A multicentre interventional study to assess blood-borne viral infections in Belgian prisons

Dana Busschots, Cécile Kremer, Rob Bielen, Özgür M Koc, Leen Heyens, Christian Brixko, Pierre Laukens, Hans Orlent, Pascal Bilaey, Francis De Smet, Geert Hellemans, Gaetan Muyldermans, Luk Van Baelen, Niel Hens, Hans Van Vlierberghe, Geert Robaeys, Dana Busschots, Cécile Kremer, Rob Bielen, Özgür M Koc, Leen Heyens, Christian Brixko, Pierre Laukens, Hans Orlent, Pascal Bilaey, Francis De Smet, Geert Hellemans, Gaetan Muyldermans, Luk Van Baelen, Niel Hens, Hans Van Vlierberghe, Geert Robaeys

Abstract

Background: Prevalence data on viral hepatitis B (HBV), hepatitis C (HCV), and HIV infection in prison are often scarce or outdated. There is currently no systematic screening for these blood-borne viral infections (BBV) in Belgian prisons. There is an urgency to assess the prevalence of these BBV to inform policymakers and public healthcare.

Methods: This was a multicentre, interventional study to assess the prevalence of BBV using opt-in screening in prisons across Belgium, April 2019 - March 2020. Prisoners were tested using a finger prick and BBV risk factors were assessed using a questionnaire. A generalized linear mixed model was used to investigate the association between the various risk factors and HCV.

Results: In total, 886 prisoners from 11 Belgian prisons were screened. Study uptake ranged from 16.9 to 35.4% in long-term facilities. The prevalence of HCV antibodies (Ab), hepatitis B surface antigen (Ag) and HIV Ab/Ag was 5.0% (44/886), 0.8% (7/886), and 0.2% (2/886). The adjusted odds for HCV Ab were highest in prisoners who ever injected (p < 0.001; AOR 24.6 CI 95% (5.5-215.2). The prevalence of detectable HCV RNA in the total cohort was 2.1% (19/886). Thirteen (68.4%) prisoners were redirected for follow-up of their HCV infection.

Conclusions: Opt-in testing for viral hepatitis B, C and HIV was relatively well-accepted in prisons. Compared with the general population, prisoners have a higher prevalence of infection with BBV, especially for HCV. Systematic screening for these BBV should be recommended in all prisons, preferably using opt-out to optimize screening uptake.

Trial registration: Retrospectively registered at clinical trials NCT04366492 April 29, 2020.

Keywords: Blood borne viral infections; HIV; Hepatitis B; Hepatitis C; Prison; Recommendations; Screening.

Conflict of interest statement

D.B. has received travel grants from AbbVie and Gilead Sciences and research grants from Gilead; R.B. has received travel grants from AbbVie, Gilead Sciences and Merck Sharp & Dohme (MSD) and research grants from Gilead and MSD; O.K. has received a travel grant from Gilead Sciences and his institution received research grants from Gilead Sciences and CyTuVax BV; C.B. has received travel grants from AbbVie and Gilead Sciences; N.H. has received grants from GlaxoSmithKline (GSK), Johnson & Johnson pharmaceuticals and Pfizer,; H.V.V has not received grants, but the department has received grants from Gilead, Janssen Pharmaceuticals, Roche, Abbvie, Merck, Falk, Ferring, Bayer; G.R. has received research grants from AbbVie, Janssen Pharmaceuticals, MSD, and consultancy agreements for AbbVie, BMS, Gilead Sciences and MSD. All other co-authors report no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Cascade of care of hepatitis C in prison. Abbreviations: HCV hepatitis C virus, Ab antibody

References

    1. Walmsley Roy. World prison population list (12th edition) London: Institute for Criminal Policy Research; 2018.
    1. World prison brief data: Belgium [].
    1. Larney S, Kopinski H, Beckwith CG, Zaller ND, Jarlais DD, Hagan H, Rich JD, van den Bergh BJ, Degenhardt L. Incidence and prevalence of hepatitis C in prisons and other closed settings: results of a systematic review and meta-analysis. Hepatology. 2013;58(4):1215–1224. doi: 10.1002/hep.26387.
    1. Rich JD, Beckwith CG, Macmadu A, Marshall BDL, Brinkley-Rubinstein L, Amon JJ, Milloy MJ, King MRF, Sanchez J, Atwoli L, Altice FL. Clinical care of incarcerated people with HIV, viral hepatitis, or tuberculosis. Lancet. 2016;388(10049):1103–1114. doi: 10.1016/S0140-6736(16)30379-8.
    1. Dolan K, Wirtz AL, Moazen B, Ndeffo-Mbah M, Galvani A, Kinner SA, Courtney R, McKee M, Amon JJ, Maher L, et al. Global burden of HIV, viral hepatitis, and tuberculosis in prisoners and detainees. Lancet. 2016;388(10049):1089–1102. doi: 10.1016/S0140-6736(16)30466-4.
    1. Busschots D, Toghanian S, Bielen R, Salomonsson S, Koc OM, Hendrickx G, Jadoul M, Nevens F, Sokal E, Brixko C, Peerlinck K, Apers L, Robaeys G, Lazarus JV. Eliminating viral hepatitis C in Belgium: the micro-elimination approach. BMC Infect Dis. 2020;20(1):181. doi: 10.1186/s12879-020-4898-y.
    1. Muyldermans G, Bielen R, Botterman R, Bourgeois S, Colle I, Deressa B, Devolder G, Horsmans Y, Hutse V, Lanthier N, et al. Hepatitis C virus (HCV) prevalence estimation in the adult general population in Belgium : a meta-analysis. Acta Gastroenterol Belg. 2019;82(4):479–485.
    1. ECDC . Edited by control ECfDPa. Stockholm: European Centre for Disease Prevention and Control; 2016. Systematic review on hepatitis B and C prevalence in the EU/EEA.
    1. Arain A, Robaeys G, Stover H. Hepatitis C in European prisons: a call for an evidence-informed response. BMC Infect Dis. 2014;14(Suppl 6):S17. doi: 10.1186/1471-2334-14-S6-S17.
    1. WHO. Prisons and health. Copenhagen: WHO; 2014.
    1. ECDC . Surveillance and prevention of hepatitis B and C in Europe. Stockholm: European Centre for Disease Prevention and Control; 2010.
    1. Stone K. The global state of harm reduction 2016. London: Harm Reduction International; 2016.
    1. Walker M, Kautz A, Chavdarova L. Hepatitis B and C - an action plan for saving lives in europe. 2015. p. 44.
    1. Costella A, Craine N, Goldberg D, Harris H, Hutchinson S, Jessop L, Mandal S, Ramsay M, Salmon J. Hepatitis C in the UK; 2017 report. 2017. p. 34.
    1. Rumble C, Pevalin DJ, O'Moore E. Routine testing for blood-borne viruses in prisons: a systematic review. Eur J Pub Health. 2015;25(6):1078–1088. doi: 10.1093/eurpub/ckv133.
    1. de la Flor C, Porsa E, Nijhawan AE. Opt-out HIV and hepatitis C testing at the Dallas County jail: uptake, prevalence, and demographic characteristics of testers. Public Health Rep. 2017;132(6):617–621. doi: 10.1177/0033354917732755.
    1. Morris MD, Brown B, Allen SA. Universal opt-out screening for hepatitis C virus (HCV) within correctional facilities is an effective intervention to improve public health. Int J Prison Health. 2017;13(3–4):192–199. doi: 10.1108/IJPH-07-2016-0028.
    1. Martin NK, Vickerman P, Brew IF, Williamson J, Miners A, Irving WL, Saksena S, Hutchinson SJ, Mandal S, O'Moore E, et al. Is increased hepatitis C virus case-finding combined with current or 8-week to 12-week direct-acting antiviral therapy cost-effective in UK prisons? A prevention benefit analysis. Hepatology. 2016;63(6):1796–1808. doi: 10.1002/hep.28497.
    1. He T, Li K, Roberts MS, Spaulding AC, Ayer T, Grefenstette JJ, Chhatwal J. Prevention of hepatitis C by screening and treatment in U.S. prisons. Ann Intern Med. 2016;164(2):84–92. doi: 10.7326/M15-0617.
    1. Rich JD, Allen SA, Williams BA. Responding to hepatitis C through the criminal justice system. N Engl J Med. 2014;370(20):1871–1874. doi: 10.1056/NEJMp1311941.
    1. Larney S, Beckwith CG, Zaller ND, Montague BT, Rich J. “Seek, test, treat and retain” for hepatitis C in the United States criminal justice system. Int J Prison Health. 2014;10(3):164–171. doi: 10.1108/IJPH-11-2013-0051.
    1. Lazarus JV, Wiktor S, Colombo M, Thursz M, Foundation EIL Micro-elimination - a path to global elimination of hepatitis C. J Hepatol. 2017;67(4):665–666. doi: 10.1016/j.jhep.2017.06.033.
    1. WHO . Guidelines for the screening, care and treatment of persons with chronic hepatitis C infection. Geneva: World Health Organization; 2016. p. 138.
    1. Smith JM, Uvin AZ, Macmadu A, Rich JD. Epidemiology and treatment of hepatitis B in prisoners. Curr Hepatol Rep. 2017;16(3):178–183. doi: 10.1007/s11901-017-0364-8.
    1. Koc OM, Kremer C, Bielen R, Buscchots D, Hens N, Nevens F, Robaeys G. Prevalence and risk factors of hepatitis B virus infection in middle-Limburg Belgium, year 2017: importance of migration. J Med Virol. 2019;91(8):1479–1488. doi: 10.1002/jmv.25457.
    1. Sasse A, Deblonde J, De Rouck M, Montourcy M, Van Beckhoven D. Epidemiologie van AIDS en HIV-infectie in België. Brussels: Wetenschappelijk Instituut Volksgezondheid; 2018.
    1. Sayyah M, Rahim F, Kayedani GA, Shirbandi K, Saki-Malehi A. Global view of HIV prevalence in prisons: a systematic review and meta-analysis. Iran J Public Health. 2019;48(2):217–226.
    1. Meyer JP, Cepeda J, Wu J, Trestman RL, Altice FL, Springer SA. Optimization of human immunodeficiency virus treatment during incarceration: viral suppression at the prison gate. JAMA Intern Med. 2014;174(5):721–729. doi: 10.1001/jamainternmed.2014.601.
    1. Small W, Wood E, Betteridge G, Montaner J, Kerr T. The impact of incarceration upon adherence to HIV treatment among HIV-positive injection drug users: a qualitative study. AIDS Care. 2009;21(6):708–714. doi: 10.1080/09540120802511869.
    1. Belenko S, Dembo R, Copenhaver M, Hiller M, Swan H, Albizu Garcia C, O'Connell D, Oser C, Pearson F, Pankow J. HIV stigma in prisons and jails: results from a staff survey. AIDS Behav. 2016;20(1):71–84. doi: 10.1007/s10461-015-1098-7.
    1. Culbert GJ, Bazazi AR, Waluyo A, Murni A, Muchransyah AP, Iriyanti M, Finnahari, Polonsky M, Levy J, Altice FL. The influence of medication attitudes on utilization of antiretroviral therapy (ART) in Indonesian prisons. AIDS Behav. 2016;20(5):1026–1038. doi: 10.1007/s10461-015-1198-4.
    1. UNODC . The United Nations standard minimum rules for the treatment of prisoners (the Nelson Mandela Rules) Vienna: United Nations Office on Drugs and Crime; 2015. p. 38.
    1. CDC . CDC yellow book 2020. 2019.
    1. Arya R, Antonisamy B, Kumar S. Sample size estimation in prevalence studies. Indian J Pediatr. 2012;79(11):1482–1488. doi: 10.1007/s12098-012-0763-3.
    1. Pourhoseingholi MA, Vahedi M, Rahimzadeh M. Sample size calculation in medical studies. Gastroenterol Hepatol Bed Bench. 2013;6(1):14–17.
    1. Rutterford C, Copas A, Eldridge S. Methods for sample size determination in cluster randomized trials. Int J Epidemiol. 2015;44(3):1051–1067. doi: 10.1093/ije/dyv113.
    1. Kronfli N, Linthwaite B, Kouyoumdjian F, Klein MB, Lebouché B, Sebastiani G, Cox J. Interventions to increase testing, linkage to care and treatment of hepatitis C virus (HCV) infection among people in prisons: a systematic review. Int J Drug Policy. 2018;57:95–103. doi: 10.1016/j.drugpo.2018.04.003.
    1. Mason LM, Duffell E, Veldhuijzen IK, Petriti U, Bunge EM, Tavoschi L. Hepatitis B and C prevalence and incidence in key population groups with multiple risk factors in the EU/EEA: a systematic review. Euro Surveill. 2019;24(30):1800614. doi: 10.2807/1560-7917.ES.2019.24.30.1800614.
    1. Masarone M, Caruso R, Aglitti A, Izzo C, De Matteis G, Attianese MR, Pagano AM, Persico M. Hepatitis C virus infection in jail: difficult-to-reach, not to-treat. Results of a point-of-care screening and treatment program. Dig Liver Dis. 2020;52(5):541–546. doi: 10.1016/j.dld.2020.02.012.
    1. Fiore V, De Matteis G, Ranieri R, Saderi L, Pontali E, Muredda A, Ialungo AM, Caruso R, Madeddu G, Sotgiu G, et al. HCV testing and treatment initiation in an Italian prison setting: a step-by-step model to micro-eliminate hepatitis C. Int J Drug Policy. 2021;90:103055. doi: 10.1016/j.drugpo.2020.103055.
    1. Gower E, Estes C, Blach S, Razavi-Shearer K, Razavi H. Global epidemiology and genotype distribution of the hepatitis C virus infection. J Hepatol. 2014;61(1 Suppl):S45–S57. doi: 10.1016/j.jhep.2014.07.027.
    1. Semaille C, Le Strat Y, Chiron E, Chemlal K, Valantin MA, Serre P, Cate L, Barbier C, Jauffret-Roustide M. Prevalence of human immunodeficiency virus and hepatitis C virus among French prison inmates in 2010: a challenge for public health policy. Euro Surveill. 2013;18(28):20524. doi: 10.2807/1560-7917.ES2013.18.28.20524.
    1. Izquierdo L, Mellon G, Buchaillet C, Fac C, Soutiere MP, Pallier C, Dulioust A, Roque-Afonso AM. Prevalence of hepatitis E virus and reassessment of HIV and other hepatitis virus seroprevalences among French prison inmates. PLoS One. 2019;14(6):e0218482. doi: 10.1371/journal.pone.0218482.
    1. Chacowry Pala K, Baggio S, Tran NT, Girardin F, Wolff H, Getaz L. Blood-borne and sexually transmitted infections: a cross-sectional study in a Swiss prison. BMC Infect Dis. 2018;18(1):539. doi: 10.1186/s12879-018-3445-6.
    1. Morey S, Hamoodi A, Jones D, Young T, Thompson C, Dhuny J, Buchanan E, Miller C, Hewett M, Valappil M, Hunter E, McPherson S. Increased diagnosis and treatment of hepatitis C in prison by universal offer of testing and use of telemedicine. J Viral Hepat. 2019;26(1):101–108. doi: 10.1111/jvh.13017.
    1. Pontali E, Fiore V, Ialungo AM, Ranieri R, Mollaretti O, Barbarini G, Marri D, Prestileo T, Dell'Isola S, Rastrelli E, Leo G, Starnini G, Babudieri S, Madeddu G, Gruppo Infettivologi Penitenziari Treatment with direct-acting antivirals in a multicenter cohort of HCV-infected inmates in Italy. Int J Drug Policy. 2018;59:50–53. doi: 10.1016/j.drugpo.2018.06.017.
    1. Overton K, Clegg J, Pekin F, Wood J, McGrath C, Lloyd A, Post JJ. Outcomes of a nurse-led model of care for hepatitis C assessment and treatment with direct-acting antivirals in the custodial setting. Int J Drug Policy. 2019;72:123–128. doi: 10.1016/j.drugpo.2019.02.013.
    1. Papaluca T, McDonald L, Craigie A, Gibson A, Desmond P, Wong D, Winter R, Scott N, Howell J, Doyle J, Pedrana A, Lloyd A, Stoove M, Hellard M, Iser D, Thompson A. Outcomes of treatment for hepatitis C in prisoners using a nurse-led, statewide model of care. J Hepatol. 2019;70(5):839–846. doi: 10.1016/j.jhep.2019.01.012.
    1. Fiore V, Ranieri R, Dell'Isola S, Pontali E, Barbarini G, Prestileo T, Marri D, Starnini G, Sotgiu G, Madeddu G, et al. Feasibility and efficacy of 8 week Glecaprevir/Pibrentasvir to treat incarcerated viraemic HCV patients: a case-control study. Liver Int. 2021;41(2):271–275. doi: 10.1111/liv.14745.

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