefore, factors are needed to identify patients prior to therapy who have a higher or lower risk for developing a chronic course to avoid unnecessary treatment. The role of the HCV genotype for spontaneous recovery from acute hepatitis C has been discussed controversially. In the year 2002, all 1,176 new incoming prisoners in a Northern German prison for young men (age 16-24) were screened for anti-HCV antibodies and 92 tested positive. Ninety eight percent of these reported i.v.-drug abuse for a median of 32 months prior to imprisonment. HCV-RNA negative individuals (21%) were serotyped and HCV-RNA positive patients were genotyped. The prevalence of HCV genotype 3 was significantly higher among individuals who had cleared HCV spontaneously as compared to chronically infected patients (86% vs. 38%; P = 0.002). Ninety three percent of individuals exposed to HCV genotype 1 but only 63% of individuals exposed to genotype 3 experienced a chronic course of the infection (P = 0.006). Thus, acute infection in young Caucasian men with HCV genotype 3 leads more often to spontaneous clearance than infection with HCV genotype-1. Considering also the high chance of successful treatment of chronic HCV genotype 3 infection with pegylated-interferon in combination with ribavirin, we suggest not to treat acute hepatitis C genotype 3 infection early but rather to wait at least 3 months after the onset of symptoms when chronicity becomes likely. Copyright 2004 Wiley-Liss, Inc. PMID: 15170633 [PubMed - indexed for MEDLINE] 288. Am J Gastroenterol. 2004 May;99(5):866-72. Treatment of chronic hepatitis C virus in the virginia department of corrections: can compliance overcome racial differences to response? Sterling RK, Hofmann CM, Luketic VA, Sanyal AJ, Contos MJ, Mills AS, Shiffman ML. Section of Hepatology, Virginia Commonwealth University Health System/Medical College of Virginia, Richmond, Virginia 23298-0341, USA. OBJECTIVE: Chronic hepatitis C virus (HCV) is common in the correctional setting

and there are few data on the use of interferon (IFN)/ribavirin(RVN) combination therapy in this population. Given the high proportion of African Americans (AA) in correctional facilities, which may be associated with reduced response rates, the correctional setting allows a unique opportunity to compare the response rates of AA to Caucasians (CA). The present study describes our experience of treating HCV in the inmate population of the Virginia Department of Corrections. METHODS: Of the 119 inmates evaluated between 1998 and 2000, a retrospective analysis of 59 consecutive inmates (mean age 41, 83% male, 55% CA, 73% genotype (GT)1, and 41% with advanced fibrosis) who underwent HCV therapy with IFN a-2b (3 MU TIW) and RVN (1,000-1,200 mg/d) under direct observation was performed. Patients were followed by telemedicine and the primary endpoint was sustained virologic response (SVR) defined as an undetectable HCV RNA at least 24 wk after completion of therapy. RESULTS: All but one patient completed at least 12 wk of therapy and no patient required dose reduction. By wk 24, 34 inmates (58%) responded (negative HCV RNA) which was higher in CA compared to AA (70%vs 40%; p= 0.037). Although overall SVR was higher in CA compared to AA (41%vs 28%; p= ns), we observed no difference in SVR when comparing only GT 1 CA to AA (33%vs 29%). CONCLUSIONS: HCV can be effectively treated in the correctional setting with response rates similar to, if not better than the published literature. In this controlled setting of direct observational therapy, we observed similar SVR in CA and AA. PMID: 15128352 [PubMed - indexed for MEDLINE] 289. J Infect Dis. 2004 May 15;189(10):1846-55. Epub 2004 Apr 26. Clearance of hepatitis C viremia associated with cellular immunity in the absence of seroconversion in the hepatitis C incidence and transmission in prisons study cohort. Post JJ, Pan Y, Freeman AJ, Harvey CE, White PA, Palladinetti P, Haber PS, Marinos G, Levy MH, Kaldor JM, Dolan KA, Ffrench RA, Lloyd AR, Rawlinson WD; Hepatitis C Incidence and Transmission in Prisons Study (HITS) Group. Department of Pathology, School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia. j.post@unsw.edu.au Understanding the earliest virological and immunological events in acute hepatitis C virus (HCV) infection may provide insight into the determinants of protective immunity. Four cases of HCV viremia with subsequent viral clearance, but without biochemical hepatitis or anti-HCV seroconversion, are reported from a prospective cohort study of prison inmates. Two of the subjects who developed sustained viremia were assessed for production of interferon (IFN)- gamma, by use of the enzyme-linked immunospot (ELISPOT) method and by assessment of HCV

cytotoxic T lymphocyte (CTL) activity, CD4 lymphocyte proliferative responses, HCV load, and genotype. After 2-6 months of viremia, all 4 subjects cleared serum HCV RNA. Specific cellular responses were detected in both of the subjects who were assessed, and production of IFN- gamma was demonstrated in one subject. All subjects had weak, but consistent, serological reactivity against HCV nonstructural proteins on immunoblot testing, despite repeatedly nonreactive HCV ELISA tests. These cases highlight the potential for cellular immune responses against HCV to facilitate viral clearance, responses that may model those required for effective HCV vaccination. PMID: 15122521 [PubMed - indexed for MEDLINE] 290. Can HIV AIDS Policy Law Rev. 2003 Dec;8(3):48. Randomized controlled trial proves effectiveness of methadone maintenance treatment in prison. Haig T. A study on methadone maintenance treatment (MMT) undertaken by the Correctional Service of Canada in 2001 demonstrated that MMT has a positive impact on release outcome and on institutional behaviour. Now, a new study undertaken in an Australian prison system has demonstrated that MMT also reduces drug use and injection in prisons. The implications of this study are far reaching. They suggest that in all jurisdictions where community-based programs operate, prison-based methadone programs should be introduced or expanded. PMID: 15108656 [PubMed - indexed for MEDLINE] 291. Can HIV AIDS Policy Law Rev. 2003 Dec;8(3):28-9. Prison activist receives AIDS and human rights award. Garmaise D. Laurence Stocking, the recipient of the 2nd Annual Canadian Award for Action on HIV/AIDS and Human Rights, fought for the rights of prisoners to access HIV and hepatitis C (HCV) prevention and treatment programs. PMID: 15108645 [PubMed - indexed for MEDLINE] 292. Braz J Med Biol Res. 2004 May;37(5):771-6. Epub 2004 Apr 22.

The vulnerability of Brazilian female prisoners to HIV infection. Strazza L, Azevedo RS, Carvalho HB, Massad E. Laboratrio de Investigao Mdica, LIM-01, Hospital das Clnicas, Universidade de So Paulo, Sao Paulo, SP, Brazil. strazza@usp.br The purpose of the present study was to determine the vulnerability of women in prison to HIV infection. The study was carried out from August to October 2000 in a So Paulo State Penitentiary, where 299 female prisoners were serving time. We interviewed and obtained a blood sample from 290 females who agreed to enter the study. Sera were tested for the presence of antibodies to HIV, hepatitis C virus (HCV) and syphilis and the odds ratio (OR) was calculated for variables related to HIV positivity on the basis of a questionnaire. The overall prevalence data were: 13.9% for HIV (37 of 267), 22.8% for syphilis (66 of 290), and 16.2% for HCV (47 of 290). Sexual partnership variables were significantly related to HIV infection. These included HIV-positive partners (OR = 7.36, P = 0.0001), casual partners (OR = 8.96, P = 0.009), injectable drug user partners (OR = 4.7, P = 0.0001), and history of sexually transmitted disease (OR = 2.07, P = 0.05). In addition, a relationship was detected between HIV infection and drug use (OR = 2.48, P = 0.04) and injectable drug use (OR = 4.2, P = 0.002). Even women with only one partner presented a significant OR for HIV infection (OR = 2.57, P = 0.009), reflecting their vulnerability due to their trust in their partner, who did not use a condom. Although the use of injectable substances is associated with HIV infection, our results point to sexual behavior as the most important component of HIV transmission in the female prisoner population. PMID: 15107941 [PubMed - indexed for MEDLINE] 293. Gut. 2004 May;53(5):771-2. In search of the correct strategy for preventing the spread of HCV infection. Montella M, Crispo A, Wynn-Bellezza J. Comment on Gut. 2003 Oct;52(10):1500-4. PMCID: PMC1774041 PMID: 15082602 [PubMed - indexed for MEDLINE] 294. Prev Med. 2004 May;38(5):607-12. The infectious disease profile of Texas prison inmates.

Baillargeon J, Black SA, Leach CT, Jenson H, Pulvino J, Bradshaw P, Murray O. Department of Pediatrics, University of Texas Health Sciences Center at San Antonio, San Antonio, TX 78284-7802, USA. baillargeon@uthscsa.edu PURPOSE: Prison inmates present with higher rates of disease morbidity and mortality than the general population. The rates of certain infectious diseases such as hepatitis C, HIV/AIDS, and tuberculosis are reported to be particularly elevated in prison systems. Scarce information, however, exists on the overall infectious disease profile of inmate populations. The present study examined the prevalence of major infectious diseases in one of the nation's largest prison populations. METHODS: The study population consisted of 336,668 Texas Department of Criminal Justice (TDCJ) inmates who were incarcerated for any duration between January 1, 1999 and December 31, 2001. Information on medical conditions, sentencing factors, and sociodemographic factors was obtained from an institution-wide medical information system. RESULTS: Latent tuberculosis infection constituted the most prevalent infectious disease reported among inmates. This was followed in frequency by hepatitis C, HIV/AIDS, and syphilis. Prevalence estimates for most of the infectious diseases under study exhibited substantial differences across gender, age, and ethnicity. CONCLUSION: The present study shows that the prison population had prevalence rates that were substantially higher for latent TB, HIV/AIDS, and hepatitis C than those reported for the general population and some incarcerated populations. The rate of active TB among TDCJ inmates, however, was comparable to that of the general population and other incarcerated populations. PMID: 15066363 [PubMed - indexed for MEDLINE] 295. J Urban Health. 2004 Mar;81(1):25-37. Prevalence of HIV, syphilis, hepatitis B, and hepatitis C among entrants to Maryland correctional facilities. Solomon L, Flynn C, Muck K, Vertefeuille J. Maryland Department of Health and Mental Hygiene, AIDS Administration, 500 North Calvert Street, Baltimore, MD 21202, USA. solomonl@dhmh.state.md.us 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 inmates 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. PMCID: PMC3456140 PMID: 15047781 [PubMed - indexed for MEDLINE] 296. Can HIV AIDS Policy Law Rev. 2002 Mar;6(3):17-9. Ireland: HIV and hepatitis C in prisons. Lines R. Two studies from the Department of Community Health and General Practice at Trinity College, Dublin, have highlighted the extent of the HIV and hepatitis C (HCV) crisis in Irish prisons. The studies confirm that rates of HIV and HCV are disproportionately high in Irish prisons, and that high risk behaviours are commonplace. PMID: 14979231 [PubMed - indexed for MEDLINE] 297. Can HIV AIDS Policy Law Rev. 2002 Mar;6(3):13-5, 19. Inmate sues the Correctional Service of Canada. Kloeze D. This article summarizes a lawsuit commenced recently in the Ontario Superior Court of Justice by an HIV-positive inmate in the federal penitentiary system against the Correctional Service of Canada (CSC). This action is an important part of the ongoing struggle to hold government and public officials accountable

for failing to address the HIV/AIDS crisis in prisons. The suit contends that CSC must be held liable for the seroconversion of an inmate while in CSC's care and custody, and that it must also be held liable for the alleged negligent provision of medical care to HIV-positive inmates. PMID: 14979228 [PubMed - indexed for MEDLINE] 298. Am J Epidemiol. 2004 Mar 1;159(5):514-9. Incidence of hepatitis C virus infection and associated risk factors among Scottish prison inmates: a cohort study. Champion JK, Taylor A, Hutchinson S, Cameron S, McMenamin J, Mitchell A, Goldberg D. Greater Glasgow Health Board, UK. ellen.carragher@scieh.csa.scot.nhs.uk To gauge the incidence of hepatitis C virus (HCV) infection and associated risk factors among inmates during their imprisonment, the authors recruited adult males in a long-stay Scottish prison into a cohort study between April 1999 and October 2000. On two occasions (at 0 and 6 months), saliva was collected for anonymous HCV antibody testing and risk behavior data were obtained through a self-administered questionnaire. The participation rate was 85% at both initial recruitment (612/719) and follow-up (375/441; 171 men were ineligible for follow-up). For inmates who reported never having injected drugs, ever having injected drugs, having injected drugs during follow-up, and having shared needles/syringes during follow-up, HCV incidences per 100 person-years of incarceration risk were 1, 12, 19, and 27, respectively. Ever having injected drugs (relative risk = 13.0, 95% confidence interval: 1.5, 114.3) and having shared needles/syringes during follow-up (relative risk = 9.0, 95% confidence interval: 1.1, 71.7) were significantly associated with HCV seroconversion. The effectiveness of existing interventions, including the provision of bleach tablets for sterilizing injection equipment, was suboptimal. The development of methadone maintenance programs in prisons and the creation of drug courts to keep offending drug injectors out of prison might help to reduce transmission in this setting. PMID: 14977648 [PubMed - indexed for MEDLINE] 299. Can HIV AIDS Policy Law Rev. 2002 Jul;7(1):18. Canada: innovative educational tools on hepatitis C and prisons: the SHARP approach.

[No authors listed] PMID: 14765481 [PubMed - indexed for MEDLINE] 300. Scand J Gastroenterol Suppl. 2003;(239):105-10. Hepatitis C 2002 guidelines: summary and annotations. Orlent H, Vrolijk JM, Veldt BJ, Schalm SW. Dept. of Hepatology and Gastroenterology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. BACKGROUND: The current NIH and French consensus provide physicians with clear guidelines on how to care best for patients with hepatitis C. METHODS: Review and discussion. RESULTS: Confirming the diagnosis and guiding the initial investigations have become straightforward. The standard treatment and its monitoring have been described in many publications. Recommending therapy to patients with moderate fibrosis has been the custom since the 1999 EASL guidelines. The 2002 guidelines have widened the spectrum of patients with chronic hepatitis C that should be considered for antiviral therapy. Patient categories not previously considered for therapy, such as alcoholics, intravenous drug users, prison inmates and social subgroups of society that lack adequate medical care, can now be offered therapy provided they are well supported in specific programmes. Liver physicians have learned throughout the years to manage side effects successfully and encourage patient adherence. This is reflected in the higher sustained viral response rates with standard interferon and ribavirin reported in the pegylated interferon registration trials compared with the interferon-ribavirin trials. Reducing the dose rather than stopping therapy is the key issue. Antidepressive agents have their place in the management of mood disorders prior to or during therapy. CONCLUSION: Every patient with chronic hepatitis C should be considered for antiviral therapy. It is probably best for a patient to be treated by a physician who has experience in managing possible side effects and in coaching a patient through his 6 or 12 months of treatment. PMID: 14743892 [PubMed - indexed for MEDLINE] 301. Ann Intern Med. 2004 Jan 20;140(2):150-1; author reply 151. Treatment of chronic hepatitis C in a state correctional facility. Bernstein D.

Comment on Ann Intern Med. 2003 Feb 4;138(3):187-90. PMID: 14734350 [PubMed - indexed for MEDLINE] 302. Can HIV AIDS Policy Law Rev. 2002 Dec;7(2-3):13-20. HIV/AIDS in prisons: recent developments. [Article in English, French] Jrgens R. Canadian HIV/AIDS Legal Network. ralfj@aidslaw.ca In a report released on 20 November 2002, entitled Action on HIV/AIDS in Prisons: Too Little, Too Late--A Report Card, the Canadian HIV/AIDS Legal Network concluded that despite repeated studies and nearly ten years of recommendations for urgent and pragmatic action, the response of Canadian governments to HIV/AIDS, HCV, and injection drug use in prisons remains inadequate. Only a few weeks later, the House of Commons Special Committee on Non-Medical Use of Drugs released its report, which contained a number of recommendations to the Correctional Service of Canada. Although the Committee avoided talking about needle exchange programs in prisons, it did recommend them! Meanwhile, in Ireland, not even condoms or bleach are provided. PMID: 14719487 [PubMed - indexed for MEDLINE] 303. Aust Fam Physician. 2003 Oct;32(10):799-803. Preventing transmission of hepatitis C. MacDonald M, Wodak A. National Centre in HIV Epidemiology and Clinical Research, University of New South Wales. PMID: 14596074 [PubMed - indexed for MEDLINE] 304. Aust Fam Physician. 2003 Oct;32(10):796-8. Epidemiology of hepatitis C virus infection in Australia.

Dore GJ, MacDonald M, Law MG, Kaldor JM. Viral Hepatitis Program, National Centre in HIV Epidemiology and Clinical Research, University of New South Wales. PMID: 14596073 [PubMed - indexed for MEDLINE] 305. J Assoc Nurses AIDS Care. 2003 Sep-Oct;14(5 Suppl):108S-115S. Hepatitis C and HIV in incarcerated populations: fights, bites, searches, and syringes! Zalumas JC, Rose CD. Department of Family and Preventive Medicine, School of Medicine at Emory University, Atlanta, Georgia, USA. Implications of hepatitis C (HCV) infection in corrections settings and learning needs of nurses whose primary expertise is care of HIV-infected individuals will be presented. This target group of nurses who provide care for HCV-infected patients includes nurses working in corrections settings, and community settings, whose clients have been or will be incarcerated, and advanced practice nurses working in a variety of settings. For nurses who work in the community setting, background information is presented on characteristics of the incarcerated and the environments of some different settings where incarceration occurs, such as county, state, juvenile, and federal institutions. Barriers to HCV prevention, testing, and treatment for incarcerated people are unique and different than for those living in the community. These distinctions are an important area of knowledge for nurses caring for patients who are HCV positive or at risk, whether they are practicing in a community or correctional setting. PMID: 14571565 [PubMed - indexed for MEDLINE] 306. Drug Alcohol Depend. 2003 Oct 24;72(1):59-65. A randomised controlled trial of methadone maintenance treatment versus wait list control in an Australian prison system. Dolan KA, Shearer J, MacDonald M, Mattick RP, Hall W, Wodak AD. National Drug and Alcohol Research Centre, UNSW, Sydney NSW 2052, Australia. k.dolan@unsw.edu.au

OBJECTIVES: The aim was to determine whether methadone maintenance treatment reduced heroin use, syringe sharing and HIV or hepatitis C incidence among prisoners. METHODS: All eligible prisoners seeking drug treatment were randomised to methadone or a waitlist control group from 1997 to 1998 and followed up after 4 months. Heroin use was measured by hair analysis and self report; drugs used and injected and syringe sharing were measured by self report. Hepatitis C and HIV incidence was measured by serology. RESULTS: Of 593 eligible prisoners, 382 (64%) were randomised to MMT (n=191) or control (n=191). 129 treated and 124 control subjects were followed up at 5 months. Heroin use was significantly lower among treated than control subjects at follow up. Treated subjects reported lower levels of drug injection and syringe sharing at follow up. There was no difference in HIV or hepatitis C incidence. CONCLUSIONS: Consideration should be given to the introduction of prison methadone programs particular where community based programs exist. PMID: 14563543 [PubMed - indexed for MEDLINE] 307. Compr Psychiatry. 2003 Sep-Oct;44(5):409-14. Characteristics of inmates receiving prescribed benzodiazepines in a high-security Greek prison. Lekka NP, Paschalis C, Papadourakis A, Beratis S. Department of Psychiatry, University of Patras Medical School, Greece. The aim of the current study was to investigate the characteristics of Greek inmates that were taking regularly benzodiazepines (BZDs) at therapeutic doses, in the high-security prison of Patras, Greece. Three hundred eighty-four prisoners were included in the study. BZD users (BUs, n = 192), compared with non-BZD users (NBUs, n = 192), were significantly more often unemployed before imprisonment; were significantly more often single, divorced, or widowed; were significantly more often on remand; were taking in significantly greater proportions antidepressant and antipsychotic medications; had significantly more often a history of psychiatric hospitalization; and had significantly more often a history of illicit intravenous (IV) drug use. BUs were significantly more often positive on serum antibodies to hepatitis C (anti-HCV), and scored significantly higher on Hamilton's Rating Scale for Anxiety (HAM-A) and Zung's Self-Rating Depression Scale (SDS). Multivariable logistic regression analysis showed that the history of psychiatric hospitalization, history of illicit drug use, history of unemployment, symptoms of anxiety, and anti-HCV positivity were independently associated with BZD use in this prison. Medical and psychiatric interventions focusing on anxiety problems, depression, drug addiction, and HCV in this group of BUs are warranted.

PMID: 14505302 [PubMed - indexed for MEDLINE] 308. Gut. 2003 Oct;52(10):1500-4. Evaluation of a prison outreach clinic for the diagnosis and prevention of hepatitis C: implications for the national strategy. Skipper C, Guy JM, Parkes J, Roderick P, Rosenberg WM. HMP Parkhurst, Isle of Wight, UK. Comment in Gut. 2004 May;53(5):771-2. BACKGROUND: Hepatitis C virus (HCV) infection is a major public health problem recognised by the UK National Strategy that proposes that a care pathway for assessment, diagnosis, and treatment be established in all prisons, integrated within managed clinical networks. A prison sentence provides the opportunity to focus on traditionally hard to reach patients. AIMS: To evaluate the prevalence of HCV infection in a UK prison cluster and to assess the effectiveness of a prison outreach service for hepatitis C. SUBJECTS: Male prisoners. METHODS: A nurse specialist led clinic within a cluster of adult prisons was established, offering health education on hepatitis C, advice on harm minimisation, and HCV testing. Infected prisoners were offered access to a care pathway leading to treatment. Outcome measures were uptake of the service, and diagnosis and treatment of hepatitis C. RESULTS: A total of 8.5% of 1618 prisoners accepted testing: 30% had active infection with HCV. Most were ineligible for treatment due to psychiatric illness or did not receive treatment for logistic reasons. Injecting drug use was the major risk factor in all cases. Only 7% of HCV polymerase chain amplification positive inmates received treatment in prison. CONCLUSION: There is a large pool of HCV infected prisoners at risk of complications, constituting a source of infection during their sentence and after discharge. A prison outreach clinic and care pathway was perceived as effective in delivering health education, reducing the burden on prison and hospital services. It provided an opportunity for intervention but had a limited effect in eradicating HCV in prisoners and it remains unclear how this might be achieved. PMCID: PMC1773842 PMID: 12970145 [PubMed - indexed for MEDLINE] 309. Int J STD AIDS. 2003 Aug;14(8):511-3.

Sexually transmitted infections in a young offenders institution in the UK. David N, Tang A. Department of Genitourinary Medicine, Royal Berkshire Hospital, London Road, Reading RG1 5AN, UK. Comment in Int J STD AIDS. 2003 Aug;14(8):513. According to the recently published National Strategy for Sexual Health and HIV, prisoners need targeted sexual health information. However, there is a paucity of published data on incidence of sexually transmitted infections (STIs) among prisoners in the UK. The aim of this study was to assess the sexual behaviour and spectrum of STI in a young offenders institution (YOI) in the UK. Case notes of all patients seen in a male YOI in Reading over a one-year period were reviewed. All were either self-referrals or referred by the prison staff. Age- and sex-matched patients attending the genitourinary medicine (GUM) clinic at the Royal Berkshire Hospital Reading during the same period served as a control group. A total of 177 patients aged 17-20 were seen in the YOI during the study period. Ninety (51.72%) had STI vs 95 (54.91%) in the control group (P = 0.5942). Three YOI patients and four GUM attendees declined STI screening. Twenty-nine (16.38%) patients in the YOI had >or=2 sexual partners in the preceding three months vs 41 (23.16%) in the control group (P = 0.0811). Fourteen (7.90%) YOI patients had a previous history of STI vs 25 (14.12%) in the GUM clinic population (P = 0.0618). Thirty-five (20.11%) YOI patients gave a history of having injected drugs vs none amongst GUM clinic attendees. Of the 35 patients with a history of intravenous drug use four were hepatitis C-antibody positive. This study showed high rates of STI in a YOI. Past history of high risk behaviour was common and a significant number had been intravenous drug users. This study strongly supports the need for immediate care, targeted sexual health information and STI prevention in YOI in the UK. PMID: 12935377 [PubMed - indexed for MEDLINE] 310. Addiction. 2003 Sep;98(9):1257-65. Prior opiate injection and incarceration history predict injection drug use among inmates. Calzavara LM, Burchell AN, Schlossberg J, Myers T, Escobar M, Wallace E, Major C, Strike C, Millson M. HIV Social, Behavioural and Epidemiological Studies Unit, and Department of

Public Health Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. livinia.calzavara@utoronto.ca AIMS: To describe injection drug use among inmates, and to identify correlates of drug injection while incarcerated. DESIGN: Cross-sectional survey. SETTING: Six provincial correctional centres in Ontario, Canada. PARTICIPANTS: Face-to-face interviews were conducted with a random sample of 439 adult males and 158 females. MEASUREMENTS: Inmates were asked about drug use in their lifetime, outside the year prior to their current incarceration, and while incarcerated in the past year. Among the 32% (189 / 597) with a prior history of drug injection, independent correlates of injection while incarcerated in the past year were identified using multiple logistic regression. FINDINGS: Among all inmates while incarcerated in the past year, 45% (269 /597) used drugs and 19% (113 / 596) used non-cannabis drugs. Among those with a prior history of injecting, 11% (20 / 189) injected while incarcerated in the past year. Rates of injection with used needles were the same pre-incarceration as they were while incarcerated (32%). Independent correlates of drug injection while incarcerated were injection of heroin (OR = 6.4) or other opiates (OR = 7.9) and not injected with used needles (OR = 0.20) outside in the year prior to incarceration, and ever being incarcerated in a federal prison (OR = 5.3). CONCLUSIONS: The possibility of transmission of human immunodeficiency virus (HIV), hepatitis C (HCV) or other blood-borne diseases exists in Ontario correctional centres. In this setting, drug injection while incarcerated is primarily related to opiate use prior to incarceration. The correlation between injecting and extensive incarceration history suggests missed opportunities to improve inmates' health. PMID: 12930213 [PubMed - indexed for MEDLINE] 311. Can HIV AIDS Policy Law Rev. 2003 Apr;8(1):52. Canada: community stakeholders withdraw from consultation processes with CSC. Lines R. In November, a group of twelve community-based HIV/AIDS organizations and service providers announced their decision to withdraw from participation in consultation processes and committees of the Correctional Service of Canada (CSC). PMID: 12924316 [PubMed - indexed for MEDLINE] 312. Can HIV AIDS Policy Law Rev. 2003 Apr;8(1):51.

Canada: new report on HIV, HCV, and women prisoners. Lines R. In March, 2003, the Prisoners' HIV/AIDS Support Action Network (PASAN) released Unlocking Our Futures: A National Study on Women, Prisons, HIV and Hepatitis C, a qualitative, evaluative study investigating the perceptions and lived experiences of federally incarcerated women regarding HIV/AIDS and hepatitis C (HCV). PMID: 12924315 [PubMed - indexed for MEDLINE] 313. Can HIV AIDS Policy Law Rev. 2003 Apr;8(1):5-6. Transparency, participation, and accountability. [No authors listed] PMID: 12924288 [PubMed - indexed for MEDLINE] 314. Probl Tuberk Bolezn Legk. 2003;(5):6-9. [A category of patients with tuberculosis concomitant with HIV infection in an anti-TB facility]. [Article in Russian] Batyrov FA, Frolova OP, Zhukova GN, Sementsova IG, Mukhanova OI. A category of patients with tuberculosis concomitant with HIV infection, who were admitted for inpatient care to the infection department of Tuberculosis Clinical Hospital No. 7, Moscow, during 1996-2001, was analyzed. Peculiarities of the mentioned patients' category (205 subjects) were studied at the anti-TB facility. It was established that males (83.4%), aged 21-30 (48.9%), as well as unemployed (71%) prevailed. As much as 14% of them were homeless and 33% had a prison history. Drug-addiction (76%) and hepatitis C and B (77%) were found to be the key concomitant pathologies in them. HIV was primarily diagnosed at the anti-TB facility in 52% of patients, while tuberculosis had set on before HIV in 34.8% of patients. A major part of patients with tuberculosis concomitant with HIV, who were at the anti-TB facility, had early HIV stages. Specific features of the clinical course of tuberculosis were defined for patients with early HIV stages. It was established that tuberculosis concomitant with early HIV stages is deprived of any peculiarities except for the primary signs' stage, if it has the form of an acute infection. An exacerbation of the tuberculosis process, which

quite often leads to its generalization and fatal outcome, can happen during the mentioned period due to a pronounced immunodeficiency. PMID: 12899005 [PubMed - indexed for MEDLINE] 315. AIDS Treat News. 2000 May 5;(342):5. Prison and HIV or hepatitis: June 17 meeting in Washington. [No authors listed] An important one-day meeting on several issues affecting prisoners with HIV and/or hepatitis is being sponsored by the ACLU. PMID: 12870460 [PubMed - indexed for MEDLINE] 316. Public Health. 2003 Jan;117(1):43-8. Hepatitis C seroprevalence among newly incarcerated inmates in the Texas correctional system. Baillargeon J, Wu H, Kelley MJ, Grady J, Linthicum L, Dunn K. Department of Pediatrics, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX 78284-7802, USA. baillargeon@uthscsa.edu The seroprevalence of hepatitis C (HCV) infection was examined among a sample of incoming inmates in the Texas Department of Criminal Justice (TDCJ) prison system. Rates were compared across demographic factors and three types of prison facilities: substance abuse felony punishment units (SAFPs), state jails and prisons. The study sample consisted of 3712 incoming inmates incarcerated for any duration, dating from 1 November 1998 to 31 May 1999. Among males, inmates entering SAFPs and state jails had comparable HCV infection rates (29.7 and 27.0%, respectively) to those entering prisons (27.3%). Among females, inmates entering prisons had a higher rate of infection (48.6%) than those entering state jails (35.1%) or SAFPs (38.3%). For both genders, blacks exhibited a lower overall infection rate than whites and Hispanics, and HCV seroprevalence increased in a stepwise fashion with age. All subgroups of TDCJ inmates, including those held in alternative correctional facilities, exhibited HCV infection rates that were comparable with previous reports of inmate populations, but dramatically higher than general community samples. Given that most inmates held in alternative facilities will return to the general community in a short period of time, understanding the HCV infection rates in these subgroups holds particular public health relevance.

PMID: 12802904 [PubMed - indexed for MEDLINE] 317. Med J Aust. 2003 Jun 2;178(11):546-9. Hepatitis C transmission and HIV post-exposure prophylaxis after needle- and syringe-sharing in Australian prisons. O'Sullivan BG, Levy MH, Dolan KA, Post JJ, Barton SG, Dwyer DE, Kaldor JM, Grulich AE. New South Wales Department of Health, Sydney, NSW, Australia. OBJECTIVES: To determine whether infection with human immunodeficiency virus (HIV), hepatitis B virus (HBV) or hepatitis C virus (HCV) occurred after two potential episodes of exposure through needle- and syringe-sharing in Australian prisons, and to examine use of post-exposure prophylaxis (PEP) against HIV infection in the prison setting. DESIGN: Cohort study of potential contacts of two prisoners infected with HIV, HBV and HCV followed up for up to 14 months. SETTING: Two Australian prisons between November 2000 (time of exposure) and December 2001. PARTICIPANTS: Two index patients (both infected with HIV and HCV; one also infectious for HBV) from two different prisons, and 104 inmates who shared needles and syringes. MAIN OUTCOME MEASURES: Seroconversions to HIV, HBV and HCV related to the high-risk exposure and uptake and completion of HIV PEP determined from medical records of inmates. RESULTS: There were four seroconversions to HCV within 14 months of the potential exposure (14% of those susceptible in the cohort), but no recorded HIV or HBV seroconversions. Forty-six inmates (82% of those eligible) were offered PEP, and 34 of these (74%) elected to receive it. Only eight (24% of the 34) completed the full PEP course. CONCLUSIONS: HCV transmission in the prison setting is related to high-risk needle- and syringe-sharing. Administering HIV PEP in the prison setting is complicated by challenging risk assessment and follow-up. PMID: 12765501 [PubMed - indexed for MEDLINE] 318. Health Bull (Edinb). 2001 Mar;59(2):114-9. Prison admission health screening as a measure of health needs. Morrison DS, Gilchrist G.

MRC Social and Public Health Sciences Unit, 4 Lilybank Gardens, Glasgow. OBJECTIVE: To assess the validity of routine prison screening admission data for measuring health needs and planning health services. DESIGN: Retrospective descriptive study of routinely collected admission data. SETTING: The largest Scottish men's prison with an annual throughput of around 20,000 men. SUBJECTS: All adult male (> or = 21 years) prisoners admitted during January 1998. RESULTS: Nine hundred and six men were screened in January 1998. Thirty-eight per cent of men entering prison said they currently or had previously used illegal drugs and 22% of all admissions gave a history of intravenous drug use. Six men (0.7%) reported hepatitis C infection and two (0.2%) reported hepatitis B infection. A history of major mental illness was reported by 10% of all prisoners, 7% of drug users and 15% of problem drinkers. Deliberate self-harm was reported by 10% of all prisoners, 9% of drug users and 17% of problem drinkers. CONCLUSION: There is a high prevalence of reported substance misuse and its sequelae and mental illness in prisoners. However, mental illness, substance use and some infectious diseases (such as HIV, hepatitis B and hepatitis C) may be under-reported, possibly because of social stigma or low expectations of treatment in prison. Health screening on admission to prison presents a unique opportunity to identify health needs at an early stage. However, there is a need to improve detection of some stigmatized conditions if individual care and health service planning are to be improved. PMID: 12664725 [PubMed - indexed for MEDLINE] 319. MMWR Recomm Rep. 2003 Jan 24;52(RR-1):1-36; quiz CE1-4. Prevention and control of infections with hepatitis viruses in correctional settings. Centers for Disease Control and Prevention. Weinbaum C, Lyerla R, Margolis HS; Centers for Disease Control and Prevention. Division of Viral Hepatitis, National Center for Infectious Diseases, USA. Erratum in MMWR Recomm Rep. 2003 Mar 14;52(10):205-14. This report consolidates previous recommendations and adds new ones for preventing and controlling infections with hepatitis viruses in correctional settings. These recommendations provide guidelines for juvenile and adult correctional systems regarding 1) identification and investigation of acute viral hepatitis; 2) preexposure and postexposure immunization for hepatitis A and

hepatitis B; 3) prevention of hepatitis C virus infection and its consequences; 4) health education; and 5) release planning. Implementation of these recommendations can reduce transmission of infections with hepatitis viruses among adults at risk in both correctional facilities and the outside community. These recommendations were developed after consultation with other federal agencies and specialists in the fields of corrections, correctional health care, and public health at a meeting in Atlanta, March 5-7, 2001. This report can serve as a resource for those involved in planning and implementing health-care programs for incarcerated persons. PMID: 12562146 [PubMed - indexed for MEDLINE] 320. Ann Intern Med. 2003 Feb 4;138(3):I-50. Summaries for patients. Treatment for hepatitis C virus infection among inmates. [No authors listed] Comment on Ann Intern Med. 2003 Feb 4;138(3):187-90. PMID: 12558381 [PubMed - indexed for MEDLINE] 321. Ann Intern Med. 2003 Feb 4;138(3):235-6. Adopting more systematic approaches to hepatitis C treatment in correctional facilities. Hammett TM. Comment on Ann Intern Med. 2003 Feb 4;138(3):187-90. PMID: 12558365 [PubMed - indexed for MEDLINE] 322. Ann Intern Med. 2003 Feb 4;138(3):187-90. Treatment of chronic hepatitis C in a state correctional facility. Allen SA, Spaulding AC, Osei AM, Taylor LE, Cabral AM, Rich JD. Rhode Island Department of Corrections, 39 Howard Avenue, Cranston, RI 02920, USA.

Erratum in Ann Intern Med. 2003 Oct 7;139(7):605. Comment in Ann Intern Med. 2003 Feb 4;138(3):235-6. Ann Intern Med. 2003 Feb 4;138(3):I-50. Ann Intern Med. 2004 Jan 20;140(2):150-1; author reply 151. BACKGROUND: Approximately 1 in 4 of the nearly 2 million individuals in state and federal correctional facilities are infected with hepatitis C virus (HCV). Currently, there are few reports of treatment outcomes of this common infection in this setting. OBJECTIVE: To describe HCV therapy in the incarcerated setting. DESIGN: Retrospective, descriptive observational study. SETTING: Rhode Island Department of Corrections, Cranston, Rhode Island. PATIENTS: 93 inmates with chronic HCV infection. INTERVENTION: Interferon-alpha with ribavirin. MEASUREMENTS: HCV RNA levels 6 months after treatment. RESULTS: Response rates are similar to previously published rates achieved in the community; 63% (50 of 79) of patients achieved viral clearance after 6 months of therapy, and 46% (26 of 57) achieved sustained response 6 months after treatment. CONCLUSION: The incarcerated population (which is disproportionately affected by addiction and psychiatric illness) can be effectively treated for HCV infection with interferon and ribavirin. The correctional setting may provide an opportunity to safely treat patients with these two challenging comorbid conditions. PMID: 12558357 [PubMed - indexed for MEDLINE] 323. Addiction. 2003 Feb;98(2):153-8. Prison-based syringe exchange programmes: a review of international research and development. Dolan K, Rutter S, Wodak AD. National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia. k.dolan@unsw.edu.au Journal publications and conference presentations on prison-based syringe exchange (PSE) programmes were identified by a comprehensive search of electronic databases. Experts involved with development and evaluation of current PSE programmes or policy were contacted for reports, documents and unpublished material. Spanish information on PSE was translated for this review. We

identified 14 papers specifically on PSE programmes in Switzerland (six papers), Germany (four) and Spain (four). The first PSE programme started in 1992 in Switzerland. As of December 2000, seven PSEs were operating in Switzerland, seven in Germany and five in Spain. There have been six evaluations of prison syringe exchange programmes and all have been favourable. Reports of drug use decreased or remained stable over time. Reports of syringe sharing declined dramatically. No new cases of HIV, hepatitis B or hepatitis C transmission were reported. The evaluations found no reports of serious unintended negative events, such as initiation of injection or of the use of needles as weapons. Staff attitudes were generally positive but response rates to these surveys varied. Overall, this review indicated that prison syringe exchange programmes are feasible and do provide benefit in the reduction of risk behaviour and the transmission of blood-borne infection without any unintended negative consequences. PMID: 12534419 [PubMed - indexed for MEDLINE] 324. Emerg Med J. 2003 Jan;20(1):48-51. Impact of a newly opened prison on an accident and emergency department. Boyce SH, Stevenson J, Jamieson IS, Campbell S. Accident and Emergency Department, Crosshouse Hospital, Kilmarnock, Scotland. steveboyce_scotland@yahoo.com OBJECTIVE: To determine the impact of a newly opened prison on an accident and emergency (A&E) department. METHOD: A new category B prison opened in April 1999, the first privately run prison in Scotland and the third largest in population. All prisoners referred to the A&E department for treatment were identified prospectively during the first year after the opening of the prison. RESULTS: 99 prisoners and four members of staff attended during the one year period. Ages ranged from 18-64 years with a mean age of 29.8 years. Presentations were as a result of deliberate self harm (22%), injury after violence (18%), sports injury (15%), surgical condition (15%), medical illness (13%), accidental injury (9%), ENT problem (2%), and miscellaneous (6%). Thirty seven prisoners (35.6%) were admitted to the hospital. Further review at outpatient clinics was arranged for 15 prisoners. One prisoner died, the result of suicide by hanging. The remaining prisoners were returned to the prison for further management by the prison medical and nursing team. Twelve prisoners re-attended a total of 37 times, ranging from twice to a maximum of eight visits. Some 42.3% of attendances were during "working hours" (09.00-17.00) and 57.7% attended "out of hours" (17.00-09.00). Twenty four referrals (23.1%) were deemed inappropriate by the prison medical team on retrospective review. Sixteen of these occurred "out of hours". Forty one prisoners (39.4%) were known to have a history of injecting

drug misuse. Including re-attenders, 59 presentations (56.7%) to the A&E department had a history of injecting drug misuse. Of these 41 prisoners, 11 (26.8%) were hepatitis C positive, with eight of these having a positive polymerase chain reaction test. No prisoners had HIV and only one prisoner was hepatitis B positive. CONCLUSION: The opening of the prison resulted in only a slight increase in the workload of the A&E department. A significant proportion of prisoners were admitted to the hospital highlighting the practical and logistical problems of managing people restrained and in custody. Most cases can be safely referred back to the prison. Increased input is required from the prison medical team when dealing with deliberate self harm, frequent attenders, and "out of hours" referrals. All A&E staff must be aware of the increased risk of hepatitis C infection when dealing with a confined prison population. PMCID: PMC1726011 PMID: 12533368 [PubMed - indexed for MEDLINE] 325. Pediatrics. 2003 Jan;111(1):153-7. Prevalence of hepatitis C virus infection and risk factors in an incarcerated juvenile population: a pilot study. Murray KF, Richardson LP, Morishima C, Owens JW, Gretch DR. Hepatobiliary Program, Division of Gastroenterology and Nutrition, Department of Pediatrics, Children's Hospital and Regional Medical Center, Seattle, Washington 98105-0371, USA. kmurra@chmc.org OBJECTIVE: Hepatitis C virus (HCV) infection is the leading cause of liver failure in adulthood. Although the prevalence of HCV is reportedly as high as 80% in incarcerated adult populations, little is known about the prevalence of HCV in incarcerated juvenile populations. The purpose of this study was to determine the prevalence of HCV and high-risk behaviors in a population of incarcerated youths. METHODS: We conducted a cross-sectional prevalence study of HCV infection in youths who were admitted to a juvenile detention center between September 1999 and January 2001. Subjects were asked questions regarding behaviors that might put them at risk for acquiring HCV, and blood was drawn for HCV antibody testing. Qualitative HCV RNA testing was performed on antibody-positive subjects. RESULTS: Seventy-four percent (n = 305) of youths consented to participate in the seroprevalence study. HCV risk behaviors were common in this population: sexual activity (70%), intravenous drug use (6%), intranasal drug use (32%), body piercing (53%), and tattoos (33%). Six study youths (2%) were HCV antibody positive; 4 of these subjects were also HCV RNA positive. HCV-positive status was significantly associated with history of intravenous drug use and having had a sexually transmitted disease. Only 17% of study participants could correctly

identify behaviors that might put them at risk for HCV. CONCLUSIONS: The prevalence of HCV in incarcerated youths is higher than in the general pediatric population but not yet at adult levels of prevalence. Given the high prevalence of risk factors in this population, future studies should address the need for targeted HCV screening and education of incarcerated youths regarding risks for HCV. PMID: 12509569 [PubMed - indexed for MEDLINE] 326. Med Health R I. 2002 Nov;85(11):341-4. Management of hepatitis C in Rhode Island: opportunities for improvement within and beyond the department of corrections. Berzin T, Allen S, Taylor L, Rich J, Feller E. Rhode Island Department of Correcttons, USA. Tyler_Berzin@brown.edu PMID: 12462866 [PubMed - indexed for MEDLINE] 327. CMAJ. 2002 Nov 12;167(10):1154. Methadone maintenance expands inside federal prisons. Sibbald B. PMCID: PMC134303 PMID: 12427715 [PubMed - indexed for MEDLINE] 328. AIDS. 2002 Nov 8;16(16):2236-8. Trends in hepatitis C and HIV infection among inmates entering prisons in California, 1994 versus 1999. Ruiz JD, Molitor F, Plagenhoef JA. PMID: 12409752 [PubMed - indexed for MEDLINE] 329. Hepatology. 2002 Nov;36(5 Suppl 1):S226-36. Understudied populations with hepatitis C.

Strader DB. Veterans Affairs Medical Center and Georgetown University School of Medicine, Washington, DC 20422, USA. doris.strader@med.va.gov Managing patients with hepatitis C virus (HCV) infection consists primarily of antiviral treatment, currently with peginterferon and ribavirin. Unfortunately, treatment recommendations derive largely from trials that have focused on highly selected patient populations. As a consequence of the strict inclusion and exclusion criteria in these studies, more than half of all HCV-infected patients would be ineligible for enrollment. Even among the selected patients enrolled into studies, only 50% achieve a sustained virological response (SVR). Patients not eligible for current therapies include those with mild disease and normal alanine aminotransferase (ALT) levels, patients with advanced and decompensated liver disease, children, the elderly, patients with ongoing or recent alcohol and substance abuse, renal disease, human immunodeficiency virus (HIV) infection, severe psychiatric or neurologic illness, autoimmune disorders, solid organ transplant, and other significant comorbid conditions. Because these patients have been excluded from most clinical trials, little is known about the safety or efficacy of therapy in these populations. The expense and side effects of therapy are also an impediment to treatment of patients who are on public assistance, in prisons, and in institutions. Clearly, new efforts and new approaches are needed to expand the eligibility for antiviral therapy of hepatitis C and make treatment more available for understudied populations with this disease. PMID: 12407598 [PubMed - indexed for MEDLINE] 330. Am J Public Health. 2002 Nov;92(11):1789-94. The burden of infectious disease among inmates of and releasees from US correctional facilities, 1997. Hammett TM, Harmon MP, Rhodes W. Abt Associates Inc, Cambridge, Mass 02138, USA. ted_hammett@abtassoc.com Comment in Am J Public Health. 2003 Jun;93(6):858; author reply 858-9. OBJECTIVES: This study developed national estimates of the burden of selected infectious diseases among correctional inmates and releases during 1997. METHODS: Data from surveys, surveillance, and other reports were synthesized to develop these estimates. RESULTS: During 1997, 20% to 26% of all people living with HIV in the United States, 29% to 43% of all those infected with the hepatitis C virus, and 40% of

all those who had tuberculosis disease in that year passed through a correctional facility. CONCLUSIONS: Correctional facilities are critical settings for the efficient delivery of prevention and treatment interventions for infectious diseases. Such interventions stand to benefit not only inmates, their families, and partners, but also the public health of the communities to which inmates return. PMCID: PMC1447330 PMID: 12406810 [PubMed - indexed for MEDLINE] 331. Ann Med Interne (Paris). 2002 Jun;153(4):219-25. Association between first injection risk behaviors and hepatitis C seropositivity among injecting drug users. Vidal-Trecan GM, Varescon-Pousson I, Gagnire B, Tcherny- Lessenot S, Madariaga E, Boissonnas A. Dpartement de Sant Publique et Service de Sant Publique, AP-HP, CHU Cochin-Port Royal, Universit Ren-Descartes, 24, rue du Faubourg Saint-Jacques, 75014 Paris, France. HCV infection is rapidly acquired after drug addicts first inject drug intravenously. The risk behaviors accompanying the first intravenous substance injection are not well known. We used in 1997 a structured questionnaire to investigate the relationships between risk behaviors at the first injection and current reported HCV status. We interviewed 151 injecting drug users from four treatment centers and one prison in Paris. Risk markers for reported HCV seroconversion were explored by use of logistic regression models. One hundred and forty-three injecting drug users (95%) agreed to participate in the study. At the first injection, 50% shared preparation equipment; 22% borrowed and 26% lent injecting equipment. At the time of the study, 46% reported that they were HCV-positive. Sharing preparation equipment (odds ratio=3.1; 95% confidence interval: 1.2-7.8) and lending injection equipment (odds ratio=3.0; 95% confidence interval: 1.1-8.5) during the first injection were independently associated with reported HCV seropositivity. The high-risk behaviors accompanying the first intravenous injection of drugs justifies the implementation of specific prevention measures, aimed at young drug users who have not started to inject. PMID: 12218887 [PubMed - indexed for MEDLINE] 332. Gastroenterol Clin Biol. 2002 Apr;26 Spec No 2:B133-7. [Hepatitis C in France].

[Article in French] Dhumeaux D. Service d'Hpatologie et de Gastroentrologie, Hpital Henri-Mondor, Crteil. PMID: 12180280 [PubMed - indexed for MEDLINE] 333. Gastroenterol Clin Biol. 2002 Apr;26 Spec No 2:B112-20. [Hepatitis C and drug use: epidemiology, screening, natural history and treatment]. [Article in French] Lucidarme D. Service d'Hpato-Gastro-Entrologie, Hpital Saint-Philibert, 115, rue du Grand-But, 59160 Lomme. PMID: 12180278 [PubMed - indexed for MEDLINE] 334. Acta Gastroenterol Belg. 2002 Apr-Jun;65(2):99-100. Management of hepatitis C virus infections in intravenous drug users. Robaeys G, Mathe C, Buntinx F, Vanranst M. Division of Gastro-enterology and Hepatology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, B-3600 Genk, Belgium. Intravenous drug use is a major route of hepatitis C virus (HCV) transmission. In Belgium, more than 70% of the intravenous drug users (IVDUs) are HCV seropositive. In the past, medical treatment of HCV-positive IVDUs has been controversial. However, current studies support that the anti-HCV therapy of IVDUs should be the same as in other HCV-infected patients. In prison populations, HCV screening and therapy has to be performed. Patients should be counseled about the benefits of alcohol abstinence, should be educated about safer injection techniques to avoid reinfection, and should be vaccinated to avoid hepatitis A or B co-infections. Treatment of HCV infections should not be withheld from patient populations with complicated social problems. Physicians should rather develop individual treatment and follow-up plans in order to optimize compliance in IVDUs.

PMID: 12148448 [PubMed - indexed for MEDLINE] 335. Rev Neurol (Paris). 2002 Apr;158(4):482. [Medico-legal aspects of temporal lobe epilepsy in prison]. [Article in French] Vespignani H, Roger J. PMID: 12035754 [PubMed - indexed for MEDLINE] 336. HIV Clin Trials. 2002 Mar-Apr;3(2):139-47. Differential characteristics of HIV-infected penitentiary patients and HIV-infected community patients. Prez-Molina JA, Fernndez-Gonzlez F, Hernangmez S, Gonzlez C, Miralles P, Lpez-Bernaldo De Quirs JC, Bouza E. Clinical Microbiology and Infectious Diseases Department, Madrid, Spain. jperezmol@efd.net PURPOSE: To identify particular characteristics of HIV+ patients from correctional facilities (CF) compared with an HIV+ population from the community to better detect variables for intervention. METHOD: In our hospital, HIV+ patients are admitted to an infectious diseases ward (IDW) when they come from the community or to a penitentiary unit (PU) when they are transferred from CF. We retrospectively reviewed admissions of those patients in both areas during 1999. RESULTS: Admissions of HIV+ patients to IDW and PU generate 2.3% and 53.4% of hospital and PU stays, respectively. Both populations were equivalent in terms of mean age, CD4 count, viral load, prophylaxis for opportunistic infections, average stay, and death during stay. Male sex (91% vs. 74%), previous or current intravenous drug use (88% vs. 77%), and hepatitis C virus (HCV) seropositivity (97% vs. 82.6%) were more frequent in the PU than in the IDW. Multivariate analysis identified three factors as being independently related to admission from prison: longer time of known HIV infection (average 3.3 years; 95% CI 1.9-4.6), no previous antiretroviral treatment (odds ratio [OR] 2.95; 95% CI 1.46-6.0), and admission due to tuberculosis (OR 2.5; 95% CI 1.03-6.0). CONCLUSION: HIV infection is still a serious medical problem in CF. Although imprisonment can provide access to health programs, HIV-infected prison patients suffer more frequently from tuberculosis and take less antiretroviral treatment.

PMID: 11976992 [PubMed - indexed for MEDLINE] 337. Ann Med Interne (Paris). 2001 Nov;152 Suppl 7:9-14. [Changes in high-dose buprenorphine maintenance therapy at the Fleury-Merogis (France) prison since 1996]. [Article in French] Durand E. Unit de Consultations et de Soins Ambulatoires des Maisons d'Arrt de Fleury-Mrogis, 7, avenue des Peupliers, 91705 Sainte-Genevive-des-Bois, France. edurand_fr@yahoo.fr Since the law of January 1994, the ministry of Health is responsible for inmate health in France. This law created medical wards inside French prisons by conventions between hospitals and prisons. Since July 1995, Fleury-Merogis state-prison is linked to the Sud-Francilien Hospital. During the last few years, more and more IV drug users have been incarcerated and the number of infectious diseases has increased (AIDS, hepatitis C and B). Risk behavior is rather frequent and it has become a major concern of public authorities to fight this evolution. Prisons are part of structures having to take care of IV drug users. A few months after the authorization of buprenorphine in France (March 1996), the ministry of Health decided to give access to this treatment for incarcerated IV drug users. The aim of this study is to present the evolution of maintenance medication by high dose buprenorphine in a big state-prison and to explain the difficulties we have to face. The aim of this study was also to present how this treatment can contribute to reducing infectious risks. Surveying prescription is under the control of the Pharmacy since 1995. We have studied since 1996 the number of prescriptions, segregating initialized inside the prison and prescriptions continued. We have also studied and evaluated the number of psychotropic drugs for each prescription since 1996 in "two test buildings". Evolution of self mutilations and reducing infectious risks support measures have also been studied. PMID: 11965093 [PubMed - indexed for MEDLINE] 338. Ann Med Interne (Paris). 2001 Nov;152 Suppl 7:6-8. [Prevalence of HBV and HCV infections and incidence of HCV infection after 3, 6 and 12 months detention in La Sant prison, Paris].

[Article in French] Arrada A, Zak Dit Zbar O, Vasseur V. Unit de Consultations et de Soins Ambulatoires, Hpital Cochin, Maison d'Arrt de Paris, La Sant, France. arrada-75@hot_mail.com The concentration of a marginal population (35% drug addicts) in prisons necessitates systematic and rigorous screening for hepatitis B and hepatitis C in subjects at risk. In June 1998, a screening program was initiated to determine the prevalence of HBV and HBC infections in prisoners and to determine the incidence after 3, 6 and 12 months detention. The screening program was proposed to 900 prisoners in a Paris prison (Maison d'arrt de Paris-La Sant) from June 3 to November 10, 1998. The program included hepatitis B and hepatitis C serology at incarceration. For prisoners who were seronegative for HCV at incarceration, a new HCV serology was proposed after 3, 6 and 12 months detention. It was postulated that HCV contamination could occur during incarceration (syringe sharing, tattooing). After one year of incarceration, no seroconversions for HCV were observed among the prisoners participating in this study. These findings should be interpreted with caution due to the particular detention conditions at the prison involved, raising important methodology interrogations concerning this type of survey. PMID: 11965092 [PubMed - indexed for MEDLINE] 339. Can HIV AIDS Policy Law Rev. 2001;6(1-2):71-4. Irish prison guards call for expansion of methadone access. [Article in English, French] Lines R. ricklines@yahoo.com In many Western countries, including Canada, seroprevalence rates in prisons have reached epidemic levels, with infection rates among prisoners many times higher than among people outside prisons. PMID: 11837036 [PubMed - indexed for MEDLINE] 340. Can HIV AIDS Policy Law Rev. 2001;6(1-2):65-9. Inquest into the death of a prisoner co-infected with HIV and hepatitis C: how

many more will there be? [Article in English, French] Betteridge JG. HIV & AIDS Legal Clinic, Ontario. betterg@olap.org Michael Joseph LeBlanc probably became infected with HIV and Hepatitis C while incarcerated in a federal penitentiary. On 18 November 1999, he died at the Regional Hospital in Kingston Penitentiary of complications relating to hepatitis C. Mr LeBlanc died inhumanely, in extreme physical, psychological and emotional distress. His death raises the issues of transmission and prevention of HIV and hepatitis C, compassionate release, and health care and palliative care in federal prisons. An Inquest under the Coroners Act was held in Kingston, Ontario from 30 January to 1 February 2001. These same issues had been raised previously at the October 1997 coroners inquest into the death of William Bell, a person living with AIDS who died while incarcerated in another federal penitentiary. PMID: 11837034 [PubMed - indexed for MEDLINE] 341. Can HIV AIDS Policy Law Newsl. 2000 Spring-Summer;5(2-3):68-9. Surveillance and prevention of hepatitis C in Australian prisons. Dolan K. National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia. k.dolan@unsw.edu.au Hepatitis C (HCV) prevalence rates in prisons are even higher than HIV prevalence rates. Studies undertaken in the early and mid 1990s in Canadian prisons revealed rates of between 28 and 40 percent, and rates continue to rise. In one federal prison, 33 percent of study participants tested positive in 1998, compared to 27.9 percent in 1995; and at the Burnaby Correctional Centre for Women in British Columbia, over 78 percent of 69 inmates tested for HCV between 1 January 1996 and 8 August 1996 were seropositive. Similar figures are reported from other countries, including Australia. This raises many challenges for prison systems: how best to provide care and treatment to HCV-positive inmates; and how to prevent the further spread of HCV. Most HCV-positive inmates come to prison already infected, but the potential for further spread is high: HCV is much more easily transmitted than HIV, and transmission has been documented in prisons in several countries, including Canada. In Australia, an action plan for the surveillance and prevention of HCV in prisons has been developed as a result of meetings held in 1998 and 1999. We reproduce here the executive summary of the

plan. PMID: 11833205 [PubMed - indexed for MEDLINE] 342. Epidemiol Infect. 2001 Dec;127(3):475-84. Association between heroin use, needle sharing and tattoos received in prison with hepatitis B and C positivity among street-recruited injecting drug users in New Mexico, USA. Samuel MC, Doherty PM, Bulterys M, Jenison SA. Public Health Division, New Mexico Department of Health, Sanita Fe, USA. This study aimed to assess the seroprevalence and risk factors for hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV-1 infections among injecting drug users (IDU) in New Mexico. Serological and behavioural surveys were conducted in conjunction with street-based outreach, education and HIV counselling and testing. High rates of antibody positivity for HCV (82.2%) and HBV (61.1%), and a low rate for HIV (0.5%) were found. In multivariate analyses, both HBV and HCV infection were positively associated with increasing age, increasing years of injection and heroin use. Receipt of a tattoo in prison/jail was associated with HBV (odds ratio = 2.3, 95% confidence interval 1.4, 3.8) and HCV (OR = 3.4, 95% CI = 1.6, 7.5) infections. Prevention of bloodborne pathogens among IDUs should focus on young users, early in their drug use experience. Studies examining the relationship between tattooing and HBV and HCV infection are needed as are efforts to promote sterile tattooing, in prisons and elsewhere. PMCID: PMC2869773 PMID: 11811881 [PubMed - indexed for MEDLINE] 343. Addiction. 2001 Dec;96(12):1787-97. Predictors of hepatitis B and C infection in injecting drug users both in and out of drug treatment. Cook PA, McVeigh J, Syed Q, Mutton K, Bellis MA. Public Health Sector, School of Health and Human Sciences, Liverpool John Moores University, Liverpool, UK. p.a.cook@livjm.ac.uk AIMS: To assess prevalence of, and behavioural risk factors for, hepatitis B and C in drug users both in and out of contact with drugs services. DESIGN: Cross-sectional survey of hepatitis B and C prevalence using blood

samples and self-completed risk factor questionnaires. PARTICIPANTS: Three hundred and sixty injecting drug users (IDUs) in treatment for their drug use, attending syringe exchange schemes (SES), and not in contact with any services in Wirral and Manchester between 1997 and 1999, for whom test results were available for 334 (hepatitis B) and 341 (hepatitis C). FINDINGS: Hepatitis B prevalence differed between groups, from 19% of those not in contact to 41% of those presenting to request a test (p = 0.040). Prevalence of hepatitis C ranged from 48% (SES) to 62% among those presenting for a test (p = 0.233). After multivariate adjustment, hepatitis B was predicted by prison stays (p = 0.030) and injecting for longer (p = 0.003). For hepatitis C, length of injecting career (p = 0.036), having been to prison (p = 0.034), having injected more than one drug type (p < 0.001) and being female (p = 0.037) predicted infection. Overall, 38% had shared some form of injecting equipment in the previous 4 weeks. People recently starting injecting were more likely to share, and sharing was more likely to occur when injecting with only one other user rather than in larger groups. Those who had previously presented for a hepatitis C test, regardless of the result, were less likely to have recently shared injecting equipment. CONCLUSIONS: Behaviours associated with transmission of hepatitis B and C are common among IDUs. In particular, sharing of injecting equipment was more likely in small groups and in those recently beginning injecting. More broadly, chaotic drug use and time in prison were also risk factors for hepatitis infections. When assessing prevalence of hepatitis B and C, our results suggest that figures cannot be extrapolated from those in service contact to those in the wider drug-using population. PMID: 11784471 [PubMed - indexed for MEDLINE] 344. BMJ. 2001 Nov 24;323(7323):1209-13. Prevalence of antibodies to hepatitis B, hepatitis C, and HIV and risk factors in entrants to Irish prisons: a national cross sectional survey. Long J, Allwright S, Barry J, Reynolds SR, Thornton L, Bradley F, Parry JV. Department of Community Health, Trinity College Center, Adelaide and Meath Hospital, Dublin 24, Republic of Ireland. Comment in BMJ. 2002 Apr 6;324(7341):850. BMJ. 2002 Apr 6;324(7341):850. OBJECTIVES: To determine the prevalence of antibodies to hepatitis B core antigen, hepatitis C virus, and HIV in entrants to Irish prisons and to examine risk factors for infection.

DESIGN: Cross sectional, anonymous survey, with self completed risk factor questionnaire and oral fluid specimen for antibody testing. SETTING: Five of seven committal prisons in the Republic of Ireland. Participants: 607 of the 718 consecutive prison entrants from 6 April to 1 May 1999. MAIN OUTCOME MEASURES: Prevalence of antibodies to hepatitis B core antigen, hepatitis C virus, and HIV in prison entrants, and self reported risk factor status. RESULTS: Prevalence of antibodies to hepatitis B core antigen was 37/596 (6%; 95% confidence interval 4% to 9%), to hepatitis C virus was 130/596 (22%; 19% to 25%), and to HIV was 12/596 (2%; 1% to 4%). A third of the respondents had never previously been in prison; these had the lowest prevalence of antibodies to hepatitis B core antigen (4/197, 2%), to hepatitis C (6/197, 3%), and to HIV (0/197). In total 29% of respondents (173/593) reported ever injecting drugs, but only 7% (14/197) of those entering prison for the first time reported doing so compared with 40% (157/394) of those previously in prison. Use of injected drugs was the most important predictor of antibodies to hepatitis B core antigen and hepatitis C virus. CONCLUSIONS: Use of injected drugs and infection with hepatitis C virus are endemic in Irish prisons. A third of prison entrants were committed to prison for the first time. Only a small number of first time entrants were infected with one or more of the viruses. These findings confirm the need for increased infection control and harm reduction measures in Irish prisons. PMCID: PMC59992 PMID: 11719410 [PubMed - indexed for MEDLINE] 345. AIDS Policy Law. 2001 Sep 14;16(17):9. Inmate claims Canadian policies caused his HIV infection. [No authors listed] PMID: 11682872 [PubMed - indexed for MEDLINE] 346. AIDS Policy Law. 2001 May 11;16(9):3. Action needed to stem HIV, hepatitis C in California prisons. Allen L. PMID: 11668826 [PubMed - indexed for MEDLINE]

347. Eur J Public Health. 2001 Sep;11(3):243-50. Surveillance of HIV infection and related risk behaviour in European prisons. A multicentre pilot study. Rotily M, Weilandt C, Bird SM, Kll K, Van Haastrecht HJ, Iandolo E, Rousseau S. INSERM U 379, 23 Rue Stanislas Torrents, 13006 Marseille, France. rotily@marseille.inserm.fr BACKGROUND: In order to demonstrate the feasibility of human immunodeficiency virus (HIV) infection and related risk behaviour surveillance in European prisons, a multicentre pilot study was undertaken. METHODS: A cross-sectional survey was carried out in six European prisons (France, Germany, Italy, The Netherlands, Scotland and Sweden). Inmates were invited to complete a self-administered and anonymous questionnaire and to give a saliva sample in order to test for HIV antibodies. RESULTS: Eight hundred and forty-seven out of 1,124 inmates participated in the survey (response rate 75%). Saliva from 817 inmates (73%) was collected and processed for HIV antibodies. Twenty-seven per cent reported that they had ever injected drugs and 49% of these reported they had injected whilst in prison. Eighteen per cent of inmates reported that they had been tattooed whilst in prison, which was found to be higher among injecting drug users (IDUs). One and sixteen per cent reported that they had ever had homosexual and heterosexual intercourse in prison respectively. The HIV prevalence among IDUs was 4% (versus 1% among non-IDUs) (p = 0.02). The proportions of inmates previously tested for hepatitis C and vaccinated against hepatitis B were 24 and 16% respectively. CONCLUSION: This survey demonstrates the feasibility of cross-sectional surveys in European prison inmates and highlights the importance of surveillance of HIV prevalence and related risk behaviour among inmates. The continuing high HIV prevalence and potential for HIV spread in prisons should encourage decision makers in implementing or enhancing harm reduction and education programmes and substance abuse treatment services in prison. PMID: 11582600 [PubMed - indexed for MEDLINE] 348. AIDS Policy Law. 2001 Jul 20;16(13):8. Prisons and jails. Court denies inmate with hepatitis C sole occupancy of cell. [No authors listed] PMID: 11548624 [PubMed - indexed for MEDLINE]

349. Braz J Infect Dis. 2001 Jun;5(3):111-8. High prevalence of hepatitis C infection in a Brazilian prison: identification of risk factors for infection. Guimares T, Granato CF, Varella D, Ferraz ML, Castelo A, Kalls EG. Federal University of So Paulo, Medical College, So Paulo, SP, Brazil. tguimaraes@wac.com.br Hepatitis C virus (HCV) causes infectious hepatitis worldwide. It is transmitted mainly by blood products and sharing of intravenous paraphernalia during illicit drug use. High prevalence rates have been described among specific groups considered to be at higher risk for HCV infection, including prison inmates. The objectives of this study were: to determine the HCV seroprevalence among inmates of Casa de Deteno de So Paulo; to identify risk factors for HCV infection; and to compare the seroprevalence of HCV to other blood borne or sexually transmitted diseases. From December, 1993, to January, 1994, a total of 779 inmates were interviewed to collect information on sociodemographic status, sexual behavior, and past experience with illicit drugs. Blood samples were obtained from 756 inmates for serological tests. 310 (41%) blood samples were positive for anti-HCV, 425 (56.2%) were negative, and 21 (2.8%) showed indeterminate results. In this population, we found a seroprevalence of 13.7% for HIV, 3.3% for syphilis (VDRL), and 68.1% for hepatitis B virus previous infection. Four variables were each identified as associated with a positive anti-HCV serologic test: a positive VDRL (OR = 2.63 IC 95% 1.08 to 6.36); a time of current imprisonment longer than 130 months (OR = 2.44 IC 95% 1.04 to 5.71); previous incarceration at Casa de Deteno de So Paulo (OR = 1.73 IC 95% 1.19 to 2.52) and; illicit drug use before admission to the Casa de Deteno de So Paulo (OR = 1.64 IC 95% 1.15 to 2.33). The seroprevalence of HCV antibodies among the study population was high (41%), indeed, one of the highest clusters of HCV infection recorded until now. Four variables were each shown to be associated with HCV infection. The simultaneous presence of these 4 variables is associated with an 82% probability of being anti-HCV positive. Although risk factor analysis indicates most HCV infections occur prior to inprisonment, initiation of control measures to prevent continued transmission after incarceration should be done. PMID: 11506773 [PubMed - indexed for MEDLINE] 350. Rev Clin Esp. 2001 May;201(5):249-55. [Study of cases of HIV infection in Castile-Leon prisons]. [Article in Spanish]

Grupo castellano-leons para el estudio de infeccin VIH en prisiones. OBJECTIVE: To study the HIV infection cases among inmates in Castile-Len prisons and the therapy status and clinical follow-up. MATERIALS Y METHODS: The socio-demographic, clinical and virological parameters were studied of all seropositive inmates of seven out of eight prisons in Castile-Len. A personal survey and a review of the medical records were conducted. RESULTS: A total of 413 HIV infected inmates were detected (12.05% out of 3,426 inmates); 98.6% were males, mostly of them caucasians. Parenteral drug abuse accounted for most infections (94.9%). Co-infection with hepatitis C virus was present in 81.4%, whereas the presence of surface antigen of the hepatitis B virus was detected in 12.6%. The median of CD4 lymphocyte count was 426.5 (interquartile range: 264.25 to 598.50) and of viral load 3.69 logs of particles/ml (interquartile range: 2.18 to 4.45). A total of 171 individuals are on anti-retroviral therapy, most of them with triple therapy; 40.4% of them had a viral load below 400 copies/ml. Over one third of seropositive individuals (37.3%) required therapy and are not on therapy, either because they have not initiated therapy or because of non-compliance. CONCLUSIONS: A highly representative study of the area which reveals a low number of identified seropositive individuals, mainly in association with drug abuse. The therapeutic guidelines are the standards but there is a high percentage of individuals requiring therapy. Co-infection with hepatitis C virus is extremely high, which will undoubtedly pose new therapeutic approaches. PMID: 11458793 [PubMed - indexed for MEDLINE] 351. J Epidemiol Biostat. 2001;6(3):243-65; discussion 279-85. Projecting severe sequelae of injection-related hepatitis C virus epidemic in the UK. Part 1: Critical hepatitis C and injector data. Bird SM, Goldberg DJ, Hutchinson SJ. MRC Biostatistics Unit, Institute of Public Health, Cambridge, UK. BACKGROUND: Hepatitis C is transmitted by transfusion of unscreened blood, through injecting drugs, from mother-to-child and, on occasion, sexually. Transmission generally requires that the infector is hepatitis C virus (HCV) RNA positive, a 'carrier'. About three-quarters of injectors who are hepatitis C antibody positive are HCV-RNA positive and so infectious to others. Incubation periods from HCV infection to cirrhosis and hepatocellular carcinoma are even longer than from HIV infection to AIDS, being counted in decades; they depend on age, gender, alcohol consumption and co-infection with other viruses. We identify 25 data sources that are available, or required, for projecting the severe sequelae of the injection-related hepatitis C epidemic.

DATA SOURCES: Three data sources relate to hepatitis C diagnosis: register of confirmed HCV infections (with initial of first name + soundex of surname + date of birth + gender = master index, exposure category, year of starting to inject, and region); surveys of HCV test-uptake by injectors and others; documentation of pregnancy and its outcome in HCV-infected women (injectors and others). Four data sources relate to HCV prevalence and incidence among injectors and others: anonymous testing for HCV antibodies in blood or saliva (for sentinel groups ranging from new blood donors, pregnant women, patients awaiting kidney transplantation, non-injector prisoners, health-care workers, non-injector heterosexuals attending genitourinary medicine clinics; to injectors in the community, at drug treatment centres or in prison); historical data on HCV prevalence in injectors; HCV incidence studies in injectors; and uptake of harm reduction measures--frequency of sharing and methadone substitution--by injectors. Key reporting problems in HCV incidence studies, which inhibit checks on the convenient exponential assumption for time from start of injecting to hepatitis C infection, are discussed. Nine critical data sources are identified for monitoring the late sequelae of hepatitis C carriage, its investigation and treatment: linkage surveillance, for example by master index, to identify deaths, hospitalisations or cancer registrations among confirmed HCV infections; surveys of HCV status among patients who undergo liver biopsy, are newly diagnosed with cirrhosis or are newly diagnosed with liver cancer; surveys of liver-biopsy rate in HCV-infected injectors and others; uptake and outcome of interferon + ribavirin in the treatment of hepatitis C carriers; cohort studies of HCV progression; sample surveys of genotype in HCV-infected injectors, and others; acute hepatitis B infections and uptake of hepatitis B immunisation by injectors; liver transplantation in HCV-infected patients; and hepatitis C-status and other risk factors in deaths from cirrhosis or liver cancer, to determine whether they are HCV and injector-related. Finally, nine critical data sources are identified for quantitative understanding of the underlying injector epidemic: drug misuse databases plus capture-recapture methods to assess number of injectors, drug-related deaths by region to assess injector numbers; number of HIV-infected injectors; HIV progression in injectors; overdose and other causes of death in injectors; expert opinion on injector incidence historically, plus survey information on age-distribution at initiation and duration of injector careers; injector incidence historically inferred from hepatitis C infected blood donors; age-distribution of current injectors and at initiation, as a check on the assumptions made in stochastic simulation about injector incidence and 'outcidence' from injecting historically; mortality of former injectors; and general population or other survey ratios of surviving ever-injectors to injectors in the last 5 years, last year and currently, as a check on simulations. RECOMMENDATIONS: We recommend a common HCV diagnosis report form to improve ascertainment of risk-factor information, especially year of starting to inject--which is a key date epidemiologically. We also recommend updated surveys of current and former injectors' HCV-test uptake, or a denominator study that

registers master index and risk factor information for all HCV testees. We recommend that injector surveys ask about typical frequency of needle sharing per 4 weeks in three distinct periods this year, last year and in the first year of injecting. We also recommend the location of stored historical samples from injectors to be tested retrospectively and anonymously for HCV antibodies. We recommend immediate attention to the uptake of, and response to, combination treatment by hepatitis C carriers who are former or recovering injectors. We rec PMID: 11437088 [PubMed - indexed for MEDLINE] 352. Eur J Epidemiol. 2000;16(11):1043-9. Prevalence and incidence of bloodborne viral infections among Danish prisoners. Christensen PB, Krarup HB, Niesters HG, Norder H, Georgsen J. Department of Clinical Immunology, Odense University Hospital, Aalborg Hospital, Denmark. peer.christensen@dadlnet.dk 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. PMID: 11421474 [PubMed - indexed for MEDLINE] 353. J Urban Health. 2001 Jun;78(2):264-78.

Using a jail-based survey to monitor HIV and risk behaviors among Seattle area injection drug users. Thiede H, Romero M, Bordelon K, Hagan H, Murrill CS. Public Health, Seattle and King County, Washington 98104, USA. hanne.thiede@metrokc.gov Routine monitoring of human immunodeficiency virus (HIV) and risk behaviors among injection drug users (IDUs) is difficult outside drug treatment settings. We developed and implemented a survey of recently arrested IDUs to describe the prevalence of HIV, drug use, and sexual behaviors among them. A probability sampling survey was instituted in the King County Correctional Facility in Seattle, Washington, to sample recently arrested IDUs at the time of booking and in the jail health clinic between 1998 and 1999. Following HIV risk assessment and blood draw, additional information on drug use practices was gathered using a standardized questionnaire. Potential participants who were released from jail early could complete the study at a nearby research storefront office. Of the 4,344 persons intercepted at booking, 503 (12%) reported injection drug use, and 201 of the IDUs (40%) participated in the study. An additional 161 IDUs were enrolled in the study from the jail health clinic. Among the 348 unduplicated subjects, HIV prevalence was 2%; in the past 6 months, 69% reported two or more shooting partners, 72% used a cooker after someone else, 60% shared a syringe to divide up drugs, and 62% injected with used needles. Only 37% reported being hepatitis C seropositive, and 8% reported hepatitis B vaccination. It was feasible to conduct a jail-based survey of recently arrested IDUs that yielded useful information. The high prevalence of reported risky drug use practices warrants ongoing monitoring and illustrates the need for improving prevention programs for HIV and hepatitis B and C in this population, including expansion of hepatitis C screening and provision of hepatitis B vaccination at the jail health clinic. PMCID: PMC3456353 PMID: 11419580 [PubMed - indexed for MEDLINE] 354. Ann Dermatol Venereol. 2001 Apr;128(4):513-6. [Dermatological consultation behind bars: an analysis on a three-year period in a French prison]. [Article in French] Grange F, Levin B, Pellenq E, Haegy JM, Guillaume JC. Service de Dermatologie, Hpital Pasteur, Colmar.

BACKGROUND: Since 1994, health care in French prisons is managed by the public hospital system. The hospitals created ambulatory consultation units for prisons and detention centers. Skin problems rapidly became a frequent reason for consultation. This is the first systematic assessment of needs concerning dermatological consultation in prisons. MATERIAL AND METHODS: A monthly dermatology consultation was established at the Colmar detention center in May 1996. We reviewed the files of all prisoners who attended between May 1996 and May 1999. Data collected concerned motivation for the consultation, drug use and serology for HIV and hepatitic C virus. RESULTS: There were 280 consultations for 180 prisoners. All were men, mean age 30 years, who represented 16% of the total prisoner population. Most consulted for one or more benign skin conditions. The two most frequent conditions were acne (29%) and mycoses (13%). Drug use was found in 36% of the consulting prisoners (64/180). One was HIV-positive. Hepatitis C virus serology was positive in 19% of those tested (28/149), and in 39% of the drug users and 2% of the non-drug users. Motivation for consultation did not differ between drug users and non users, neither between seropositive and seronegative patients for hepatitis C virus. DISCUSSION: This survey confirms the demand for dermatology consultation in the prison population and points out the frequency of hepatitis C virus in prisoners. A monthly specialized consultation was able to meet the basic demands concerning dermatology. Adapted management of hepatitis C virus in the prison population setting remains a difficult challenge. PMID: 11395649 [PubMed - indexed for MEDLINE] 355. Newsline People AIDS Coalit N Y. 1999 Apr-May:32. Canadians seek justice probe in sale of prison blood. [No authors listed] AIDS: A group of Canadians requested that the U.S. Department of Justice investigate the sale of blood donated from Arkansas prisoners to Canada in the 1980s. The U.S. Food and Drug Administration ruled the blood was unfit for use in the United States in 1983. The group has brought a $1.1 billion suit against Canadian officials, claiming they allowed the purchase of HIV-positive and hepatitis C-infected blood. A similar suit is expected to be brought against U.S. authorities and there are plans to subpoena President Clinton, who was the governor of Arkansas at the time of the sale. PMID: 11367343 [PubMed - indexed for MEDLINE]

356. AIDS Policy Law. 1997 Oct 31;12(20):12. California approves compassionate release, viatical bill. [No authors listed] AIDS: Governor Pete Wilson of California vetoed six of ten HIV-related bills approved by the Democrat-led legislature. A plan to encourage people living with AIDS to return to work and a bill to demonstrate the cost-effectiveness of public health care provision for HIV-positive patients whose disease has not progressed to AIDS were among those rejected by Governor Wilson. The governor did approve Assembly Bill 29, granting early prison release to terminally ill inmates who apply through the courts. Assembly Bill 489, allowing people with terminal illness the opportunity to viaticate their group life insurance policies, was also approved. Under the terms of the bill, a person with AIDS could make an absolute assignment for the value of the insurance policy. Senate Bill 1262 allows insurers to use any testing method approved by the Food and Drug Administration (FDA) to screen applicants for HIV. Assembly Bill 441 regulates the screening of sperm donors for infectious diseases, including hepatitis B, hepatitis C, and syphilis. HIV remains on the prohibited list of diseases. PMID: 11364781 [PubMed - indexed for MEDLINE] 357. Med J Aust. 2001 Apr 16;174(8):378-9. Can hepatitis C transmission be reduced in Australian prisons? Dolan KA. PMID: 11346077 [PubMed - indexed for MEDLINE] 358. Am J Gastroenterol. 2001 Apr;96(4):1304-5. Transmission of hepatitis C through tattooing in a United States prison. Tsang TH, Horowitz E, Vugia DJ. Comment on Am J Gastroenterol. 2000 May;95(5):1312-5. Am J Gastroenterol. 1999 May;94(5):1341-6. PMID: 11316197 [PubMed - indexed for MEDLINE] 359. Commun Dis Public Health. 2000 Dec;3(4):309.

Preventing transmission of bloodborne viruses in prisons. Munslow G. Comment on Commun Dis Public Health. 2000 Jun;3(2):84-5. PMID: 11280271 [PubMed - indexed for MEDLINE] 360. Commun Dis Public Health. 2000 Dec;3(4):253-5. Comparison between self-reported hepatitis B, hepatitis C, and HIV antibody status and oral fluid assay results in Irish prisoners. Thornton L, Barry J, Long J, Allwright S, Bradley F, Parry JV. Department of Public Health, Eastern Regional Health Authority, Dr Steevens' Hospital, Dublin 8. thornton@ehbph.iol.ie Self-reported hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV infection status was compared with the results of oral fluid assays of antibodies to these viruses in prisoners from nine of the 15 prisons in the Republic of Ireland. A total of 1205 out of 1366 prisoners completed a confidential questionnaire and 1193 provided analysable oral fluid specimens for testing for antibodies to HBV core antigen (anti-HBc), HCV (anti-HCV), and HIV (anti-HIV). The self-reported prevalence of hepatitis infection (hepatitis B: 5%; hepatitis C: 19%) was lower than that derived from oral fluid assays (anti-HBc: 9%; anti-HCV: 37%). The self-reported prevalence of HIV infection was similar to that found by oral fluid assay (2%). Many discrepancies were found between self-reported results and the results of oral fluid assays. Of those who reported being positive for HBV, HCV, or HIV, 48%, 5%, and 58%, respectively, tested negative on the oral fluid assay. Of those who reported a previous negative test result for HBV, HCV, or HIV, 10%, 37%, and 2%, respectively, had positive oral fluid assays. Self-reports of hepatitis and HIV infection status are unreliable and should not be used as a basis for planning preventive and treatment services for prisoners. All prisoners should have the opportunity to be tested for HBV, HCV, and HIV infection. PMID: 11280253 [PubMed - indexed for MEDLINE] 361. Med J Aust. 2001 Feb 19;174(4):183-4. Acute hepatitis C virus infection in an Australian prison inmate: tattooing as a possible transmission route.

Post JJ, Dolan KA, Whybin LR, Carter IW, Haber PS, Lloyd AR. Inflammation Research Unit, School of Pathology, University of NSW, Sydney. j.post@unsw.edu.au Clinically apparent hepatitis C virus (HCV) infection developed in a prison inmate after two tattooing episodes within the recognised incubation period for HCV infection. Seroconversion and HCV viraemia with subsequent resolution of hepatitis and loss of plasma viraemia were documented. Introducing licensed tattooists, and thereby improving infection control practices, may reduce the risk of hepatitis C virus infection in prisons. PMID: 11270759 [PubMed - indexed for MEDLINE] 362. Rev Neurol (Paris). 2001 Jan;157(1):87-8. [Legal aspects of temporal lobe epilepsy in prisoners]. [Article in French] Durand E, De Beaurepaire C. Unit de Consultations et de Soins Ambulatoires des maisons d'arrt de Fleury-Mrogis, Centre Hospitalier Sud Francilien, Evry. The last report of the french Direction Gnrale de La Sant noted that epilepsy is twice more common in inmates than in the French population at large for the same range of age. Temporal lobe epilepsy is well known to give rise to aggressive behaviour and to psychotic syndromes. The development in prison of auto- or hetero aggressive behaviours has also been observed. We report on a 24-years-old male who was incarcerated for violence and robbery. He worked as a plumber and had no medical history except hepatitis C and use of IV drugs. Temporal lobe epilepsy was diagnosed because of auditory hallucinations. Consequences of this behaviour are discussed. Although it can be difficult to link the behavioural disorder to the disease, we would like to suggest that his delinquency could have been prevented by appropriate medical care before incarceration. PMID: 11240554 [PubMed - indexed for MEDLINE] 363. Ann Med Interne (Paris). 2000 Oct;151 Suppl B:B5-8. [Risks incurred by the first intravenous drug injection].

[Article in French] Varescon I, Vidal-Trcan G, Gagnire B, Christoforov B, Boissonnas A. Service de Mdecine, Centre Hospitalier Universitaire Cochin-Port Royal, Universit R.-Descartes, Paris. AIMS: The objectives of the study were to describe the circumstances surrounding the initiation of intravenous drug use, the role of the introducer and to evaluate intravenous drug users risk behaviors at the first injection of drug. DESIGN: In 1997, we conducted a cross-sectional survey using a structured questionnaire concerning the initiation process into intravenous drug abuse. IDUs were interviewed in four treatment drug abuse and psychosocial centers in Paris and in one prison. PARTICIPANTS: Of the 152 consecutive IDUs interviewed, 143 completed the questionnaire, 83 were male. FINDINGS: The mean age at first opiate use and at first injection were 19 years (SD: 4.3) and 20 years (SD: 4.3). At first injection, heroin was the main used drug (91%), the subject was with others persons (91%), asked himself for injection (70%) albeit had not planned this injection (40%). The subject injected at a friend's home (31%). The introducer was an IDU (93%), mean age 23.4 (SD: 5.2). He or she was a friend (61%) or a sexual partner (14%). The preparation of the first injection and the injection were made by the introducer in 72 % and 74 % of cases. The injecting equipment had been borrowed (22%) from an IDU whose HIV status and HCV status were unknown in 83 % and 85 % of cases. CONCLUSION: Our study shows novel results about the first injection, they are of prime importance for harm reduction. The introducer plays a major role in preventing risk-behavior at the first injection and for education about safe injecting practices. PMID: 11221691 [PubMed - indexed for MEDLINE] 364. BMJ. 2001 Feb 17;322(7283):398-9. Issues in the management of prisoners infected with HIV-1: the King's College Hospital HIV prison service retrospective cohort study. Edwards S, Tenant-Flowers M, Buggy J, Horne P, Hulme N, Easterbrook P, Taylor C. Department of Genitourinary/HIV Medicine, Caldecot Centre, King's College Hospital, London SE5 9RS. Comment in BMJ. 2001 Jul 28;323(7306):230-1.

BMJ. 2001 Jul 28;323(7306):231. PMCID: PMC26569 PMID: 11179158 [PubMed - indexed for MEDLINE] 365. Clin Ter. 2000 Sep-Oct;151(5):315-8. [Italian prisons]. [Article in Italian] Ponti H. PMID: 11141711 [PubMed - indexed for MEDLINE] 366. Dig Dis Sci. 2000 Oct;45(10):1949-52. Serum alanine aminotransferase levels in relation to hepatitis B and C virus infections among drug abusers in an area hyperendemic for hepatitis B. Chang CJ, Ko YC, Liu HW. Department of Family Medicine, and School of Public Health, Kaohsiung Medical College, Taiwan. Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are the major agents responsible for hepatitis in Taiwan. The purpose of this study was to assess the serum alanine aminotransferase (ALT) activity in relation to HBV and HCV infection among drug abusers. This survey included 769 male drug abusers aged 14-59 years, from the Kaohsiung Narcotic Abstention Institute and Kaohsiung Prision. The prevalence of HBsAg seropositivity was 21.5%, and anti-HCV seropositivity was 27.2%, respectively. Drug abusers with HBsAg or anti-HCV had higher serum AST and ALT levels than those without HBsAg and anti-HCV. The prevalence of raised ALT and AST (> or =45 IU/liter) in the HCV-positive group was more significant than in the negative group, while that of the HBsAg-positive group did not reach statistical significance. Among the HCV-positive group, ALT levels are more closely associated with HCV infection than AST levels. Our results indicated that HCV infection plays an important role in the etiology of raised ALT activity among drug abusers, while HBV infection plays a minor role. ALT screening still remains a simple and valuable method in the early recognition of HCV infection. PMID: 11117565 [PubMed - indexed for MEDLINE]

367. Rev Saude Publica. 2000 Oct;34(5):431-6. Correlation between HIV and HCV in Brazilian prisoners: evidence for parenteral transmission inside prison. Burattini M, Massad E, Rozman M, Azevedo R, Carvalho H. Faculdade de Medicina, Universidade de So Paulo, So Paulo, SP, Brasil. mnburatt@usp.br 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. PMID: 11105105 [PubMed - indexed for MEDLINE] 368. BMJ. 2000 Dec 2;321(7273):1407. Health effects of prisons. Properly executed vaccination programme might minimise harm. Schmid ML, Green ST, McKendrick MW. Comment on BMJ. 2000 Jul 8;321(7253):78-82. PMID: 11099293 [PubMed - indexed for MEDLINE]

369. BMJ. 2000 Dec 2;321(7273):1406-7. Health effects of prisons. Risks of syringe exchange programmes in prisons prevail. Langkamp H. Comment on BMJ. 2000 Jul 8;321(7253):78-82. PMID: 11099292 [PubMed - indexed for MEDLINE] 370. BMJ. 2000 Dec 2;321(7273):1406. Health effects of prisons. Many injectors stop injecting while imprisoned. Smyth BP. Comment on BMJ. 2000 Jul 8;321(7253):78-82. PMCID: PMC1119121 PMID: 11099291 [PubMed - indexed for MEDLINE] 371. Int J STD AIDS. 2000 Nov;11(11):743-7. Herpes simplex virus type 2 in prisoners, New South Wales, Australia. Butler T, Donovan B, Taylor J, Cunningham AL, Mindel A, Levy M, Kaldor J. New South Wales Health Department, AIDS/Infectious Diseases Branch, NSW Health Department, North Sydney, Australia. tbutler@one.net.au Our objectives were to determine the prevalence of, and risk factors for, herpes simplex virus type 2 (HSV-2) antibodies in male and female prisoners. A cross-sectional random sample was used consisting of 789 prisoners (657 males and 132 females) from 27 correctional centres across New South Wales (NSW), stratified by sex, age and Aboriginality. Participants were questioned about demographics and behavioural risk factors and were screened for serum antibody to HSV-2. The overall prevalence of HSV-2 antibodies was higher in females (58%) than males (21%), and in Aborigines (34%) compared with non-Aborigines (24%). HSV-2 prevalence increased with the number of sexual partners. Few prisoners (1%) reported a previous diagnosis of genital herpes. Independent risk factors for the

presence of HSV-2 antibodies were increasing age and Aboriginality for men, and higher reported number of lifetime sexual partners and the presence of hepatitis C antibodies for women. HSV-2 infection is common in prison inmates. There is a need to incorporate information about STDs, including HSV-2, into education programmes for inmates. PMID: 11089789 [PubMed - indexed for MEDLINE] 372. Sex Transm Dis. 2000 Oct;27(9):491-5. Sexually transmitted diseases among female prisoners in Brazil: prevalence and risk factors. Miranda AE, Vargas PM, St Louis ME, Viana MC. Infectious Diseases Unit, Federal University of Esprito Santo State, Brazil. espinosa@tropical.com.br BACKGROUND: Sexually transmitted diseases (STDs) have become an important medical problem in prisons. GOAL: To determine the prevalence of and risk factors for STDs among female inmates in a Brazilian prison. STUDY DESIGN: All female prisoners at the Esprito Santo State Prison were offered enrollment in this cross-sectional study. An interview exploring demographics, criminal charges, and risk behavior was conducted. Blood and genital specimens were collected for STD testing. RESULTS: Of 122 eligible women, 121 (99%) agreed to participate. Prevalence rates were: HIV 9.9%, human T-cell lymphotrophic virus type I 4.1%, hepatitis B virus 7.4%, hepatitis C virus 19%, syphilis 16%, gonorrhea 7.6%, chlamydial infection 11%, human papillomavirus-related cytologic changes 9.3%, trichomoniasis 30%, and bacterial vaginosis 15%. Previous or current drug abuse (54%), injection drug use (11%), and blood transfusion (16%) were associated with at least one STD. Condom use was infrequent. CONCLUSION: The prevalence of STDs and of behaviors leading to ongoing transmission are high among female inmates in Vitria, Brazil, and demonstrate the potential importance of prevention activities targeting this population. PMID: 11034522 [PubMed - indexed for MEDLINE] 373. Rev Med Interne. 2000 Jun;21(6):505-9. [Drug-addicted prisoners: seroprevalence of human immunodeficiency virus and hepatitis B and C virus soon after the marketing of buprenorphine].

[Article in French] Claudon-Charpentier A, Hoibian M, Glasser P, Lalanne H, Pasquali JL. Service pharmacie, hpital de Hautepierre, Hpitaux universitaires de Strasbourg, France. PURPOSE: Considering the importance to public health and the frequency with which drug addicts are imprisoned, we studied the prevalence of human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV), as well as drug addiction of patients admitted to the Elsau prison in Strasbourg (France). METHODS: The prospective study included all entering inmates from 1 September to 31 October 1997 (270 persons) to whom HIV, HBV and HCV blood tests were offered as well as a questionnaire on their drug addiction. RESULTS: Thirty-six percent of the entering inmates were drug addicts, of whom 1% were HIV positive, 11.2% HBV positive and 30% HCV positive, compared to, respectively, 0.6, 9.9 and 6.4% for non-drug addicts. Ninety-five of the 98 patients used several drugs, including buprenorphine for 53 patients. At the beginning of this study, buprenorphine had been available in France for 9 months. CONCLUSION: The results are to be taken seriously regarding the misuse of this product in this selected population (intravenous use, multiple drug use, dealing). PMID: 10909149 [PubMed - indexed for MEDLINE] 374. Commun Dis Public Health. 2000 Jun;3(2):121-6. Prevalence of HIV, hepatitis B, and hepatitis C antibodies in prisoners in England and Wales: a national survey. Weild AR, Gill ON, Bennett D, Livingstone SJ, Parry JV, Curran L. PHLS Communicable Disease Surveillance Centre, London. awield@phls.nhs.uk Comment in Commun Dis Public Health. 2000 Dec;3(4):308-9. Commun Dis Public Health. 2000 Jun;3(2):84-5. Prisoners in eight of the 135 prisons in England and Wales were surveyed in 1997 and 1998 to study the prevalence of and risk factors for transmission of bloodborne viruses in prison. Subjects voluntarily completed a risk factor questionnaire and provided oral fluid specimens for unlinked anonymous testing for the presence of antibodies to HIV, hepatitis C virus (HCV), and the core antigen of hepatitis B virus (HBc). Almost 8% (4778) of the total of 60,561

prisoners were eligible and four fifths (3942) of those eligible took part. Among all those tested (3930) 0.4% (14) were positive for anti-HIV, 8% (308) for anti-HBc, and 7% (293) for anti-HCV (the anti-HBc and anti-HCV prevalences were not adjusted for assay sensitivities of 82% and 80%, respectively). Twenty-four per cent (777/3176) of adult prisoners reported ever having injected drugs, 30% of whom (224/747) reported having injected in prison. Three quarters of those who injected in prison (167/224) shared needles or syringes. Among adult injecting drug users, 0.5% (4/775) had anti-HIV, 31% (240/775) anti-HCV, and 20% (158/775) anti-HBc. The presence of anti-HCV and anti-HBc was associated with injecting inside prison and number of previous times in prison. The results suggest that hepatitis viruses are probably being transmitted in prisons through sharing non-sterile injecting equipment and that a risk of HIV transmission exists. Harm minimisation measures for the 6% of prisoners who continue to inject while in prison should be strengthened. PMID: 10902255 [PubMed - indexed for MEDLINE] 375. Commun Dis Public Health. 2000 Jun;3(2):84-5. Preventing transmission of bloodborne virus infections in prisons. Goldberg D, Taylor A. Comment in Commun Dis Public Health. 2000 Dec;3(4):309. Comment on Commun Dis Public Health. 2000 Jun;3(2):121-6. PMID: 10902247 [PubMed - indexed for MEDLINE] 376. Gastroenterol Clin Biol. 2000 May;24(5):541-6. [Organized hepatitis C screening. Results and cost of a one-year campaign in a pilot area]. [Article in French] Monnet E, Mercet P, Woronoff-Lemsi MC, Bresson-Hadni S, Pruniaux J, Cottray P, Bouiller C, Allemand H, Miguet JP. Dpartement de Sant Publique, Facult de Mdecine et de Pharmacie, Besanon. OBJECTIVES: The management and monitoring process and the efficiency of targeted

hepatitis C screening in the French health care system are not known. We assessed the main results and the cost of the program established in the Doubs area, where organized screening was integrated into the activities of voluntary physicians. METHODS: All biological laboratories in the area, 23% of the private general practitioners, 42% of occupational physicians, one prison health service and one health centre agreed to participate. Screening was targeted to the following risk factors: transfusion before 1991, intravenous drug use, tattooing and household contact. The prescription form specified the indication and allowed free testing. RESULTS: Among the volunteers, 58% of the general practitioners, 63% of the occupational physicians and 50% of the laboratories prescribed at least one screening test. In one year, 948 serologies were prescribed, mainly for tattooing (45%) or transfusion (28%). Only 83% of the tests were performed, with patient observance depending on age, indication and the place of prescription. Thirty-one patients were positive (4%). The cost of the campaign was 10 994 F per screened case. CONCLUSION: Mobilizing health professionals for organized screening is difficult which affects the efficiency of strategies. PMID: 10891743 [PubMed - indexed for MEDLINE] 377. BMJ. 2000 Jul 8;321(7253):78-82. Prevalence of antibodies to hepatitis B, hepatitis C, and HIV and risk factors in Irish prisoners: results of a national cross sectional survey. Allwright S, Bradley F, Long J, Barry J, Thornton L, Parry JV. Department of Community Health and General Practice, Trinity College, Dublin 2, Republic of Ireland. sllwrght@tcd.ie Comment in BMJ. 2000 Dec 2;321(7273):1406-7. BMJ. 2000 Dec 2;321(7273):1406. BMJ. 2000 Dec 2;321(7273):1407. BMJ. 2000 Dec 2;321(7273):1407. OBJECTIVES: To determine the prevalence of antibodies to hepatitis B core antigen, hepatitis C virus, and HIV in the prison population of the Republic of Ireland and to examine risk factors for infection. DESIGN: Cross sectional, anonymous, unlinked survey, with self completed risk factor questionnaire and provision of oral fluid specimen for antibody testing. SETTING: Nine of the 15 prisons in the Republic of Ireland. PARTICIPANTS: 1366 prisoners, of whom 1205 (57 women) participated. In the smaller prisons all prisoners were surveyed, while in the three largest prisons one half of the population was randomly sampled. Three small prisons believed not

to have a problem with injecting drug use were excluded. MAIN OUTCOME MEASURES: Prevalence of antibodies to hepatitis B core antigen, antibodies to hepatitis C virus, and antibodies to HIV. Self reported risk factor status. RESULTS: Prevalence of antibodies to hepatitis B core antigen was 104/1193 (8.7%; 95% confidence interval 7.2% to 10.5%), to hepatitis C virus, 442/1193 (37%; 34.3% to 39.9%), and to HIV, 24/1193 (2%; 1.3% to 3%). The most important predictor of being positive for hepatitis B and hepatitis C was a history of injecting drug use. Thirty four women (60%) and 474 men (42%) reported ever injecting drugs. A fifth (104) of 501 injecting drug users reported first injecting in prison, and 347 (71%) users reported sharing needles in prison. CONCLUSIONS: Infection with hepatitis C secondary to use of injected drugs is endemic in Irish prisons. Better access to harm reduction strategies is needed in this environment. PMCID: PMC27426 PMID: 10884256 [PubMed - indexed for MEDLINE] 378. Rev Soc Bras Med Trop. 2000 Jan-Feb;33(1):27-30. Prevalence of HIV-1/2, HTLV-I/II, hepatitis B virus (HBV), hepatitis C virus (HCV), Treponema pallidum and Trypanosoma cruzi among prison inmates at Manhuau, Minas Gerais State, Brazil. Catalan-Soares BC, Almeida RT, Carneiro-Proietti AB. Fundao Hemominas, Manhuau, Belo Horizonte, MG, Brazil. The purpose of this study was to determine the seroprevalence of human immunodeficiency virus (HIV-(1/2)), human T-cell lymphotropic virus (HTLV-I/II), hepatitis B virus (HBV), hepatitis C virus (HCV), Treponema pallidum and Trypanosoma cruzi among 63 male prisoners in Manhuau, Minas Gerais, Brazil and to compare this with data from eligible blood donors. The positive results were as follows: 11/63 (17.5%) for HBV, 5/63 (7.4%) for syphilis, 4/63 (6.3%) for HCV, 3/63 (4.8%) for Chagas' disease, 2/63 (3.2%) for HIV-1/2 and 1/63 (1.6%) for HTLV-I/II. The seroprevalence in prisoners was higher than among blood donors, mainly for antibodies to HIV-1/2, HCV and HBV. This is probably due to low social economic level, illiteracy, higher proportion with a prior history of intravenous drug use and/or unsafe sexual behavior. Therefore, these prisoners constitute a high-risk group and routine screening and counseling are recommended. PMID: 10881115 [PubMed - indexed for MEDLINE]

379. J Infect. 2000 Mar;40(2):176-83. Prevalence of hepatitis C virus infection among injecting drug users in Glasgow 1990-1996: are current harm reduction strategies working? Taylor A, Goldberg D, Hutchinson S, Cameron S, Gore SM, McMenamin J, Green S, Pithie A, Fox R. Scottish Centre for Infection and Environmental Health, Glasgow, UK. OBJECTIVES: To determine the prevalence of HCV antibodies among injecting drug users and to gauge the effectiveness of needle/syringe exchange in preventing the transmission of HCV infection. METHODS: Between 1990-1994 and in 1996, annual cross-sectional surveys of injecting drug users in Glasgow were conducted. In order to ensure as representative a sample as possible, the 1949 respondents were recruited from both 'in-treatment' and 'out-of treatment' settings. Injectors were interviewed about their risk behaviours for blood-borne viruses and provided a saliva sample which was initially tested, anonymously, for HIV antibodies, and subsequently tested for hepatitis C infection. RESULTS: Among 1949 injectors, the prevalence of salivary antibodies, indicative of hepatitis C viraemia, was 61%(95%, confidence interval (CI) 59%-63%): the estimated prevalence of serum antibody positivity was 72%. Length of injecting, year of commencing drug injecting and the number of times in prison were predictive of antibody positivity. Thirty-one per cent of injectors who commenced their injecting after 1992, following the full establishment of needle/syringe exchange in the city, were salivary antibody positive, and the majority of their infections were acquired outside the prison setting. Respondents who began injecting after the introduction of needle/syringe exchange in the city were significantly less likely to test HCV antibody positive than those who commenced injecting prior to the advent of needle/syringe exchange, after adjusting for length of injecting career. CONCLUSION: The prevalence of HCV among injectors in Glasgow has decreased during the era of needle/syringe exchange. However, there is evidence to suggest that the incidence of infection remains high. Since the prevalence of hepatitis C viraemia among the city's injecting population is extremely high, ongoing transmission is inevitable unless more effective interventions are identified and implemented urgently. PMID: 10841096 [PubMed - indexed for MEDLINE] 380. Addiction. 1999 Oct;94(10):1533-40. Correlates of benzodiazepine abuse in methadone maintenance treatment. A 1 year

prospective study in an Israeli clinic. Bleich A, Gelkopf M, Schmidt V, Hayward R, Bodner G, Adelson M. Dr Miriam & Sheldon G. Adelson Clinic for Drug Abuse Treatment and Research, Tel-Aviv Elias Sourasky Medical Center, Israel. bleich@post.tau.ac.il AIMS: This study addressed the following questions for patients after 1 year of methadone maintenance treatment (MMT); (1) What are the demographic features and past history of drug use of benzodiazepine (BZD) abusers? (2) Do BZD abusers abuse more heroin, cocaine and/or cannabis and do they receive a higher methadone dosage level? (3) Do BZD abusers suffer more from hepatitis C (HCV) and do they have more HIV/HCV risk-taking behaviors than non-abusers? (4) Do BZD abusers have more psychopathology and more emotional distress than non-abusers? DESIGN: All 148 patients who completed 1 year of MMT underwent random and twice-weekly observed urine analysis for various drugs of abuse, responded to self-report questionnaires (SCL-90-R; POMS; HIV/HCV risk-taking behaviors), interviews (ASI) and underwent testing for hepatitis C. Abuse in this study is defined as any use during the 12th month of treatment. FINDINGS: After 1 year of MMT, more BZD abusers (n = 63) were single, had spent time in prison, were unemployed and had at least one parent with an addiction problem or mental illness in comparison to non-abusers (n = 85). They had started using heroin and cocaine earlier and currently abused more cocaine, heroin and cannabis. They had significantly more psychopathology and negative mood. They had significantly more HCV and reported more HIV/HCV risk-taking behavior. IMPLICATIONS: We suggest that this group of patients is in need of more intensive pharmacological and psychological treatment. PMID: 10790905 [PubMed - indexed for MEDLINE] 381. Bull Soc Pathol Exot. 2000 Feb;93(1):34-40. [Prevalence of hepatitis A, B, C virus markers in Runion (south hospital and Saint Pierre prison)]. [Article in French] Michault A, Faulques B, Sevadjan B, Troalen D, Marais A, Barau G. Laboratoire de bactriologie-parasitologie-virologie, Centre hospitalier Sud Runion, Saint Pierre. We studied the prevalence of Hepatitis A, B, C in different groups in the population of the South of Reunion Island. The aims of this study were the following: to estimate the prevalence of Hepatitis C virus (HCV) (anti-HCV

antibodies) and Hepatitis B virus (HBV) (anti-HBc, HBs Ag and anti-HBs) in a population of 1455 women, who delivered in the Centre hospitalier Sud Reunion (CHSR), to estimate the prevalence of these two viruses in a population selected for risk factors (100 prisoners), to estimate the prevalence of Hepatitis A in a group of 400 persons (aged 0 to 19) hospitalised in CHSR since 1st January 1998 (100 for each 5-year age bracket), to research risks factors in these populations and immunity. The overall prevalence of anti-HCV was 0.14% in pregnant women and risk factor associated was found in 28.9% of this population (2.9% history of transfusion, 0.21% drug users). In the group of prisoners seroprevalence was 2%, far below that of prisoners in France. Anti-HCV seroprevalence is weak in Reunion Island and very inferior to seroprevalence in the French population as in other Indian Ocean islands. This is due to the low risk of parenteral transmission. Anti-HBc was found in 90 serum samples from women (overall prevalence 6.35%) and of these 90 positive samples, 9 were positive for HBs Ag (overall prevalence 0.63%), 68 were positive for anti-HBs (4.81%) and 22 (1.54%) were anti-HBc isolated (without HBs Ag and anti-HBs). The overall prevalence of anti-HBs was 62.8%. In the population of 100 prisoners, 2 were HBs Ag positive, 10 anti-HBc positive (2 anti-HBc isolated, 2 associated with HBs Ag, 6 with anti-HBs). The prevalence of anti-HBs was 22%. The major risk factor observed in this population of prisoners was tattooing and/or piercing (46%). These results show that: Reunion island is an area of low endemicity for HBV virus. The measure of protective inoculation is well followed. i.v. drug abuse and previous transfusion are weak routes of transmission. In the group aged 0 to 19, overall prevalence of anti-HAV was 11.9% with the highest rate found among 15 to 19 year-olds (25%). Seroprevalence falls with socio-economic progress. At the present time, the endemic is intermediate in Reunion Island. Given immunity levels within the young population, there is a risk of outbreak. This risk is due to the conditions in Reunion Island, but also to people who travel to other Indian Ocean countries where endemicity is high. It is thus very important that a vaccination strategy be determined. PMID: 10774493 [PubMed - indexed for MEDLINE] 382. Med J Aust. 2000 Jan 17;172(2):94. Prevalence of exposure to hepatitis C virus among prison inmates, 1999. Awofeso N, Harper SE, Levy MH. Comment on Med J Aust. 1999 Jul 5;171(1):31-3. PMID: 10738487 [PubMed - indexed for MEDLINE]

383. Eur Addict Res. 2000 Mar;6(1):20-30. Drug injectors and the cleaning of needles and syringes. Hughes RA. Department of Social Policy and Social Work, University of York, Heslington, York, UK. rhidian.hughes@ukonline.co.uk When people share needles and syringes they risk transmitting human immunodeficiency virus (HIV) and other infections including hepatitis B virus (HBV) and hepatitis C virus (HCV). Cleaning needles and syringes can help to reduce, although not eliminate, these risks. This article begins by engaging with some of the literature on the cleaning of needles and syringes. Drawing on qualitative research conducted with drug injectors in England, the article then goes on to explore drug injectors' perceptions and experiences of cleaning needles and syringes inside and outside prison. The article concludes by highlighting the implications for future research and policy making. Ultimately there should be a stronger policy response to reduce the risks associated with sharing needles and syringes inside prison, which should include the piloting of prison needle and syringe exchange schemes. Copyright 2000 S. Karger AG, Basel PMID: 10729739 [PubMed - indexed for MEDLINE] 384. QJM. 2000 Feb;93(2):113-9. HIV, hepatitis C and risk behaviour in a Canadian medium-security federal penitentiary. Queen's University HIV Prison Study Group. Ford PM, Pearson M, Sankar-Mistry P, Stevenson T, Bell D, Austin J. Departments of Medicine, Community Health and Epidemiology, Queen's University, Kingston, Ontario, Canada. fordp@post.queensu.ca In a voluntary anonymous HIV and hepatitis C serology screen in a Canadian male medium security federal penitentiary, 68% of 520 prisoners volunteered a blood sample and 99% of those giving a blood sample completed a risk behaviour questionnaire which was linked numerically to the blood sample. Compared to previous screenings for HIV (4 years earlier), and hepatitis C (3 years earlier) in the same institution, HIV seroprevalence had risen from 1% to 2% and hepatitis C seroprevalence from 28% to 33%. The overwhelming risk association for hepatitis C was with drug use outside prison, although there was a small group of men who had only ever injected drugs inside prison, over half of whom had been infected

with hepatitis C. The proportion of prisoners who had injected drugs in prison rose from 12% in 1995 to 24% in 1998. The proportion of surveyed individuals sharing injection equipment at some time in prison was 19%, and while HIV rates in the prison are currently low, HIV prevalence amongst Canadian street i.v. drug users is rising rapidly, underlining the need for urgent preventative measures in prisons. PMID: 10700482 [PubMed - indexed for MEDLINE] 385. Am J Med. 1999 Dec 27;107(6B):100S-103S. Hepatitis C and the correctional population. Reindollar RW. Center for Liver Diseases, Carolinas Medical Center, Charlotte, North Carolina 28207, USA. The hepatitis C epidemic has extended well into the correctional population where individuals predominantly originate from high-risk environments and have high-risk behaviors. Epidemiologic data estimate that 30% to 40% of the 1.8 million inmates in the United States are infected with the hepatitis C virus (HCV), the majority of whom were infected before incarceration. As in the general population, injection drug use accounts for the majority of HCV infections in this group--one to two thirds of inmates have a history of injection drug use before incarceration and continue to do so while in prison. Although correctional facilities also represent a high-risk environment for HCV infection because of a continued high incidence of drug use and high-risk sexual activities, available data indicate a low HCV seroconversion rate of 1.1 per 100 person-years in prison. Moreover, a high annual turnover rate means that many inmates return to their previous high-risk environments and behaviors that are conducive either to acquiring or spreading HCV. Despite a very high prevalence of HCV infection within the US correctional system, identification and treatment of at-risk individuals is inconsistent, at best. Variable access to correctional health-care resources, limited funding, high inmate turnover rates, and deficient follow-up care after release represent a few of the factors that confound HCV control and prevention in this group. Future efforts must focus on establishing an accurate knowledge base and implementing education, policies, and procedures for the prevention and treatment of hepatitis C in correctional populations. PMID: 10653468 [PubMed - indexed for MEDLINE] 386. Telemed Today. 1999 Aug;7(4):12-3, 36.

Managing anger and disease behind bars. Rosen E. Impact Video Communication, San Francisco, CA, USA. erosen@impactvid.com PMID: 10623391 [PubMed - indexed for MEDLINE] 387. Eur J Epidemiol. 1999 Sep;15(8):699-704. Coinfections by HIV, hepatitis B and hepatitis C in imprisoned injecting drug users. Palls JR, Farias-Alvarez C, Prieto D, Delgado-Rodrguez M. Cuerpo Facultativo de Sanidad Penitenciaria, Centro Penitenciario de Santander, Santander, Spain. In order to know the prevalence and risk factors for coinfections by human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) among injecting drug users (IDUs), a cross-sectional study was carried out in two prisons of the province of Cantabria, northern Spain. Three hundred and sixty-two IDU inmates were recruited. All inmates were interviewed and their blood tested for HIV, HBV and HCV. Crude and multiple risk factor adjusted for (by polychotomous logistic regression) odds ratios were calculated. Prevalence of HBV-HCV coinfection (42.5%) was higher than HIV-HBV-HCV coinfection (37.3%), whereas monoinfections were very uncommon (overall: 13%). Long-term injectors and reincarceration were the foremost risk factors for both coinfections, showing a trend between the degree of association and the number of viruses infecting a patient. No significant relationship between coinfection status and sexual practices was observed. The results related to coinfections are consistent with previous studies of prevalence and risk factors for HIV, HBV and HCV, in indicating that the high rates of coinfections among IDU inmates emphasise the need to harm-reduction policy across prisons in Spain. PMID: 10555612 [PubMed - indexed for MEDLINE] 388. Eur J Epidemiol. 1999 Aug;15(7):597-601. Hepatitis C virus infection among short-term intravenous drug users in southern Taiwan. Chang CJ, Lin CH, Lee CT, Chang SJ, Ko YC, Liu HW.

Department of Family Medicine, Kaohsiung Medical College, Kaohsiung City, Republic of China. The purpose of this study was to determine the correlation between the prevalence of hepatitis C virus (HCV) infection with duration of drug use and other risk factors among drug users. This survey covered 899 male drug users from Kaohsiung Narcotic Abstention Institute and Kaohsiung prison. The prevalence of positive anti-HCV was 67.2% among intravenous drug users (IVDU) and 14.7% among non-intravenous drug users (non-IVDU). Among intravenous (IV) drug users, age and duration of drug use were independently related to HCV seropositivity. Seroprevalence rate for HCV in the IVDU group increased with increasing duration of injection use within the first seven years of drug use. However, the steepest trajectory in seroprevalence of HCV infection occurred within the first four months. Due to the high rate of HCV infection among drug users, investigation of risk behaviors should be routine in such a group. A high frequency of HCV infection was also found among short-term injectors, which indicated that early risk reduction intervention was an important measure in moderating HCV infection. PMID: 10543348 [PubMed - indexed for MEDLINE] 389. J Public Health Med. 1999 Sep;21(3):348-54. Quarterly communicable disease review January to March 1999. From the PHLS Communicable Disease Surveillance Centre. Public Health Laboratory Service. Catchpole M, Hamilton G, Hawker J, Olowokure B, Ramsay M, Weinberg J, Weild A. PMID: 10528964 [PubMed - indexed for MEDLINE] 390. J Health Care Finance. 1999 Fall;26(1):63-77. Health care delivery strategies for criminal offenders. Pollack H, Khoshnood K, Altice F. University of Michigan School of Public Health, Ann Arbor, USA. Men and women under correctional supervision may be the most challenging population of public health concern. Prison inmates, parolees, and probationers experience prevalent infectious disease including HIV and hepatitis C. Many supervised individuals have significant mental or behavioral health problems that require clinical intervention. The U.S. correctional population is also rapidly growing, and now includes more than 5 million men and women. Concerns about quality, accessibility, and cost of correctional care have prompted calls for

managed care models in this population. This paper reviews pertinent experiences within Medicaid managed care and suggests four interconnected strategies--outreach, discharge planning, entitlement security, and case management--to improve the quality and efficiency of correctional care. PMID: 10497752 [PubMed - indexed for MEDLINE] 391. Fam Pract. 1999 Aug;16(4):366-8. Is there room for general practice in penitentiary institutions: screening and vaccinating high-risk groups against hepatitis. Chatziarsenis M, Miyakis S, Faresjo T, Trell E, Vlachonikolis J, Lionis C. Clinic of Social and Family Medicine, Medical School, University of Crete, Greece. OBJECTIVE: The purpose of this study was to determine the prevalence of hepatitis markers in inmates and staff of the Penitentiary of Neapolis on Crete and discuss the role of GPs in identifying and vaccinating susceptible subjects. METHOD: Forty-five prisoners and 20 house workers were invited to participate in the study. Hepatitis B (HBV) markers (HBsAg and anti-HBc) and hepatitis C antibodies (anti-HCV) were tested. Vaccination against hepatitis B was administered to all susceptible subjects. RESULTS: Hepatitis B carriage was found in 10 people, six of whom were prisoners. Fifteen of the subjects tested were found to be positive for anti-HBc, six of whom were house workers. Anti-HCV were found to be positive in seven prisoners and one worker. A vaccination programme against hepatitis B was introduced in 27 susceptible subjects (58.7% of unexposed subjects) and was completed in 22. CONCLUSION: Prisoners and staff at Neapolis Prison constitute a high-risk group for hepatitis B and C. Compliance rate in screening was high and GPs were successful in having a desirable response rate in the administration of vaccines. PMID: 10493706 [PubMed - indexed for MEDLINE] 392. Epidemiol Infect. 1999 Aug;123(1):95-102. Risk factors for monoinfections and coinfections with HIV, hepatitis B and hepatitis C viruses in northern Spanish prisoners. Palls J, Farias-Alvarez C, Prieto D, Llorca J, Delgado-Rodrguez M. Provincial Prison, Santander, Spain.

A cross-sectional study was conducted in prisons of Cantabria (northern Spain) from June 1992 to December 1994. Inmates were asked to participate in a survey on prevalence and risk factors for monoinfections and coinfections with HIV, HBV and HCV. Crude and multiple odds ratios of risk factors were calculated (by polychotomous logistic regression). Prevalence of coinfections was higher than that of monoinfections. IDU risk factors were the main independent variables associated with monoinfections and coinfections with these agents. The strength of association increased with the degree of coinfection for IDU risk factors and penal status, e.g. duration of injecting drug use for more than 5 years yielded an adjusted OR ranging from 1.3 (95% CI: 0.4-5.1) for HBV monoinfection to 180 (95% CI: 61.0-540.0) for HIV-HBV-HCV coinfection. In comparison, sexual behaviours were less important than IDU risk factors. PMCID: PMC2810732 PMID: 10487645 [PubMed - indexed for MEDLINE] 393. Lancet. 1999 Aug 28;354(9180):753. Inmates in Irish prisons face drug abuse and disease. Birchard K. PMID: 10475200 [PubMed - indexed for MEDLINE] 394. Aust N Z J Public Health. 1999 Aug;23(4):377-84. Seroprevalence of markers for hepatitis B, C and G in male and female prisoners--NSW, 1996. Butler T, Spencer J, Cui J, Vickery K, Zou J, Kaldor J. New South Wales Health Department, Olympic Planning Unit, North Sydney, NSW. tbutl@doh.health.nsw.gov.au 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. PMID: 10462860 [PubMed - indexed for MEDLINE] 395. Int J STD AIDS. 1999 Jul;10(7):475-8. High prevalence of sexually transmitted and blood-borne infections amongst the inmates of a district jail in Northern India. Singh S, Prasad R, Mohanty A. Clinical Microbiology Division, Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi. ssingh@medinst.ernet.in Two hundred and forty male and 9 female jail inmates confined for various crimes in a district jail near Delhi were screened for sexually transmitted and blood-borne diseases including HIV, syphilis and hepatitis B and C viral infections, skin diseases etc. The inmates were aged 15-50 years with a mean of 24.8+/-0.11. Their alleged criminal background, period of stay in the jail, drug addiction, education, birth place, marital status, sexual activity, and clinical complaints were recorded by an anonymous questionnaire. Serum samples were tested for antibodies against HIV (1+2), hepatitis C (HCV), Treponema pallidum and for hepatitis B surface antigen (HBsAg). Sputum examination was done for acid-fast bacilli. Out of the 240 men, 115 were married and 125 unmarried. One hundred and eighty-four (76.6%) men gave history of penetrative sex. Of the 184, 53 (28.8%) were homosexuals or bisexuals and 131 (71.2%) had sex with women only. Sixty of the 131 (45.8%) were faithful to their partners while 124 gave a history of having multiple sexual partners and 100 of them (80.6%) had unprotected sex. Eighty-three of these 100 also had had sex with commercial sex workers (CSWs). One hundred and twenty-six were addicted for alcohol, 44 for smack/charas and 8

had a history of intravenous drug abuse. One hundred and seventy-four were not aware of AIDS. On examination 28 of the 240 (11.6%) had active hepatitis with or without a history of jaundice in the last 2 years, 25 (10.4%) active pulmonary tuberculosis (TB) and 11 (4.6%) had syphilitic ulcers on the penis. Four-fifths of the teenagers confined to a particular barrack had moderate to severe scabies. Three males (1.3%) were found to be Western blot confirmed HIV-1 positive while 28 (11.1%) men and 2 (22.2%) women were positive for HBsAg. Twelve (5.0%) men but no women, were found to be positive for anti-HCV antibodies. Out of the 3 HIV-positive persons, one was an intravenous drug user (IVDU), second was a drug addict and frequent CSW visitor while the third was a homosexual. This pilot study gives an indication that sexually transmitted and blood-borne infections are highly prevalent in jail premises and pose a threat of rapid spread of these infections through IVDU and homosexuality. PIP: This is a study conducted to establish the seroprevalence rate of sexually transmitted and blood-borne infections among district jail inmates in Northern India. The subjects (240 males and 9 female inmates), aged 15-50 years, were asked to answer a questionnaire comprising their background characteristics, alleged criminal background, period of confinement in jail, sexual activity, and sexual partners. Any history of blood transfusion, injury, injecting drug use and drug addiction were also noted together with the level of AIDS awareness . Out of the 240 men, 115 were married and 125 were unmarried. Serum samples were obtained from these inmates and were tested for antibodies against HIV (1+2), hepatitis C virus (HCV), Treponema pallidum, and hepatitis B surface antigen (HBsAg). The results indicated that 76.6% gave a history of penetrative sex with their wives or other females including casual sex partners and commercial sex workers (CSWs). 71.2% had had sex only with women, while 28.8% were homosexual or bisexual. Out of 131, 60 (45.8%) had been faithful to their partners, while 124 had experienced multiple sexual partners and 80.6% had had unprotected sex. Of the 100 who had had unprotected sex, 83 did so with CSWs. 126 inmates (52.75%) were addicted to alcohol, 44 (18.33%) to smack/charas, and 8 (3.33%) used intravenous drugs. On examination, 11.6% had active hepatitis, 10.4% with active pulmonary tuberculosis, 4.6% had syphilitic ulcers on the penis, and four-fifths of the teenagers had moderate to severe scabies. 1.3% of the subjects were HIV-1 positive, while 11.1% men and 22.2% women were positive for HBsAg. These results indicate a high prevalence of sexually transmitted and blood-borne infections in the studied area. PMID: 10454185 [PubMed - indexed for MEDLINE] 396. Int J STD AIDS. 1999 Jul;10(7):464-6. Survey of risk behaviour and HIV prevalence in an English prison. Edwards A, Curtis S, Sherrard J.

Department of Genitourinary Medicine, The Radcliffe Infirmary NHS Trust, Oxford, UK. An anonymous, voluntary, linked cohort study was undertaken to determine the prevalence of HIV infection and identify risk factors for the spread of infection in an English prison. Three hundred and seventy-eight (68%) of the inmates participated. The HIV point prevalence was 0.26%. Injecting drug use (IDU) was the most significant HIV risk factor within 20% admitting IDU at any time, of whom 58% injected whilst in prison. Of those injecting in prison 73% shared needles. Two inmates admitted having sex with a male partner in prison. This study demonstrates that the potential exists in this setting for an outbreak of blood-borne virus infection; hepatitis B virus (HBV), hepatitis C virus (HCV) and HIV infection. Injecting drug use and needle sharing represent the greatest risk. PMID: 10454182 [PubMed - indexed for MEDLINE] 397. Med J Aust. 1999 Jul 5;171(1):31-3. Transmission of hepatitis C within Australian prisons. Haber PS, Parsons SJ, Harper SE, White PA, Rawlinson WD, Lloyd AR. Drug and Alcohol Services, Royal Prince Alfred Hospital, Sydney, NSW. Comment in Med J Aust. 2000 Jan 17;172(2):94. Med J Aust. 1999 Jul 5;171(1):7-8. Transmission of hepatitis C virus (HCV) within prisons has long been suspected but has not been satisfactorily documented. We present four cases of HCV infection occurring during periods of continuous imprisonment. Each subject was HCV seronegative on entering prison and on repeat testing after 4-52 months in prison, but subsequently became seropositive. Two subjects gave a history of injecting drug use, and the most likely means of infection in the other two subjects were lacerations from barbers shears and lacerations arising from physical assault. There is an urgent need for detailed study of the incidence of HCV infection and the modes of transmission in prisons. PMID: 10451669 [PubMed - indexed for MEDLINE] 398. Med J Aust. 1999 Jul 5;171(1):18-21. HIV prevalence at reception into Australian prisons, 1991-1997.

McDonald AM, Ryan JW, Brown PR, Manners CJ, Falconer AD, Kinnear RC, Harvey WJ, Hearne PR, Banaszczyk M, Kaldor JM. National Centre in HIV Epidemiology and Clinical Research, Sydney, NSW. amcdonald@nchecr.unsw.edu.au Comment in Med J Aust. 1999 Jul 5;171(1):7-8. OBJECTIVE: To measure the extent and outcome of HIV antibody testing at reception into Australian prisons. DESIGN: Cross-sectional survey at reception into prison. PARTICIPANTS AND SETTING: People received into Australian prisons from 1991 to 1997. MAIN OUTCOME MEASURES: Number of people tested for HIV infection and prevalence of diagnosed HIV infection. RESULTS: In 1991-1997, HIV antibody testing was carried out for 72% of prison entrants in Australia; the percentage tested declined significantly from 76% in 1991 to 67% in 1997 (P < 0.001). In New South Wales, the percentage of entrants tested at reception into prison dropped from almost 100% in 1991-1994 to 45% in 1997, whereas in the Northern Territory, South Australia and Western Australia the extent of testing increased significantly (P < 0.001). HIV prevalence was 0.2% among people received into Australian prisons in 1991-1997, and did not differ by sex. Most people with HIV infection (242/378; 64%) received into prison in 1991-1997 had been diagnosed at a previous entry; 136 people (36% of the total number of diagnoses) were newly diagnosed at reception into prison. CONCLUSIONS: A national monitoring system in place from 1991 indicates generally high rates of HIV antibody testing and a low prevalence of HIV infection among people entering Australian prisons. In each year, people not previously known to the prison health service to have HIV infection were received into prison, indicating continuing HIV infection in the population entering Australian prisons. PMID: 10451666 [PubMed - indexed for MEDLINE] 399. Eur J Epidemiol. 1999 May;15(5):439-45. Seroprevalence of HIV, HCV and syphilis in Brazilian prisoners: preponderance of parenteral transmission. Massad E, Rozman M, Azevedo RS, Silveira AS, Takey K, Yamamoto YI, Strazza L, Ferreira MM, Burattini MN, Burattini MN.

NUPAIDS, The University of So Paulo, Brazil. 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. PMID: 10442469 [PubMed - indexed for MEDLINE] 400. J Adolesc Health. 1999 Jul;25(1):46-51. Hepatitis infection among adolescents resident in Melbourne Juvenile Justice Centre: risk factors and challenges. Ogilvie EL, Veit F, Crofts N, Thompson SC. Melbourne Juvenile Justice Centre, Parkville, Australia. OBJECTIVE: To describe patterns of infection with, and risks for, hepatitis A, B and C viruses (HAV, HBV, and HCV) in male adolescents detained in the Melbourne Juvenile Justice Centre (MJJC). METHODS: A cross-sectional serosurvey for HAV, HBV, and HCV among 90 male adolescents aged 15-18 years who were resident in MJJC for more than 1 week in 1996. RESULTS: Nine percent had been exposed to HAV, 8% were positive or equivocal for exposure to HBV, and 21% were antibody positive for HCV. All those with hepatitis markers except one positive for HAV had been injection heroin users for more than 1 year. Of those who were not HBcAb positive, only 28% were immune to HBV. For most respondents, sexual and drug-using risks began in the early teens and were associated with leaving school prematurely. CONCLUSIONS: Respondents were vulnerable to exposure to blood-borne viruses from an early age, posing a challenge for health education programs. An opportunity exists for harm minimization and prevention of spread of blood-borne viruses within the first year of injection drug use in this population.

PMID: 10418885 [PubMed - indexed for MEDLINE] 401. Gesundheitswesen. 1999 Apr;61(4):207-13. [Transmission of infectious diseases during imprisonment--results of a study and introduction of a model project for infection prevention in Lower Saxony]. [Article in German] Keppler K, Stver H. Carl von Ossietzky-Universitt, Oldenburg. The increasing imprisonment rate of drug users is linked to a spread of infectious diseases in prisons (HIV and Hepatitis B and C). Several studies indicate a close correlation of imprisonment and transmission of infectious diseases. An analysis of international studies showed that worldwide in several cases transmissions of HIV-infection during imprisonment have been discovered. The cross-sectional examination presented here is describing the situation in the women's prison of Vechta (Lower-Saxony). Empirical data on the prevalence of infections with HIV, HBV, HCV and Lues of the years 1992 to 1994 were recorded. Moreover the scientific interest also included on the diagnosis of seroconversions. Discovered seroconversions were examinated on a possible transmission in custody. The spread of infectious diseases in prisons led to the demand for an alignment of internal drug aid services with external, tried and tested prophylaxis models. The availability of sterile syringes is included. The basic comparability of health care inside and outside prison (principle of equivalence) is not only demanded and recommended by the prison law [4] but also by international organisations [27]. As the first provencial government, the state of Lower Saxony in Germany has started to develop infection prophylaxis offers in two prisons (in the women's prison in Vechta since April 15th 1996 and in the men's prison of Lingen I, department Gross Hesepe since July 15th 1996) in 1996. These offers include the provision of sterile injection equipment to intravenous drug addicts (ivDA). Modalities of the practice and first experiences documented by the schientific evaluation are presented. PMID: 10408149 [PubMed - indexed for MEDLINE] 402. West J Med. 1999 Mar;170(3):156-60. Prevalence and correlates of hepatitis C virus infection among inmates entering the California correctional system. Ruiz JD, Molitor F, Sun RK, Mikanda J, Facer M, Colford JM Jr, Rutherford GW,

Ascher MS. California Department of Health Services, Office of AIDS, Sacramento 95814, USA. To estimate the prevalence and predictors of hepatitis C virus (HCV) infection among inmates, a cross-sectional survey was conducted in 1994 among inmates entering six reception centers of the California Department of Corrections. Discarded serum samples were tested for antibodies to human immunodeficiency virus (HIV), HCV, hepatitis B core, and hepatitis B surface antigen (HBsAg). Of 4,513 inmates in this study, 87.0% were men and 13.0% were women. Among male inmates, 39.4% were anti-HCV-positive; by race/ethnicity, prevalences were highest among whites (49.1%). Among female inmates, 53.5% were anti-HCV-positive; the prevalence was highest among Latinas (69.7%). In addition, rates for HIV were 2.5% for men and 3.1% for women; and for HBsAg, 2.2% (men) and 1.2% (women). These data indicate that HCV infection is common among both men and women entering prison. The high seroprevalence of anti-HCV-positive inmates may reflect an increased prevalence of high-risk behaviors and should be of concern to the communities to which these inmates will be released. PMCID: PMC1305533 PMID: 10214102 [PubMed - indexed for MEDLINE] 403. QJM. 1999 Jan;92(1):25-32. Prevalence of hepatitis C in prisons: WASH-C surveillance linked to self-reported risk behaviours. Gore SM, Bird AG, Cameron SO, Hutchinson SJ, Burns SM, Goldberg DJ. MRC Biostatistics Unit, Cambridge, UK. We used cross-sectional willing anonymous salivary hepatitis C (WASH-C) surveillance linked to self-completed risk-factor questionnaires to estimate the prevalence of salivary hepatitis C antibodies (HepCAbS) in five Scottish prisons from 1994 to 1996. Of 2121 available inmates, 1864 (88%) participated and 1532/1864 (82%) stored samples were suitable for testing. Overall 311/1532 (20.3%, prevalence 95% CI 18.3-22.3%) were HepCAbS-positive: 265/536 (49%, 95% CI 45-54%) injector-inmates but only 27/899 (3%, 95% CI 2-4%) non-injector-inmates. Among injectors, HepCAbS positivity was only slightly higher (p = 0.03) in those who had injected inside prison (53%, 162/305) than in those who had not (44%, 98/224). Those who began injecting in 1992-96 were much less likely to be HepCAbS-positive than those who started pre-1992 (31%, 35/114 vs. 55%, 230/422; p < 0.001). Even with injectors who began in 1992-96 but had never injected inside prison, the prevalence of hepatitis C carriage was 17/63 (95% CI 16-38%). The

prevalence and potential transmissibility of hepatitis C in injector-inmates are both high. Promoting 'off injecting' before 'off drugs' (both inside and outside prison), methadone prescription during short incarcerations, alternatives to prison, and support of HepCAbS-positive inmates in becoming eligible for treatment, all warrant urgent consideration. PMID: 10209669 [PubMed - indexed for MEDLINE] 404. Gastroenterology. 1999 Apr;116(4):893-9. Risk factors for acquisition of hepatitis C virus infection in blood donors: results of a case-control study. Delage G, Infante-Rivard C, Chiavetta JA, Willems B, Pi D, Fast M. Canadian Red Cross Society, McGill University, Montral, Quebec, Canada. gdelage@lspq.org BACKGROUND & AIMS: Few studies have explored risk factors predicting hepatitis C virus (HCV) infection in blood donors; their results are contradictory. The aim of this study was to evaluate the association between HCV infection and various risk factors in Canadian volunteer blood donors. METHODS: Four transfusion centers were involved in this case-control study. A total of 267 confirmed anti-HCV-positive blood donors were interviewed along with 1068 seronegative blood donors matched for sex, age, donation site, and date. Information was collected using a structured telephone interview. The main outcome measures were odds ratios (ORs) and 95% confidence intervals (CIs) for various risk factors from univariate and multivariate analyses using conditional logistic regression. RESULTS: By univariate analysis, 23 variables were associated with anti-HCV positivity. In the final multivariate analysis, only 5 factors remained independently predictive of HCV infection: previous intravenous drug use (OR, 127.5; 95% CI, 26.0-625.0), having lived in a prison or juvenile detention center (56.1; 11.4-275.7), previous blood transfusion (10.5; 4.7-23.2), sexual contact with an intravenous drug user (6.9; 3.1-15.2), and tattooing (5.7; 2.5-13). CONCLUSIONS: Most blood donors acquire infection by percutaneous exposure to contaminated blood. A role for sexual transmission is suggested by this study. PMID: 10092311 [PubMed - indexed for MEDLINE] 405. Prev Med. 1999 Jan;28(1):92-100. Hepatitis C in state correctional facilities.

Spaulding A, Greene C, Davidson K, Schneidermann M, Rich J. Division of Infectious Disease, Rhode Island Hospital, Providence, USA. Anne_Spaulding_MD@brown.edu BACKGROUND: No previous studies have examined the extent to which correctional facilities in the United States screen for and treat hepatitis C (HCV) infection. METHODS: Medical directors of state correctional facilities responded to a survey assessing the degree to which prisons screen for and treat hepatitis C. To estimate numbers of inmates eligible for interferon treatment and to examine costs associated with HCV management, we constructed a feasibility model that incorporated screening criteria used in California and Rhode Island. RESULTS: Thirty-six states and Washington, DC, responded, resulting in a survey response rate of 73%, representing 77% of all inmates in state facilities nationwide. Colorado alone reported routine screening. Only California reported conducting a systematic seroprevalence study, which found that 39.4% of male inmates were hepatitis C antibody positive in 1994. Seventy-three percent of the respondents sometimes consider treating with interferon. Four states follow a standard protocol. The feasibility model suggests that treating suitably screened inmates is a reasonable expenditure for correctional systems. CONCLUSION: Prison may be an appropriate setting for treatment of hepatitis C. If accompanying substance abuse issues are addressed, instituting HCV treatment for certain eligible incarcerated individuals may be a worthy target for public health dollars. PMID: 9973592 [PubMed - indexed for MEDLINE] 406. J Formos Med Assoc. 1998 Dec;97(12):826-9. Seroepidemiology of hepatitis C virus infection among drug abusers in southern Taiwan. Chang CJ, Ko YC, Liu HW. Department of Family Medicine, School of Public Health, Kaohsiung Medical College, Taiwan. The purpose of this study was to determine the risk factors for hepatitis C virus (HCV) infection among drug abusers in southern Taiwan. This survey included 935 drug abusers from Kaohsiung Narcotic Abstention Institute and Kaohsiung prison. The prevalence of anti-HCV antibody was 29.1% among male drug abusers and 19.4% among female drug abusers. The seroprevalence of anti-HCV antibody was 66.4% among intravenous drug abusers and 14.4% among nonintravenous drug abusers. Intravenous drug use, a history of hepatitis, having tattoos, and age were independently related to HCV seropositivity among drug abusers. The prevalence of

anti-HCV antibody concentrations significantly increased (10.8-fold) with intravenous drug abuse and with having tattoos (1.7-fold). These findings suggest that hepatitis C virus is mainly transmitted by the parenteral route among drug abusers in southern Taiwan. Due to the high rate of HCV infection among drug abusers, investigation of high-risk behavior should be routine in this group. To prevent HCV infection, emphasis on the use of sterile needles and aseptic procedures in tattooing is important in Taiwan. PMID: 9884484 [PubMed - indexed for MEDLINE] 407. J Infect. 1998 Sep;37(2):166-72. Early mortality of undiagnosed but prevalent (in 1983-1984) HIV infection in Lothian injectors who tested hepatitis B surface antigen positive (group A) or negative but were high risk for blood-borne virus transmission (group B) in 1983-1984. Gore SM, Brettle RP, Burns SM, Lewis SC. MRC Biostatistics Unit, Cambridge, U.K. OBJECTIVE: To estimate the early death-rate in HIV infected injectors whose HIV infection was during the injection-related HIV outbreak in Lothian region in Scotland in 1983-1984, which was coincident with Hepatitis B transmissions. SETTING: Regional Virus Laboratory in Edinburgh. SAMPLES: Sera from 1983-1984, originally received for Hepatitis B surface antigen testing, from individuals aged 15-55 years who were positive for Hepatitis B surface antigen in 1983-1984 (group A: census) or tested negative but were at high risk for blood-borne virus transmission according to their reason for testing (group B: 50% sample). METHODS: Survival status of individuals in groups A and B who had not been diagnosed with HIV disease by the end of December 1995 was checked against the deaths' records of the Registrar General for Scotland. Stored sera from 1983-1984 for patients who had died early (that is: in 1983-1984) were tested anonymously for HIV and Hepatitis C antibodies; and prior to testing, causes of death were scored by RPB according to the likelihood of their being HIV or drugs related. RESULTS: Three early deaths were found in group A patients who were not known to be HIV infected. None of the deaths was likely to be HIV-related; the sera were not tested in order not to risk deductive disclosure. Twenty-four early deaths were found in group B patients who were not known to be HIV-infected, five of whom were both HIV and Hepatitis C antibody positive, and one other was HIV antibody negative but Hepatitis C positive. Reclassification after unlinked anonymous testing and multiplying up of the group B results (to account for 50% sample) gave the early death rate (that is: in 1983-1986) as 15/155 (10%) for HIV-infected drug users (95% CI: 6%-13%).

CONCLUSION: Injection-related outbreaks of HIV infection in Lothian in 1983-1984 and at Glenochil Prison in 1993 were each associated with substantial--estimated 10%--early death-rate in HIV-infected injectors. Both HIV outbreaks were coincident with Hepatitis B transmissions, which may be relevant. Further investigations of the death-rate within 2 years of HIV infection are warranted in other exposure categories than injection-related and for injectors who have been immunized against Hepatitis B. PMID: 9821092 [PubMed - indexed for MEDLINE] 408. J Med Virol. 1998 Nov;56(3):246-52. Prevalence patterns and genotypes of GB virus C/hepatitis G virus among imprisoned intravenous drug users. Anastassopoulou CG, Paraskevis D, Sypsa V, Psichogiou M, Katsoulidou A, Tassopoulos N, Skoutelis A, Malliori M, Hatzakis A. Department of Hygiene and Epidemiology, Athens University Medical School, Goudi, Greece. An RT-PCR assay using primers from the 5'-UTR of the GBV-C/HGV genome was used to detect viremia, and a serological assay was used to detect past exposure to GBV-C/HGV, in sera from 106 imprisoned Greek intravenous drug users. High seroprevalence rates indicative of the parenteral route of transmission of the virus were found (32.1% for GBV-C RNA and 46.2% for anti-GBV-C E2). These rates were nonetheless lower in comparison to the corresponding rates of HCV infection markers (64.2% for HCV RNA and 77.4% for anti-HCV). Statistically significant univariate associations were observed between GBV-C-RNA positivity and younger age (P=0.006) and HCV-RNA positivity (P=0.024), as well as with higher serum alanine aminotransferase levels (P< 0.001); this latter association was shown to be independent of coinfection with HCV and of age by a multiple logistic regression model. Apparently, GBV-C/HGV had spread readily by needle-sharing in prison, while causing acute subclinical hepatitis in infected inmates. Phylogenetic analysis of the partial 5'-UTR of the GBV-C/HGV genome from 16 seropositive individuals, which delineated their grouping within genotype 2, also revealed a close genetic relationship between two sets of sequences from 4 drug addicts, 3 of whom admitted to sharing needles while imprisoned. PMID: 9783693 [PubMed - indexed for MEDLINE] 409. Gastroenterol Clin Biol. 1998 Jan;22(1):55-8.

[Infection with hepatitis C virus in a prison environment. A prospective study in Loos-lez-Lille, France]. [Article in French] Hedouin V, Gosset D. Service de Mdecine Lgale et Pntientiaire, Hpital Roger-Salengro, Lille. OBJECTIVES: The aim of this study was to assess the prevalence of hepatitis C virus (HCV) markers, and risk factors of contamination in a prison population. PATIENTS AND METHODS: Eight hundred and six prisoners were prospectively included, at the moment of their imprisonment, between December 1st 1995 and May 31st 1996. Each prisoner was included in a group "drug abusers" or "non drug abusers" based on a clinical examination. Serum anti-HCV antibodies were tested in each group. Other risk factors were also analysed (type of drug abuse, share of syringes and needles, blood transfusion, haemodialysis, and hemophilia). RESULTS: Among the 806 prisoners, 30.3% were anti-HCV positive. Four hundred and thirty nine prisoners (54.4%) were placed in the "drug abuser" group and 367 (45.5%) in the "non drug abuser" group. In the first group, 55.6% were anti-HCV positive (80% of the prisoners who were intravenous drug users and 10.8% for the others) and 4.2% were anti-HCV positive in the second group. CONCLUSIONS: Half of the prisoners entering our center were drug abusers and half were anti-HCV antibody positive. HCV infection is a major public health problem in prison. PMID: 9762167 [PubMed - indexed for MEDLINE] 410. Gastroenterol Clin Biol. 1998 Jan;22(1):41-2. [Hepatitic C in a prison environment: is screening necessary?]. [Article in French] Roudot-Thoraval F. PMID: 9762164 [PubMed - indexed for MEDLINE] 411. QJM. 1998 May;91(5):353-7. Study size and documentation to detect injection-related hepatitis C in prison. Gore SM, Bird AG.

MRC Biostatistics Unit, Institute of Public Health, Cambridge, UK. We used existing data on hepatitis C prevalence, injection-related hepatitis C transmission and needle use in prisons and new data on infectiousness, to estimate the size of study required to detect injection-related hepatitis C in UK prisons. A pilot study of 500 prisoners followed for 10 weeks would have a 65% chance of detecting a hepatitis C seroconversion, conservatively assuming one injection per prisoner per week, and a 3% transmission rate per injection, but uncertainty might persist as to whether transmission had occurred during a short incarceration or before it. If the actual transmission rate was 10%, as recently documented, then such a study would have more adequate statistical power. A definitive study of 3000 prisoners for 10 weeks would expect to detect about six seroconversions, even with conservative estimates of injection frequency and transmission rate. Adequate design and power of these studies is important because of the complacency that could result from false-negative findings. We suggest six risk-factor themes that studies should document. PMID: 9709469 [PubMed - indexed for MEDLINE] 412. Aust N Z J Public Health. 1998 Jun;22(4):517-8. Dealing with the problem of hepatitis C in prisons. Keliher L. Comment on Aust N Z J Public Health. 1998 Feb;22(1):5-7. PMID: 9659787 [PubMed - indexed for MEDLINE] 413. Addiction. 1998 Feb;93(2):243-51. A survey of bloodborne viruses and associated risk behaviours in Greek prisons. Malliori M, Sypsa V, Psichogiou M, Touloumi G, Skoutelis A, Tassopoulos N, Hatzakis A, Stefanis C. Department of Psychiatry, University of Athens, Greece. AIMS: To determine HIV and hepatitis infection prevalence and correlates with risk behaviour. DESIGN: Cross-sectional study: voluntary, anonymous HIV, hepatitis (HCV, HBV and HDV) surveillance and questionnaire on risk factors. SETTING: Korydallos Prison, Athens and Ag. Stefanos Prison, Patra, Greece.

PARTICIPANTS: Of 544 drug users imprisoned for drug related offences, all completed the questionnaire and 533 blood samples were collected. MEASUREMENTS: HIV (by anti-HIV-1), HCV (by anti-HCV), HBV (by anti-HBc, HBsAg) and HDV (by anti-HDV) prevalence. Data on demography, legal status, drug use, sharing of injecting equipment. FINDINGS: Of the 544 drug users, 375 (68.9%) had injected drugs (IDUs) at some time, 35% of whom had injected whilst in that prison. Of the 533 blood samples tested, one was positive for anti-HIV-1 (0.19%), 310 for anti-HCV (58.2%), 306/531 (57.6%) for anti-HBc, 34/527 (6.5%) for HBsAg and 12/527 (2.3%) for anti-HDV. Prevalence rates for IDUs only were 0.27% for HIV-1, 80.6% for hepatitis C, 62.7% for hepatitis B and 3.3% for hepatitis D. Ninety-two per cent of IDUs injecting in prison shared needles, indicating that IDUs inject less but share more during incarceration. Multiple logistic regression revealed needle-sharing as the most important risk factor for HCV infection in IDUs. Prior knowledge of a positive hepatitis result did not appear to inhibit IDUs from practising risky behaviours in prison. CONCLUSIONS: The epidemic of hepatitis B and C among imprisoned IDUs identified by this study constitutes a major public health problem. Prevention programmes, such as counselling, HBV vaccination, community-based methadone maintenance treatment and syringe exchange schemes, are necessary in order to prevent a further spread. PMID: 9624725 [PubMed - indexed for MEDLINE] 414. Aust N Z J Public Health. 1998 Feb;22(1):5-7. Hepatitis C, prisons, and public health. Cregan J. Comment in Aust N Z J Public Health. 1998 Jun;22(4):517-8. PMID: 9599844 [PubMed - indexed for MEDLINE] 415. Rev Esp Salud Publica. 1998 Jan-Feb;72(1):43-51. [Seroprevalence of hepatitis C virus infection at the time of entry to prison in the prison population in the north-east of Spain]. [Article in Spanish] Martn Snchez V, Ferrer Castro V, Pallas lvarez JR, Alonso Herrero LE, Andrs

Honorato M, Coterillo Gonzlez MJ, Garca Marcos LS, Gonzlez Mrquez J, Hernndez Alonso I, LLanos Gallegos M, Mallada Garca E, Martnez Martnez ML, Morillo Prez M, Prez Martnez I, Valles Martnez J. BACKGROUND: Spanish prisons have a high number of inmates whose behaviour puts them at risk of being infected by hepatitis C virus (HCV). The object of this study was to establish the prevalence of this infection and its associated factors in the prison population of the north-east of Spain. METHODS: Inmates in seven prisons in the north-east of Spain were studied. Socio-demographic and prison variables were gathered, as well as risk factors for infection by HCV. Antibodies against HCV were determined (EIA and INNO-LIA HCV III), Hepatitis B virus (VHB) (EIA), and human immunodeficiency virus (HIV) (EIA and Western-Blott). The analysis of associated factors was based on logistic regression. RESULTS: Of the total number of inmates studied, 47.9% presented HCV antibodies. There was greater prevalence in the case of the following: UDVP (89.6%); those who shared needles (94%); those infected by HIV (92.7%); carriers of Australia antigen (65.1%) and antibodies to the HBV core antigen (79.8%); those who had been in prison before (60.9%); unmarried men (54.8%); gypsies (52%); unqualified workers (50.4%); those who had no basic school qualifications (50.9%); those with tattoos (66.7%); and those with a background of self-inflicted injuries (79.3%). In the logistic regression analysis the variables associated to infection by HCV were: UDVP (OR = 33.3; I.C. 95% = 25-50), HBcAc (+) (OR = 4.1; I.C. 95% = 1.1-5.3), age (OR = 0.98; I.C. 95% = 0.96-1.00), months in prison (OR = 1.011; I.C. 95% = 1.004-1.019) and a background of previous prison sentences (OR = 2.3; I.C. 95% = 1.5-3.6). CONCLUSIONS: The prevalence of infection by HCV in prison inmates is very high. It is therefore recommended that preventive measures be increased (harm reduction programmes) and that clinical and analysis protocols be drawn up for those infected and for treatment in cases of chronic active hepatitis in order to control this serious public health problem. PMID: 9477715 [PubMed - indexed for MEDLINE] 416. Int J STD AIDS. 1998 Jan;9(1):25-30. A lasting public health response to an outbreak of HIV infection in a Scottish prison? Goldberg D, Taylor A, McGregor J, Davis B, Wrench J, Gruer L. Scottish Centre for Infection and Environmental Health, Ruchill Hospital, Glasgow, UK. Between April and June 1993, 8 cases of acute clinical hepatitis B infection and

2 seroconversions to HIV infection were detected among drug injecting inmates of HM Prison Glenochil in Scotland. To prevent the further spread of infection, an initiative which involved counselling and voluntary attributable HIV testing was conducted over a 10-day period commencing at the end of June. A team of 18 counsellors and phlebotomists was brought together rapidly as part of a unique organizational exercise in the field of public health. Fourteen cases of HIV infection were identified of which 13 were almost certainly infected in Glenochil. Following the exercise, a range of harm reduction measures for injecting prisoners was introduced; these included the availability of hepatitis B vaccine, provision of bleach tablets which could be used to clean injecting equipment, a methadone detoxification programme, increased training for prison officers and improved access to drug and harm minimization counselling for inmates. By mid-1996 all these measures had been sustained and several could be found in many other prisons throughout Scotland. Follow-up investigations showed no evidence of epidemic spread of HIV during the 12 months after the initiative. While the frequency of injecting and needle/syringe sharing may have decreased over the last 3 years, these activities are still being reported and it is highly likely that transmissions of bloodborne infections, in particular hepatitis C, continue to occur. The surveillance and prevention of infections associated with injecting drug use in the prison setting remain a high public health priority. PMID: 9518011 [PubMed - indexed for MEDLINE] 417. Int J Epidemiol. 1997 Dec;26(6):1359-66. History of syringe sharing in prison and risk of hepatitis B virus, hepatitis C virus, and human immunodeficiency virus infection among injecting drug users in Berlin. Stark K, Bienzle U, Vonk R, Guggenmoos-Holzmann I. BACKGROUND: Injecting drug users (IDU) are at risk of parenterally transmitted diseases such as hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) infection. We investigated whether a history of syringe sharing in prison is a risk factor for these infections. In the longitudinal part of the study, HBV, HCV, and HIV seroincidence rates were determined. METHODS: The participants were recruited by multisite-sampling at different agencies for IDU. Data on risk behaviour were obtained by a standardized questionnaire. Serological markers for HBV, HCV, and HIV were determined. Logistic regression analysis was performed to adjust for confounding effects. RESULTS: A history of syringe sharing in prison was significantly associated with HBV (adjusted prevalence odds ratio [POR] = 3.9, 95% confidence interval [CI]: 2-10), HCV (POR = 9.7, 95% CI: 3-33), and HIV infection (POR = 10.4, 95% CI: 4-29). The HIV seroincidence rate was 5.9 per 100 person-years. None of the IDU

receiving methadone maintenance treatment (MMT) seroconverted whereas the HIV incidence was 8.5 among IDU not in MMT (P = 0.01). CONCLUSIONS: The increased risk of HBV, HCV, and HIV infection among IDU who had shared syringes in prison warrants specific preventive action. The longitudinal data suggest that IDU in MMT have a lower risk of HIV infection. PMID: 9447418 [PubMed - indexed for MEDLINE] 418. Bull Acad Natl Med. 1997 Jun-Jul;181(6):1177-85; discussion 1186-9. [Effectiveness of measures taken in France to reduce the risks of heroin addiction via intravenous route]. [Article in French] Henrion R. French policy towards illicit drug use is based on abstinence, and on withdrawal for drug-dependent users. Its basis is the December 31, 1970 law, which is still applicable, and prohibits the use of theses drugs, even in private. It provides for prison sentences for users who do not accept to be treated. Under the pressure of new events, in particular the epidemics of AIDS, hepatitis B and C, the reappearance of tuberculosis, and an increasing marginalization of drug users, a harm reduction policy was developed. The first measure taken was to authorize over-the-counter sale of syringes and needles in pharmacies in May 1987. It was only in 1993 that programs were established: needle exchange, methadone maintenance centers, drop-in centers, sleep in, and bus for care, involvement of general practitioners, improved access to hospitals, better medical care of prisoners, participation of associations of former users, and licensing of buprenorphine high dosage for the treatment of drug dependency. The results have been clear: the number of consultations in specialized treatment centers increased, the incidence of HIV decreased spectacularly, overdoses decreased substantially, and arrests for heroin use and misdemeanours declined. However, harm reduction policies do not solve all the problems. They are applicable only to intravenous heroin users, and don't avoid using others licit or illicit drugs. Substitute drugs can be injected or resold. Finally, the prevalence of hepatitis C infection has not significantly decreased and the decrease in HIV infections is less marked among young users and women. PMID: 9453840 [PubMed - indexed for MEDLINE] 419. Int J STD AIDS. 1997 Mar;8(3):166-75.

Anonymous HIV surveillance with risk-factor elicitation: at Perth (for men) and Cornton Vale (for women) prisons in Scotland. Gore SM, Bird AG, Burns S, Ross AJ, Goldberg D. MRC Biostatistics Unit, Institute of Public Health, Cambridge, UK. 434 male and 145 female prisoners were available to participate in cross-sectional, voluntary anonymous HIV surveillance (using saliva samples) with linked self-completion questionnaire at HMP (Her Majesty's Prison) Perth on 17 May and at HMP Cornton Vale on 18 May 1995. Three hundred and four men (70%) and 136 women (94%) completed a risk-factor questionnaire and 304 and 135 samples were received for HIV antibody testing. Two hundred and eighty-two and 132 questionnaires passed logical checks. Six saliva samples from Perth (all injectors) out of 304 and none from Cornton Vale out of 134 tested were HIV antibody positive. Four were presumptively from known HIV-infected male inmates; the other 2 were local men, under 26 years, who began injecting in 1989-91, and both reported having had a recent HIV test. Overall HIV prevalence was estimated at 2% compared to a known prevalence of 1.4% (6/434), giving a 1.5 ratio of overall: disclosed HIV prevalence at HMP Perth. HIV prevalence was estimated at 7% (6/82) for injector-participants and 14% (5/35) for local injector participants. At Cornton Vale, where both known HIV-infected inmates abstained, overall and disclosed HIV prevalence, were equal at 1.4%. At Perth Prison, 29% of prisoners had injected drugs (82/278); 85% of injector-inmates reported having injected inside (some prison and 31% (25/80) had started to inject while inside, 7 during their present sentence. Of all 21 injector-inmates who first injected after 1991, 10 had started to inject inside, including one of 69 male inmates who had never been inside before. The corresponding figures for Cornton Vale, where 46% of inmates were injectors (58/132), were that 57% of injector-inmates had injected inside (32/56) but only one woman, for whom this was not her first sentence, had started to inject inside. Twenty-eight per cent of male prisoners (78/277) and 57% of male injector-inmates (47/82) had had a personal HIV test since January 1993, as had 35% of female prisoners (43/124) and 57% of female injector-inmates (30/53). A much higher proportion of Glasgow's female prisoners (64%: 38/60) were injectors than of women prisoners from the Edinburgh, Dundee and Fife area (21%: 5/26) or from elsewhere (34%: 15/45). Rape was reported by 23% of women (30/130). Women who had been raped had a more polarized distribution of male sexual partners (none to 2 plus) in the year before sentencing than other women and were more likely to report anal sex (11/30 vs 11/100, P < 0.001). Prostitution had been engaged in by 19% of female injector-inmates (11/57) and was acknowledged by one other woman. However, only 5% of women (6/130) reported ever having been treated for an STD. PMID: 9089027 [PubMed - indexed for MEDLINE]

420. Med J Aust. 1997 Feb 3;166(3):127-30. Hepatitis B and C in New South Wales prisons: prevalence and risk factors. Butler TG, Dolan KA, Ferson MJ, McGuinness LM, Brown PR, Robertson PW. New South Wales Health Department, AIDS/Infectious Diseases Branch, Sydney. OBJECTIVES: To determine the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection among inmates entering the New South Wales correctional system and to examine risk factors for infection. DESIGN: Cross-sectional survey. SETTING: Reception Centre at Long Bay Correctional Centre, Sydney, New South Wales, June to December 1994. PARTICIPANTS: 408 adult male inmates received at the Reception Centre (28% of the 1450 new inmates eligible for compulsory HIV testing). OUTCOME MEASURES: Presence of HBV core and surface antibody and surface antigen; HCV antibody; risk factors; inmates' knowledge about risk factors. RESULTS: 37% of inmates tested positive for HCV antibody, 31% for HBV core antibody and 3.2% for HBV surface antigen (indicating recent infection or carrier status). Among those who reported a history of injecting illegal drugs, rates rose to 66% for HCV antibody and 43% for HBV core antibody. Prevalence of HBV and HCV antibodies was similar in Aboriginal and non-Aboriginal inmates, but HBV antigen carrier rate was significantly higher among Aboriginals (12% versus 2.2%). Knowledge about hepatitis risk factors was poor (only 20% named injecting drug use), although recidivists were significantly better informed than those new to the correctional system. Multivariate analysis identified injecting drug use, past exposure to hepatitis B virus and previous imprisonments as significant predictors for HCV infection, and age over 25 years and HCV antibodies for HBV infection. CONCLUSIONS: Results suggest that about a third of adult male prisoners entering the NSW correctional system may have been infected with HBV or HCV. Measures such as education about hepatitis risk factors and HBV vaccination are needed to reduce hepatitis transmission in this population. PMID: 9059433 [PubMed - indexed for MEDLINE] 421. AIDS Care. 1997 Feb;9(1):92-5. Prisons. Vancouver Conference Review. Turnbull P. Centre for Research on Drugs and Health Behaviour, University of London, UK.

Interesting and innovative programmes to tackle the problems associated with HIV/AIDS in prison have been and are being tried throughout the world. However, a number of political, legal and cultural barriers exist hindering the development of effective prevention and care and treatment approaches. PMID: 9155924 [PubMed - indexed for MEDLINE] 422. Nihon Koshu Eisei Zasshi. 1997 Jan;44(1):55-60. [Prevalence of hepatitis C virus and human immunodeficiency virus infection among female prison inmates in Japan]. [Article in Japanese] Nara K, Kawano M, Igarashi M. Department of Emergency and Critical Care Medicine, Jichi Medical School, Tochigi, Japan. To investigate the prevalence of hepatitis C virus and human immunodeficiency virus infection in female inmates, 504 out of 513 female inmates in a certain female prison in Japan were tested for anti-hepatitis C virus, anti-hepatitis B virus, anti-hepatitis A virus and anti-human immunodeficiency virus makers. They were also interviewed with regard to past history of blood transfusion, tattooing, acupuncture, intravenous drug abuse, and psychiatric disease. Prevalence of seropositives for anti-hepatitis C virus antibody was found to be significantly higher in prisoners who had a history of intravenous drug abuse (63%) compared to the controls (4.5%). There was no difference between the two groups in prevalence of seropositivity for anti-hepatitis B, anti-hepatitis A and anti-human immunodeficiency virus. Of all inmates who had a history of intravenous drug abuse, anti-hepatitis C positives used drugs longer and in greater quantities than anti-hepatitis C negatives. From these results it is concluded that intravenous drug abuse is a predominant risk factor for hepatitis C virus infection. PMID: 9094854 [PubMed - indexed for MEDLINE] 423. Aust N Z J Public Health. 1996 Oct;20(5):525-9. Investigation of notifications of hepatitis C in 1994: the experience of three health departments. Selvey LA, Lush D, Mistry SA, Sheridan JW, Krause V, Passaris I, Plant AJ.

National Centre for Epidemiology and Population Health, Australian National University, Canberra. Laboratories must notify health departments of cases of hepatitis C in Queensland, the Northern Territory (NT) and the Australian Capital Territory (ACT). Our objectives were to estimate the minimum proportion of notified cases of hepatitis C that were recent infections and to determine the risk factors for infection of the notified cases. We conducted a retrospective investigation of all eligible notifications received at the health departments in Queensland, the Northern Territory and the Australian Capital Territory. Of the 963 notifications about which information was received, 16 per cent were repeat notifications. These were excluded from further analysis. In Queensland, 7 per cent, and in both NT and ACT, 3 per cent of the notifications were considered to be recent infections. The most common risk factor reported for both recent and all other hepatitis C cases was a history of injecting drug use, although the proportion of cases with that history was different in NT from ACT and Queensland. Cases were tested because of screening programs: for drugs and alcohol, in sexually transmitted diseases clinics and prison; and because of clinical indications such as a risk factor, symptoms, or results of liver function tests. Another common reason for testing was a request from a patient. A significant proportion of recorded notifications was repeat notifications. Most notifications were of patients who had become infected more than 12 months ago and the most common risk factor was injecting drug use. There was not a high proportion of cases with unknown risk factors. PMID: 8987225 [PubMed - indexed for MEDLINE] 424. Am J Forensic Med Pathol. 1996 Sep;17(3):264-8. Fatal fat embolism in acute hepatic necrosis with associated fatty liver. Schulz F, Trbner K, Hildebrand E. Gerichtsrztlicher Dienst, Behrde fr Arbeit, Gesundheit, und Soziales, Hamburg, Germany. We report two cases of generalized nonviolent hepatogenic fat embolism. A 63-year-old woman was sent to the hospital with suspected mushroom poisoning. Shock symptoms occurred quickly and could not be treated effectively; the patient died 24 h after admission. Postmortem examination showed acute yellow dystrophy of the liver with a severe preexisting fatty liver. Any intoxication including Amanita phalloides could be excluded. In all probability, a fulminant viral hepatitis caused liver dystrophy, and the decay of the fatty liver cells led to generalized fat embolism as the cause of death. The second patient, a 46-year-old

man, was reported to have suffered from an acute illness while in prison and died after having been transferred to the local hospital. Histological examinations showed an acute liver dystrophy probably caused by fulminant viral hepatitis with fatty degeneration. In this case, the cause of death was also found to be generalized fat embolism. PMID: 8870880 [PubMed - indexed for MEDLINE] 425. Aust N Z J Public Health. 1996 Jun;20(3):317-8. Hepatitis C transmission through tattooing: a case report. Thompson SC, Hernberger F, Wale E, Crofts N. Macfarlane Burnet Centre for Medical Research, Melbourne. We report the case of a prisoner for whom tattooing was the likely source of hepatitis C virus (HCV) infection. Many of the tattoos were carried out within prison using equipment that was multiply shared with other prisoners with limited access to means of disinfection. This case supports previous reports that prison is a risk factor for HCV infection and that HCV can be transmitted through tattooing. Use of unsterilised equipment for tattooing within prison must be a high-risk activity, given the high prevalence of HCV infection among those incarcerated. Harm reduction approaches are required to diminish risk in this environment. PMID: 8768424 [PubMed - indexed for MEDLINE] 426. AIDS. 1996 Mar;10(3):311-7. Frontloading: a risk factor for HIV and hepatitis C virus infection among injecting drug users in Berlin. Stark K, Mller R, Bienzle U, Guggenmoos-Holzmann I. Institute of Tropical Medicine, Free University of Berlin, Germany. OBJECTIVE: To determine whether frontloading (i.e., syringe-mediated drug-sharing) is a risk factor for HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV) infection among injecting drug users (IDU). DESIGN: Cross-sectional study. Data on sociodemographic and behavioural characteristics were obtained by a standardized questionnaire. Serum samples were tested for seromarkers for HIV, HBV and HCV. SETTING AND PARTICIPANTS: IDU were recruited at 'low-threshold' storefront

agencies (out-of-treatment sample), and at a centre for long-term drug use treatment (in-treatment sample). Individuals were included in the study if they had injected drugs within the previous 3 months. MAIN OUTCOME MEASURES: Serological evidence for HIV, HBV, HCV exposure. RESULTS: Of all IDU (n = 324), 84% had ever practised frontloading with non-sterile injecting equipment, and 46% had done so more than 100 times; 32% had front-loaded during the 6 months prior to the interview. The crude seroprevalence rates for HIV, HBV and HCV increased with the overall frequency of frontloading, and reached 22, 71 and 94%, respectively, among IDU who had frontloaded more than 100 times. After controlling for confounding effects by logistic regression, having practised frontloading more than 100 times was significantly associated with HIV infection [adjusted prevalence odds ratio (POR) 3.5; 95% confidence interval (CI), 1.4-9], and HCV infection (adjusted POR, 5.4; 95% CI, 2.3-12), but not with HBV infection. Another independent risk factor for all three virus infections was needle-sharing in prison. CONCLUSIONS: In communities where sterile injection equipment is readily available, and IDU have substantially reduced their overall levels of needle-sharing, the practice of frontloading appears to be a major risk factor for infections by blood-borne viruses among IDU. Prevention activities should specifically address this risk behaviour. PMID: 8882671 [PubMed - indexed for MEDLINE] 427. AIDS Alert. 1996 Feb;11(2):23. HIV rate in CA prisons higher than in community. [No authors listed] AIDS: Health officials in California have found that the HIV rate among the state's prison population has remained relatively stable since 1988. The most recent figures, which were gathered during a massive communicable disease screening of 118,000 inmates and employees of the state correctional system, indicate that 2.5 percent of male inmates and 3.2 percent of female inmates are HIV-positive. The health care workers were particularly concerned because both hepatitis B virus (HBV) and hepatitis C virus (HCV) are at significant levels in the prison population. HBV was found in 47 percent of the women and 32 percent of the men, while HCV was in 54 percent of the women and 39 percent of the men. Because both hepatitis and HIV are spread through sex and needles, the high hepatitis infection rate may indicate a future increase in the rate of HIV infection and AIDS cases. PMID: 11363237 [PubMed - indexed for MEDLINE] 428. Med Law. 1996;15(3):391-8.

Illegal drugs policy, AIDS and hepatitis: from prohibition to harm reduction. Oscapella E. Canadian Foundation for Drug Policy, Ottawa, Canada. PMID: 9009587 [PubMed - indexed for MEDLINE] 429. J Orthop Trauma. 1996;10(5):366-70. Hazards to the orthopaedic trauma surgeon: occupational exposure to tuberculosis. Risk reduction, testing, and treatment (a review article). Esterhai JL Jr, Reynolds MR, Chou L. Department of Orthopedic Surgery, Veterans Administration Hospital, Philadelphia, Pennsylvania, USA. Infection with tuberculosis (TB) in the United States has risen over the last decade. In the past 5 years, health care worker exposure to multidrug-resistant TB has lead to more than 100 skin-test conversions, 17 cases of active TB, and at least six deaths. As with human immunodeficiency virus, hepatitis B virus, and hepatitis C virus, the orthopaedic traumatologist is at risk of exposure and infection because, in many cases, the medical histories of patients encountered in the trauma bay cannot be determined until well into the course of care. Risk depends principally on two factors: (a) likelihood of exposure (large urban settings, prisons, concentration of persons from countries with high TB prevalence), and (b) immune status of the surgeon. Prompt recognition, isolation, and appropriate treatment of patients with infectious TB; engineering controls; and the use of personal protective respiratory equipment can help prevent the transmission of TB to health care workers. PMID: 8814582 [PubMed - indexed for MEDLINE] 430. CMAJ. 1995 Dec 1;153(11):1605-9. Voluntary anonymous linked study of the prevalence of HIV infection and hepatitis C among inmates in a Canadian federal penitentiary for women. Ford PM, White C, Kaufmann H, MacTavish J, Pearson M, Ford S, Sankar-Mistry P, Connop P. Department of Medicine, Queen's University, Kingston, ON.

OBJECTIVE: To determine the seroprevalence of HIV infection and hepatitis C among inmates of a federal penitentiary for women. DESIGN: Voluntary, anonymous, linked, point-prevalence study involving testing of blood samples for antibodies to HIV and hepatitis C virus. PARTICIPANTS: All inmates of the multilevel security federal Prison for Women, Kingston, Ont., who volunteered to participate in the study. Inmates at this long-stay facility are from across Canada. OUTCOME MEASURE: Seroprevalence rate among participants of antibodies to HIV and hepatitis C virus. RESULTS: Of the 130 inmates available for study 113 (86.9%) agreed to donate a blood sample. One woman (0.9%) was HIV positive; 45 (39.8%) were positive for hepatitis C antibody. CONCLUSIONS: It is possible to obtain a high participation rate in a voluntary, anonymous, linked point-prevalence study in a long-stay penitentiary. The HIV seroprevalence rate of 0.9% is lower than that found in studies in provincial (short-stay) prisons. However, the high rate of antibodies to hepatitis C suggests a significant level of risk behaviour, most likely injection drug use, and suggests the potential for a rapid increase in the rate of HIV infection should the number of newly admitted HIV-positive inmates who use injection drugs rise. PMCID: PMC1488017 PMID: 7489553 [PubMed - indexed for MEDLINE] 431. Can Commun Dis Rep. 1995 Jul 30;21(14):134-6. Voluntary screening for hepatitis C in a Canadian federal penitentiary for men. [Article in English, French] Pearson M, Mistry PS, Ford PM. Department of Family Medicine, Queen's University, Kingston, Ontario. PMID: 7670433 [PubMed - indexed for MEDLINE] 432. Can Commun Dis Rep. 1995 Jul 30;21(14):132-4. Seroprevalence of hepatitis C in a Canadian federal penitentiary for women. [Article in English, French]

Ford PM, White C, Kaufmann H, MacTavish J, Pearson M, Ford S, Mistry PS, Connop P. Department of Medicine, Queen's University, Kingston, Ontario. PMID: 7670432 [PubMed - indexed for MEDLINE] 433. Rev Esp Enferm Dig. 1995 Jul;87(7):505-8. [The hepatitis C virus among the prison population of Valencia]. [Article in Spanish] An C, del Olmo JA, Llovet F, Serra MA, Gilabert S, Rodrguez F, Rodrigo JM. Equipo de Salud, Centro Penitenciario de Preventivos, Picassent, Valencia. AIM: To know the prevalence of anti-VHC in the Valencia Male Penitentiary Centre. DESIGN: A prospective study in which a representative sample of the inmates is included. In each case the anti-VHC and the ALT are studied. Serological results were correlated with history of intravenous drug addiction, alcohol abuse and duration and number of internments. INMATES: 750 inmates are included; they represent 41% of the people interned in this Centre during 1991. RESULTS: A high prevalence (45%) of the serological marker for VHC infection was observed. The prevalence of anti-VHC+ among the drug addict inmates is around 90% and this situation was already found during the first year of drug addiction. Among non-drug addict inmates the prevalence is 14%. Hepatitis C virus infection has a correlation with the duration and number of internments; 75% of the inmates with high ALT values have anti-VHC+. CONCLUSIONS: Nearly half of the inmates are infected with hepatitis C virus. The drug addict inmates are infected during the first year of their habit. The majority of the inmates with elevated ALT has anti-VHC+. PMID: 7662418 [PubMed - indexed for MEDLINE] 434. BMJ. 1995 Feb 4;310(6975):285-8. Spread of bloodborne viruses among Australian prison entrants. Crofts N, Stewart T, Hearne P, Ping XY, Breshkin AM, Locarnini SA. Epidemiology and International Health Unit, Macfarlane Burnet Centre of Medical Research, Fairfield, Victoria, Australia.

OBJECTIVES: To assess spread of bloodborne viruses among prison entrants in Victoria, Australia. DESIGN: Voluntary confidential testing of all prison entrants for markers of exposure to bloodborne viruses with collection of minimal data on demography and risk factors over 12 months. SETTING: Her Majesty's Prisons, Pentridge and Fairlea, Victoria, Australia. SUBJECTS: 3429 male and 198 female prison entrants (> 99% of all prison entrants); 344 entered prison and were tested more than once. MAIN OUTCOME MEASURES: Prevalence and incidence of antibodies to HIV, hepatitis B, and hepatitis C viruses, and minimal data on risk factors. RESULTS: 1562 (46%) gave a history of use of injected drugs, 1171 (33%) had antibody to hepatitis B core antigen, 1418 (39%) were anti-hepatitis C positive including 914 (64%) of the men who injected drugs, 91 (2.5%) were positive for hepatitis B surface antigen, and 17 (0.47%) were positive for antibody to HIV. Incidence rates for infection with hepatitis B and C virus were 12.6 and 18.3 per 100 person years, respectively; in men who injected drugs and were aged less than 30 years (29% of all prison entrants) these were 21 and 41 per 100 person years. Seroconversion to hepatitis B or C was associated with young age and shorter stay in prison. Only 5% of those who were not immune to hepatitis B reported hepatitis B immunisation. CONCLUSIONS: Hepatitis B and C are spreading rapidly through some populations of injecting drug users in Victoria, particularly among men aged less than 30 years at risk of imprisonment in whom rates of spread are extreme; this group constitutes a sizeable at risk population for spread of HIV. This spread is occurring in a context of integrated harm reduction measures outside prisons for prevention of viral spread but few programmes within or on transition from prisons; it poses an urgent challenge to these programmes. PMCID: PMC2548691 PMID: 7866168 [PubMed - indexed for MEDLINE] 435. Scand J Infect Dis. 1995;27(4):331-7. Prevalence and determinants of anti-HCV seropositivity and of HCV genotype among intravenous drug users in Berlin. Stark K, Schreier E, Mller R, Wirth D, Driesel G, Bienzle U. Institute of Tropical Medicine, Free University, Berlin, Germany. A cross-sectional study was carried out to identify risk factors for seropositivity for antibodies against hepatitis C virus (HCV) and to assess to the distribution and determinants of HCV genotypes among intravenous drug users (IVDUs). The study population consisted of 405 IVDUs. Serum specimens were tested

for seromarkers for HCV, for human immunodeficiency virus (HIV), for hepatitis B virus (HBV) and for syphilis. HCV RNA determination by polymerase chain reaction (PCR) and virus typing were performed in a subsample of anti-HCV-positive specimens (n=135). Of the IVDUs, 83% were anti-HCV-positive, 18% HIV-infected, and 58% HBV (anti-HBc)-positive. Longer duration of intravenous drug use, syringe sharing in prison, and higher number of IDVU sex partners were independent risk factors for anti-HCV positivity. GCV RNA was detected in 76% of anti-HCV-positive IVDUs. HCV genotypes 1 (49%) and 3 (44%) were most commonly found. All the type 3 isolates were identified as subtype 3a, and 95% of the type 1 isolates as subtype 1b. In logistic regression analysis, HCV type 3a viraemia was significantly associated with lack of HIV infection and a higher number of sex partners. The results indicate that preventive measures are needed to reduce syringe sharing among IVDUs in prisons. Sexual contacts with other IVDUs may play a role in the HCV epidemic among IVDUs. In Germany, HCV type 3a infection appears to be much more common among IVDUs than among other HCV risk groups such as transfusion recipients or haemophiliacs. PMID: 8658065 [PubMed - indexed for MEDLINE] 436. Eur J Epidemiol. 1994 Dec;10(6):687-94. Blood-borne virus infections among Australian injecting drug users: implications for spread of HIV. Crofts N, Hopper JL, Milner R, Breschkin AM, Bowden DS, Locarnini SA. Macfarlane Burnet Centre for Medical Research, Fairfield, Victoria, Australia. To describe the epidemiology of infection with hepatitis C virus (HCV), hepatitis B virus (HBV) and human immunodeficiency virus (HIV) among injecting drug users (IDUs) in Australia, in relation to the potential for further spread of HIV in IDUs, a cross-sectional analysis was performed on data from a sample of injecting drug users, correlating markers of exposure to blood-borne viruses with sex, age, sexual orientation, primary current drug injected and duration of injecting in rural and metropolitan Victoria, Australia. The subjects were currently active IDUs from a wide spectrum of age, sex, sexual orientation, geographical location and social background, contacted and recruited through their social networks and from community agencies and prisons by trained peer workers who interviewed and collected blood from them in the field. Sera were tested for antibody to HIV, HCV and hepatitis B core antigen (HBcAg), for hepatitis B surface antigen (HBsAg), and for HCV RNA using reverse transcription and polymerase chain reaction (RT-PCR). At entry to the study, 4.5% (14/311) had antibody to HIV, 47% (146/308) to HBcAg and 68% (206/303) to HCV. Prevalence of HBsAg was 1.8% overall (5/282), and 50% (84/168) were positive for HCV RNA. By multivariate analysis, HIV seropositivity was strongly associated with a history of homosexual contact in

males and with exposure to HBV but not to HCV. Those who reported their current primary injected drug to be amphetamines were at greater and continuing risk of HIV infection than were current heroin injectors, while the reverse applied for HCV.(ABSTRACT TRUNCATED AT 250 WORDS) PMID: 7672048 [PubMed - indexed for MEDLINE] 437. J Med Virol. 1994 Dec;44(4):379-83. Hepatitis C and arboviral antibodies in the island populations of Mauritius and Rodrigues. Schwarz TF, Dobler G, Gilch S, Jger G. Max von Pettenkofer Institute for Hygiene and Medical Microbiology, Ludwig Maximilians University, Munich, Federal Republic of Germany. A serological survey for antibodies to hepatitis C virus (HCV), dengue viruses (DEN), West Nile virus (WN), and sindbis virus (SIN) was carried out in sera of selected groups of the population of the Islands of Mauritius (n = 449) and Rodrigues (n = 115), Indian Ocean. 8.3% of 564 sera were positive for anti-HCV. In Mauritius, 2.1% of sera of healthy individuals were found with anti-HCV. The highest prevalence was found in sexually transmitted disease (STD) patients and prison inmates with 46.2% and 43.8%, respectively. None of the sera from blood donors sampled from Rodrigues Island had anti-HCV. Antibodies to arboviruses were detected in sera of individuals from both islands. Anti-DEN IgG was detected in 3.8% of sera from Mauritius and 0.9% from Rodrigues. Anti-WN IgG was detected in 2.2% of sera from Mauritius and 0.9% from Rodrigues. All sera from Rodrigues were without anti-SIN IgG, 1.1% of those from Mauritius were positive. This suggests that arboviruses occur on these islands. PMID: 7534820 [PubMed - indexed for MEDLINE] 438. BMJ. 1994 Oct 1;309(6958):876. Hepatitis C and injecting drug use in prisons. McBride AJ, Ali IM, Clee W. PMCID: PMC2541076 PMID: 7524876 [PubMed - indexed for MEDLINE] 439. Eur J Epidemiol. 1993 Sep;9(5):566-9.

Prevalence and incidence of hepatitis C virus infection among male prison inmates in Maryland. Vlahov D, Nelson KE, Quinn TC, Kendig N. Department of Epidemiology, Johns Hopkins School of Hygiene and Public Health, Baltimore, Maryland 21205. To identify incidence of antibody to hepatitis C virus among 265 male prison inmates, we assayed paired serum specimens obtained at intake in 1985-1986 with follow-up specimens in 1987. Intake prevalence was 38 percent. Seroincidence was 1.1/100 person years in prison. This finding might reflect saturation of high-risk subgroups or possibly reduced frequency of exposures following incarceration. PMID: 8307145 [PubMed - indexed for MEDLINE] 440. Eur J Clin Microbiol Infect Dis. 1993 Sep;12(9):673-6. Prevalence of antibodies to hepatitis C virus and association with intravenous drug abuse and tattooing in a national prison in Norway. Holsen DS, Harthug S, Myrmel H. Health Service, Bergen National Prison, Norway. A study was performed in order to determine the prevalence of anti-hepatitis C virus (HCV) antibodies, the risk factors for HCV infection and the markers of hepatic disease in a population of prisoners. Of 101 new prisoners admitted to a Norwegian national prison over a three month period, 70 were included in the study, of whom 32 (46%) were anti-HCV positive. Intravenous drug abuse was the predominant risk factor for HCV infection, although a history of tattooing was found by logistic regression analysis to be a significant risk factor independent of intravenous drug abuse. Most anti-HCV positive prisoners had a history of previous incarcerations. Among the anti-HCV positive subjects, increased alanine aminotransferase (> 50 U/l) was found in 23 (72%). HCV infection was the major cause of hepatic abnormalities in the study population. Only 15 (47%) of the anti-HCV positive prisoners reported knowledge of previous hepatic disease. PMID: 7694850 [PubMed - indexed for MEDLINE] 441. Med J Aust. 1993 Aug 16;159(4):237-41.

Hepatitis C virus infection among a cohort of Victorian injecting drug users. Crofts N, Hopper JL, Bowden DS, Breschkin AM, Milner R, Locarnini SA. Epidemiology and International Health Unit, Macfarlane Burnet Centre for Medical Research, Fairfield, Vic. Comment in Med J Aust. 1993 Nov 1;159(9):635-6. Med J Aust. 1994 Aug 15;161(4):286; author reply 287. Med J Aust. 1994 Aug 15;161(4):286; author reply 287. OBJECTIVE: To describe the epidemiology of infection with hepatitis C virus (HCV) among injecting drug users (IDUs) in Victoria. DESIGN AND SUBJECTS: Subjects were current IDUs from a wide spectrum of age, sex and social background, enrolled in a prospective study of injecting drug use. They were contacted by peer workers through their social networks and through community agencies and prisons, and were regularly followed for interview and blood collection in the field. Sera were tested for presence of antibody to HCV (anti-HCV), for the presence of HCV RNA directly in serum, and for measures of liver function. The results were correlated with demographic variables. SETTING: Rural and metropolitan Victoria. MAIN OUTCOME MEASURES: Presence of anti-HCV and demonstration of HCV RNA. RESULTS: Two-thirds (68%, 206/303) of the current cohort of IDUs were seropositive for HCV, risk being particularly associated with duration of injecting, and independently for men with opiate use and prison history, and for women with a history of methadone therapy. HCV RNA was detected in 48% (76/160) by polymerase chain reaction (PCR); 61% (74/122) of these subjects were HCV seropositive and 5% (2/38) seronegative. Of 32 HCV seronegative subjects followed for a mean period of 291 days, five seroconverted to HCV, an incidence of 20 infections per 100 person-years. Those who seroconverted were older, more likely to be male, had been injecting longer, more often reported opiate use, and were more likely to be based in the country. Serum liver enzyme levels were higher and more likely to be abnormal in HCV seropositive than seronegative subjects, and were highest in those seropositive subjects in whom HCV RNA was detected. CONCLUSIONS: This population of IDUs has a very high rate of exposure to HCV, related to duration of injecting and independently to opiate use and prison history, perhaps reflecting increased risk in particular social networks. There is evidence of high rates of carriage of HCV, of continuing transmission of HCV, and of ongoing liver disease among these IDUs. If these IDUs are at all representative of all IDUs in Australia, we estimate that 80,000 current and former IDUs may be at risk of chronic liver disease from HCV, and that 8000-10,000 new infections may be occurring each year. Two subjects who were seronegative had HCV RNA detectable in sera. These data have important

implications for screening programs and document the need for further measures to prevent spread of blood-borne viruses including HIV among IDUs. PMID: 7692222 [PubMed - indexed for MEDLINE] 442. N Z Med J. 1993 May 26;106(956):199-201. An unusual strain of hepatitis C virus in New Zealand. Couper A, Croxson M. Department of Virology and Immunology, Auckland Hospital. AIMS: To investigate the prevalence of hepatitis C virus (HCV) viraemia in selected cohorts of New Zealand patients and to examine the strains of hepatitis C virus circulating in New Zealand. METHODS: Hepatitis C viraemia was identified using a highly sensitive polymerase chain reaction (PCR) assay to detect HCV ribonucleic acid (RNA). Selected virus isolates were analysed for strain variation by restriction fragment length polymorphism (RFLP) of PCR products and two of the amplified products were sequenced. RESULTS: A high frequency of HCV viraemia was found in patients with a history of repeated exposures to blood or blood products. RFLP analysis revealed the prevalence of an unusual strain of hepatitis C which was further confirmed by sequencing. Identification of the infecting hepatitis C strains resolved a suspected point source outbreak occurring in a maximum security prison. CONCLUSIONS: Detection of circulating hepatitis C RNA is a sensitive and specific method for identifying active hepatitis C infection. Typing hepatitis C isolates has useful epidemiological application and facilitates the detection of unusual HCV variants. PMID: 7688109 [PubMed - indexed for MEDLINE] 443. Gesundheitswesen. 1993 May;55(5):246-9. [Hepatitis A, B and C as desmoteric infections]. [Article in German] Gaube J, Feucht HH, Laufs R, Polywka S, Fingscheidt E, Mller HE. Justizvollzugsanstalt Wolfenbttel, Universitt Hamburg. There is a distinct spectrum of infectious diseases in prisons, known as

desmoteric infections. We investigated the incidence of HIV, hepatitis A, B, and C in a group of 539 prisoners and compared them with the incidences of these infections in the normal population. The incidence of HIV was 928 out of 100,000. This figure is similar to that of the normal population. Hence, HIV infection does not seem to be a desmoteric disease. In contrast to AIDS the incidences of hepatitis A, B, and C among prisoners were 2968, 1670, and 20,000, respectively. Of course, hepatitis A, B, and C occur 100-200 times more often among prisoners and thus seem to be desmoteric infections. Moreover, especially hepatitis C is correlated strongly with intravenous drug abuse. About 80% of drug abusers were HCV positive and 50% of the total of HC infections are due to drug abusers. PMID: 8334312 [PubMed - indexed for MEDLINE] 444. Enferm Infecc Microbiol Clin. 1993 Jan;11(1):8-13. [Infection by HIV and the hepatitis B, C, and D viruses in intravenous drug addicts. Seroprevalence at 1 year and its follow-up]. [Article in Spanish] Delgado-Iribarren A, Wilhelmi I, Padilla B, Caedo T, Gmez J, Elviro J. Servicio de Microbiologa, Hospital Severo Ochoa, Legans, Madrid. BACKGROUND: The aim of the present article was to study the serology of intravenous drug user patients against the hepatitis B, C, D, and HIV, during 1990 and the follow-up during the same year, and 1991. METHODS: A study of 265 patients (mean age: 25 years, range: 16-45; 206 males and 59 females) was carried out. Forty-two percent came because of detoxication treatment, 30% requested diagnosis for hepatic disturbances and the only data provided in 28% were that they were intravenous drug users. None of the patients was an inmate from prisons. RESULTS: Seroprevalences were 67.5% for the HBV, 75.6% for HCV, 17% for HDV and 50.2% for HIV. In the patients seronegative for HBV (65%) and HIV (58%) no new serologic controls were performed during the study period, while in those who underwent controls the rates of seroconversion were 43.3% and 32%, respectively. In 30% of all seroconversions to HBV coinfection with HDV was found and in 23% antibodies against HIV were observed. CONCLUSIONS: Due to the high rates of infection obtained, the authors believe that serologic follow up of intravenous drug users is advisable. PMID: 8384891 [PubMed - indexed for MEDLINE]

445. Ann Ig. 1992 Sep-Oct;4(5):289-92. [The possible risks of transmission of hematogenous viroses in a prison community]. [Article in Italian] Liguori G, Rossano F, Perrella O, Iannucci F, Tempone G, Marinelli P. Ist. di Igiene e Medicina Preventiva, Fac. di Medicina e Chirurgia, II Universit degli Studi di Napoli. PMID: 1284901 [PubMed - indexed for MEDLINE] 446. Ann Ig. 1992 Mar-Apr;4(2):73-6. [Control of the diffusion of viral hepatitis in detention and penal institutions: a problem not to be underrated]. [Article in Italian] Patti AM, Pompa MG, Santi AL. Ist. di Igiene G. Sanarelli, Universit degli Studi di Roma, La Sapienza. PMID: 1283946 [PubMed - indexed for MEDLINE] 447. Can Dis Wkly Rep. 1990 Dec 29;16(52):265-6. Seroepidemiologic study of hepatitis B and C viruses in federal correctional institutions in British Columbia. [Article in English, French] Prfontaine RG, Chaudhary RK. Correctional Services of Canada, Abottsford, British Columbia. PMID: 1963577 [PubMed - indexed for MEDLINE] 448. Ann Ig. 1990 Sep-Oct;2(5):359-63. [Prevalence of hepatitis virus (HBV and HCV) and HIV-1 infections in a prison

community]. [Article in Italian] Pinducciu G, Arnone M, Piu G, Usai M, Melis A, Pintus L, Pitzus F. Ist. di Igiene e Medicina Preventiva, Universit di Cagliari. PMID: 1715727 [PubMed - indexed for MEDLINE] 449. Ann Intern Med. 1985 Sep;103(3):391-402. Recommendations for protection against viral hepatitis. Recommendation of the Immunization Practices Advisory Committee. Centers for Disease Control, Department of Health and Human Services. [No authors listed] This following statement updates all previous recommendations on use of immune globulins for protection against viral hepatitis and use of hepatitis B vaccine and hepatitis B immune globulin for prophylaxis of hepatitis B. Recommendations cover hepatitis A; hepatitis B; non-A, non-B hepatitis; and delta hepatitis. Specific indications are included for use of immune globulin, hepatitis B immune globulin, and hepatitis B vaccine for high-risk groups, including medical and dental personnel, hemodialysis patients, workers at daycare centers, workers at institutions for the mentally retarded, prison inmates, homosexual men, intravenous drug abusers, international travelers, household and sexual contacts of persons at risk, and heterosexually active persons. Recommendations are given for maternal and fetal screening for serologic markers of hepatitis B virus, and guidelines for treatment are provided. PMID: 3161440 [PubMed - indexed for MEDLINE]