Global prevalence of hepatitis C in prisoners: a comprehensive systematic review and meta-analysis

Prevalence of hepatitis C virus seropositivity and active infection in a Rohingya refugee population in Cox's Bazar camps, Bangladesh: a cross-sectional study

BACKGROUND

Hepatitis C virus (HCV) infection is a significant public health concern. Limited data have shown unusually high HCV seroprevalence among Rohingya refugees residing in camps in Cox's Bazar, Bangladesh. We aimed to assess the prevalence of HCV seropositivity and active infection and identify risk factors to inform the HCV response.

METHODS

A cross-sectional survey was conducted between May 10 and June 14, 2023, in adult (≥18 years) residents of seven camps in Cox's Bazar. Households were selected by simple random geosampling and one participant per household was selected at random. Participants were screened for HCV antibodies with a rapid finger prick blood test and, if seropositive, venous samples were tested for HCV viral load. A structured questionnaire collected information about demographics, HCV knowledge, and exposure risks. Survey-adjusted prevalence estimates of HCV seropositivity and active infection were generated by applying sampling weights. Factors associated with HCV seropositivity were identified using univariable and multivariable current status analysis and those associated with active infection via logistic regression.

FINDINGS

The survey included 641 participants, of whom 425 (66%) were women and for whom the median age was 34 years (IQR 28-46). 191 individuals tested positive for HCV antibodies. 187 of these individuals were tested for active infection and 124 had a detectable HCV viral load. The survey-adjusted prevalence estimate of HCV seropositivity was 30·4% (95% CI 26·5-34·5), and that of active infection 19·8% (95% CI 16·5-23·4). Current status analysis identified higher odds of HCV seropositivity among individuals reporting medical injection(s) (adjusted odds ratio 1·8 [95% CI 1·2-2·8]) or surgery (5·9 [1·9-18·4]), and among women (2·1 [1·3-3·2]). 328 (51%) of 641 participants had never heard of hepatitis C. Five (4%) of 124 participants with HCV viraemia reported previous HCV treatment.

INTERPRETATION

There is a substantial burden of active HCV infection among adult Rohingya camp residents, highlighting the urgent need to scale up testing and treatment capacities. The survey had constraints in identifying risk factors and could not provide data on HCV incidence. Reassessing infection prevalence after mass interventions and prospective surveillance are recommended to monitor ongoing transmission. A well-concerted multi-stakeholder action plan is needed to prevent future large-scale burden of severe liver disease and halt ongoing transmission.

FUNDING

Médecins Sans Frontières.

Blood-Borne Infection Prevention in Combat Sports: Position Statement of the Association of Ringside Physicians

ABSTRACT

The Association of Ringside Physicians (ARP) emphasizes the importance of screening combat sports athletes for blood-borne infections, including hepatitis B, HIV, and hepatitis C, to mitigate transmission risks and ensure participant safety. Although transmission of hepatitis B and C and HIV in combat sports is rare, protecting athletes is of utmost importance. It is the recommendation of the ARP that all fighters participating in combat sports, in which the presence of blood is a common occurrence and is allowed during competition, should undergo testing for HIV, hepatitis B (HBV), and hepatitis C (HCV). Testing should be conducted using serum samples, because rapid tests are not considered acceptable for accurate results. Testing for HBV, HCV, and HIV should optimally be done within 3 months of competition, but within 6 months is acceptable. Athletes whose tests suggest active HBV, HCV, or HIV infection should be disqualified from competition in sports where blood is common and allowed. Athletes with cured prior HCV infection may be cleared for competition in all combat sports. Athletes with prior HBV infection and no detectable HBV DNA in blood can be cleared for competition in all combat sports. Athletes with latent HBV infection with detectable HBV DNA in blood have a small risk of disease reactivation, so they should not be cleared.

Economic evaluation of mass screening as a strategy for hepatitis C virus elimination in South Korea

BACKGROUND

This study examines Hepatitis C virus (HCV) screening scenarios to meet World Health Organization (WHO) elimination targets (incidence ≤5 per 100,000, mortality ≤2 per 100,000) and assesses their timeframes and cost-effectiveness.

METHODS

A closed cohort model of Koreans aged 30-79 in 2020 projected HCV incidence and mortality over 20 years. Economic evaluations used a dynamic transmission model, considering prevalent and annual incident cases. This approach addresses the limitations of previous models that neglected annual new HCV infections. Nine scenarios with varying screening intervals were created considering health checkup uptake, treatment rates, and HCV incidence reduction. Economic evaluations from the healthcare system's perspective employed cost-utility and cost-benefit analyses.

RESULTS

Without national HCV screening, incidence slightly decreases, whereas mortality triples over 20 years. Introducing HCV screening offers five scenarios to meet WHO targets in 20 years. The quickest, involving biennial screening, high uptake, and a 30% incidence reduction, meets the incidence target at 6 years and mortality target at 14 years. For the most cost-efficient scenario, screening every 4 years with moderate uptake and a 20% incidence reduction meets the incidence target at 17 years and mortality target at 18 years. The Incremental Cost-Effectiveness Ratio (ICER) is $8,867 per quality-adjusted life-year (QALY), with a Benefit-Cost Ratio (BCR) of 1.60.

CONCLUSION

The absence of HCV screening impedes elimination goals and increases mortality. Biennial screening, with high participation and treatment rates, rapidly achieves targets but is less economically efficient. Screening every 4 years with moderate uptake and treatment rates is economically feasible and meets elimination goals within 20 years. Rapid screening implementation is crucial for effective HCV elimination.

HBV, HCV and HIV among inmates in Latin America and the Caribbean: A systematic review and meta-analysis

OBJECTIVES

Hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) affect 340 million people worldwide and have a high impact on vulnerable populations. The aim of this systematic review and meta-analysis was to estimate the prevalence of these infections among inmates in Latin America and the Caribbean.

METHODS

Searches were conducted in Medline, Embase, LILACS and Web of Science databases on 17 May 2024, without time or language restriction, according to PRISMA guidelines. The Joanna Briggs Institute Critical Appraisal Checklist was used to assess the bias risk in the selected studies. Meta-analysis was performed by using the random-effects model and heterogeneity between studies was assessed with I2 statistic. Subgroup analyses and meta-regression were performed to investigate possible sources of heterogeneity.

RESULTS

Seventy-nine studies were included, encompassing over 230,000 inmates. The estimated prevalences of HBV, HCV and HIV were 1.0% (95% CI: 0.0-1.0), 7.0% (95% CI: 6.0-8.0) and 4.0% (95% CI: 3.0-4.0), respectively. Subgroup analysis showed the following prevalences: HBV among females was 1.0% (95% CI: 0.0-3.0) and among males was 10.0% (95% CI: 3.0-17.0); HCV among females and males was 12.0% (95% CI: 7.0%-17.0%); and HIV among females was 10.0% (95% CI: 5.0-15.0) and among males was 8.0% (95% CI: 6.0-10.0).

CONCLUSIONS

A substantial proportion of inmates in Latin America and the Caribbean are infected with HBV, HCV or HIV, underscoring the need for viral infection testing, primary care for inmates and increased efforts to promote public health policies for the prison system.

Hepatitis C Virus Infection in Hemodialysis Patients in the Era of Direct-Acting Antiviral Treatment: Observational Study and Narrative Review

Background and Objectives: Hepatitis C virus (HCV) infection is a major global public health concern, particularly in hemodialysis (HD) patients. This study aims to evaluate the demographic, clinical, and laboratory characteristics of HCV-positive patients undergoing HD and assess the long-term impact of direct-acting antivirals (DAAs) on patient outcomes. Moreover, a narrative review aims to summarize the current knowledge regarding HCV treatment in HD patients. The search in the PubMed, Google Scholar, and Scopus databases identified 48 studies relevant to our topic, 18 regarding clinical history and 29 related to HCV treatment. Methods: A retrospective analysis was performed on 165 HD patients from Bihor County HD centers, Romania, between 2014 and 2024. The cohort was divided into two groups: 54 patients who tested positive for HCV and 111 controls who were HCV-negative. Data collected from GPs included demographic information, comorbidities, laboratory parameters, and psychological assessments. Outcomes were evaluated at over 5 years after DAA treatment. A literature review was conducted using PubMed and Google Scholar to identify relevant studies on HCV in HD patients from 1989 to 2024. Results: Laboratory results showed similar parameters across groups, except for lower serum cholesterol levels in the HCV-positive DAA-treated group vs. HCV-positive non-treated ones (155.607 mg% vs. 170.174 mg%, p = 0.040) and increased ALT levels when comparing the same groups (29.107 vs. 22.261, p = 0.027), whereas comorbidities did not differ significantly. The incidence of malignancies was significantly higher among HCV-positive compared to HCV-negative patients (20.3% vs. 8.1%, p = 0.023), mainly among those treated with DAAs, highlighted by the multivariate analysis. Cardiovascular disease remains the leading cause of mortality regardless of HCV status or the use of antiviral therapy. Psychological assessments revealed more severe depression in HCV-positive patients compared to their HCV-negative counterparts. Conclusions: HCV infection in the hemodialysis population typically follows a subclinical course. At over five years after DAA therapy, the results indicate a stabilization of the liver function and the absence of major complications. However, the incidence of malignancies remains high in HCV-positive patients.

Prevalence of blood-borne virus infections and uptake of hepatitis C testing and treatment in Australian prisons: the AusHep study

Background

Incarcerated people are at high risk of blood-borne virus infections, particularly HCV, and a priority population for elimination efforts. This national bio-behavioural survey evaluated blood-borne virus prevalence and HCV testing-and-treatment uptake amongst people in Australian prisons.

Methods

Randomly-selected participants from 23 representative prisons nationally were offered point-of-care testing for HIV and HCV (anti-HCV) antibodies, hepatitis B surface antigen (HBsAg), and HCV RNA (if anti-HCV positive). Demographic data and previous HCV testing and treatment were collected by structured interview.

Findings

1599 individuals participated (98% participation; 89%male; median age 35 years; 49% ever injected drugs). Prevalence estimates were: 31.7% (95% CI:28.8-34.8) for anti-HCV; 8.0%for HCV RNA (95% CI:6.4-9.9); 0.5% (95% CI:0.2-1.1) for HBsAg, and 0.8% (95% CI: 0.4-1.7) for HIV antibody. Among participants who had ever injected drugs (n = 787), HCV RNA prevalence was highest among those injecting and sharing needles/syringes within the past month [27.9%; adjusted odds ratio (aOR):4.54 (95% CI:2.65-7.77). Among participants (n = 1599), 70.4% (95% CI: 67.4-73.2) had ever been tested for HCV (62.6% in prison). The highest likelihood of having had HCV testing was observed among participants who injected drugs in the past month (aOR = 10.37, 95% CI:5.72-0.18.78). Among those eligible (n = 318), 84.6% (95% CI:79.2-88.7) had ever received HCV treatment (75.0% in prison), and 67.8% (95% CI:61.7-73.4) were cured. The likelihood of HCV treatment was higher among those previously imprisoned, (aOR = 2.67, 95% CI:1.20-5.93).

Interpretation

Despite high overall HCV testing and treatment uptake, the lower uptake and substantial ongoing HCV disease burden in some sub-populations highlights the need for continued prison-based elimination efforts with population-specific interventions.

Funding

The AusHep study was funded by the Australian GovernmentDepartment of Health and Aged Care.

20 years on from the Dublin Declaration: European Committee for the Prevention of Torture and Inhuman or Degrading Treatment reporting on the provision of prison needle and syringe programmes in the Council of Europe region

Background

Prisons in Europe remain high-risk environments and conducive for infectious disease transmission, often related to injection drug use. Many infected people living in prison unaware of their infection status (HIV, hepatitis C). Despite all Council of Europe (CoE) member states providing community needle and syringe programmes (NSP), prison NSP are limited to seven countries. The study aim was to scrutinise the Committee for the Prevention of Torture and Inhuman or Degrading Treatment (CPT) reporting of periodic and ad hoc country mission visits to prisons, with an explicit focus on the extent to which member states are/were fulfilling obligations to protect prisoners from HIV/hepatitis C; and implementing prison NSP under the non-discriminatory equivalence of care principle.

Study design

Socio-legal review.

Methods

A systematic search of the CPT database was conducted in 2024 with no date restriction. All CPT reports were screened in chronological order with the terms; "needle", "syringe", "harm reduction" and "NSP". Relevant narrative content on prison NSP operations, including repeat CPT reminders and any official/publicly expressed reasons for not implementing is presented.

Results

CPT reporting reveals limited prison NSP provision in selected prisons visited on mission, with little change in status over time, despite documented evidence of prior observations around absent/insufficient harm reduction measures and explicit (often longstanding) recommendations to address deficits. Reasons for not implementing prison NSP include; existing availability of opioid substitute treatment, lack of evidence for injecting drug use, for security and maintenance of order, and contradiction with prison protocols sanctioning drug use.

Conclusions

Prison health is public health. Regular research and evaluations of prison NSP in Europe are warranted. Future CPT visits should also continue to assess availability and standards of provision; recommend where appropriate including when opioid substitute treatment is already provided, and in line with broad availability of community NSP in Europe.

A preregistered meta-meta-analysis on the global distribution of Hepatotropic Viruses

INTRODUCTION

Hepatotropic viruses (HAV, HBV, HCV, HDV, and HEV) significantly impact global health, with varying prevalence across regions.

OBJECTIVE

This study aims to systematically consolidate data from diverse meta-analyses to provide a contemporary reference on virus distribution and prevalence.

MATERIALS AND METHODS

Adhering to PRISMA guidelines, the study utilized a mixed effects model for data integration. Quality evaluation was carried out with QUOROM and AMSTAR tools, with heterogeneity assessed via the Higgins I2 statistic, Q-statistic and Tau squared (τ2) values.

RESULTS

The study analyzed 86 meta-analyses from 56 studies (2017-2022) with minimal overlap. Prevalence rates by region were as follows: MENA - 29.2%, Afghanistan - 9.14%, Africa - 8.10%. Prevalence rates by virus type: HAV - 82.5%, HBV - 8.6%, HCV - 15.1%, HDV - 8.9%, HEV - 13.9%, dual HBV-HCV coinfection - 2.2%. Prevalence rates by risk groups: general population - 8.3%, healthcare workers - 4.0%. Continent-specific HBV-HCV prevalence rates: Africa - 9.2%, China - 6.9%, others. HCVprevalence rates among at-risk groups: healthcare workers - 5.58%, hemodialysis patients - 34.8%. Regional HCV rates: Africa - 7.42%, Middle East - 25.30%.

CONCLUSION

Diverse global hepatotropic virus prevalence patterns are influenced by multifaceted factors. MENA faces higher rates due to healthcare challenges, while Africa struggles with limited resources. Tailored public health strategies, including vaccination and awareness campaigns, are essential to alleviate burdens and enhance global health. This consolidated data serves as a valuable resource for informed decision-making.

Mental and physical health morbidity among people in prisons: an umbrella review

BACKGROUND

People who experience incarceration are characterised by poor health profiles. Clarification of the disease burden in the prison population can inform service and policy development. We aimed to synthesise and assess the evidence regarding the epidemiology of mental and physical health conditions among people in prisons worldwide.

METHODS

In this umbrella review, five bibliographic databases (Web of Science, PubMed, PsycINFO, Embase, and Global Health) were systematically searched from inception to identify meta-analyses published up to Oct 31, 2023, which examined the prevalence or incidence of mental and physical health conditions in general prison populations. We excluded meta-analyses that examined health conditions in selected or clinical prison populations. Prevalence data were extracted from published reports and study authors were contacted for additional information. Estimates were synthesised and stratified by sex, age, and country income level. The robustness of the findings was assessed in terms of heterogeneity, excess significance bias, small-study effects, and review quality. The study protocol was pre-registered with PROSPERO, CRD42023404827.

FINDINGS

Our search of the literature yielded 1909 records eligible for screening. 1736 articles were excluded and 173 full-text reports were examined for eligibility. 144 articles were then excluded due to not meeting inclusion criteria, which resulted in 29 meta-analyses eligible for inclusion. 12 of these were further excluded because they examined the same health condition. We included data from 17 meta-analyses published between 2002 and 2023. In adult men and women combined, the 6-month prevalence was 11·4% (95% CI 9·9-12·8) for major depression, 9·8% (6·8-13·2) for post-traumatic stress disorder, and 3·7% (3·2-4·1) for psychotic illness. On arrival to prison, 23·8% (95% CI 21·0-26·7) of people met diagnostic criteria for alcohol use disorder and 38·9% (31·5-46·2) for drug use disorder. Half of those with major depression or psychotic illness had a comorbid substance use disorder. Infectious diseases were also common; 17·7% (95% CI 15·0-20·7) of people were antibody-positive for hepatitis C virus, with lower estimates (ranging between 2·6% and 5·2%) found for hepatitis B virus, HIV, and tuberculosis. Meta-regression analyses indicated significant differences in prevalence by sex and country income level, albeit not consistent across health conditions. The burden of non-communicable chronic diseases was only examined in adults aged 50 years and older. Overall, the quality of the evidence was limited by high heterogeneity and small-study effects.

INTERPRETATION

People in prisons have a specific pattern of morbidity that represents an opportunity for public health to address. In particular, integrating prison health within the national public health system, adequately resourcing primary care and mental health services, and improving linkage with post-release health services could affect public health and safety. Population-based longitudinal studies are needed to clarify the extent to which incarceration affects health.

FUNDING

Research Foundation-Flanders, Wellcome Trust, National Institutes of Health.

The Epidemiology of Chronic Hepatitis C: Where We Are Now

One of the main objectives of the World Health Organization is the eradication of viral hepatitis by 2030 by identifying subjects before disease progression. In 2019, only 21% of the 58 million people chronically infected with hepatitis C virus (HCV) had been diagnosed, while overall 13% had been treated. The key recommendation of international screening programs is to reach the people at major risk of viral hepatitis and the general population. National plans, including that in Italy, have dedicated budget lines to support efforts to achieve the objective of elimination. The Italian program involves free screening for HCV in the general population born between 1969 and 1989 and also for all persons in the care of addiction services (Ser.D) and prisoners. The screening programs differed slightly among regions in Italy. In particular, referring to the screening for people born in the period of 1969–1989, in Tuscany, these people received an invitation by SMS to undergo a HCV antibody test. If the test results were positive, the subject was registered on a regional platform and required to undergo HCV RNA testing, prescribed by their GP. In the case of testing positive for HCV RNA, the linkage to care (i.e., patient entry into specialist care after diagnosis) is guaranteed. A strong effort is currently required to eliminate HCV effectively. This review highlights the most recent changes to the epidemiological scenario at the global, European, Italian, and regional (Tuscany) levels.

Global epidemiology of hepatitis C virus in dialysis patients: A systematic review and meta-analysis

Dialysis is a replacement therapy for patients with End-Stage Renal Disease (ESRD). Patients on dialysis are at high risk of acquiring hepatitis C virus (HCV), which has become a leading cause of morbidity and mortality in this population. There is a wide range of prevalence of HCV in dialysis populations around the world. It is still unknown how prevalent HCV infection is among worldwide dialysis patients (including those undergoing hemodialysis and peritoneal dialysis). A review was conducted to estimate the global epidemiology of hepatitis C in dialysis patients. We searched PubMed, Excerpta Medica Database (Embase), Global Index Medicus and Web of Science until October 2022. A manual search of references from relevant articles was also conducted. Heterogeneity was evaluated by the χ2 test on Cochrane's Q statistic, and the sources of heterogeneity were investigated using subgroup analysis. In order to assess publication bias, funnel plots and Egger tests were conducted, and pooled HCV prevalence estimates were generated using a DerSimonian and Laird meta-analysis model. The study is registered with PROSPERO under CRD42022237789. We included 634 papers involving 392160 participants. The overall HCV case fatality rate was 38.7% (95% CI = 28.9-49). The global prevalence of HCV infection in dialysis population group were 24.3% [95% CI = 22.6-25.9]. As indicated by UNSD region, country, dialysis type, and HCV diagnostic targeted; Eastern Europe had the highest prevalence of 48.6% [95% CI = 35.2-62], Indonesia had 63.6% [95% CI = 42.9-82], hemodialysis patients had 25.5% [95% CI = 23.8-27.3], and anti-HCV were detected in 24.5% [95% CI = 22.8-26.2]. Dialysis patients, particularly those on hemodialysis, have a high prevalence and case fatality rate of HCV infection. Hemodialysis units need to implement strict infection control measures.

Chronic hepatitis C elimination prison initiative: HCV-intensive test and treat, a whole prisoner population HCV test-and-treat program in England

Background and Aim

Prison residents are at high risk for hepatitis C virus (HCV) infection. HCV test-and-treat initiatives within prisons provide an opportunity to engage with prison residents and achieve HCV micro-elimination. The aim of the prison HCV-intensive test and treat initiative was to screen over 95% of all prison residents for HCV infection within a defined number of days determined by the size of the prison population and to initiate treatment within 7-14 days of a positive HCV RNA diagnosis.

Methods

An HCV-intensive test and treat toolkit was developed based on learnings from pilot HCV-intensive test and treat events. From January 2020 to September 2021, 13 HCV-intensive test and treat events took place at prisons in England selected based on high levels of reception blood-borne virus testing and good access to peers from The Hepatitis C Trust.

Results

Among a total of 8487 residents, 8139 (95.9%) underwent testing for HCV. Across the 13 prisons included, HCV antibody and RNA prevalence was 8.2% and 1.5%, respectively. The treatment initiation rate among HCV RNA-positive individuals (n = 124) was 79.0%.

Conclusion

The HCV-intensive test and treat initiative presented here provides a feasible and rapid test-and-treat process to achieve HCV elimination within individual prisons. The HCV-intensive test and treat toolkit can be adapted for rapid HCV testing and treatment events at other prisons in the United Kingdom and worldwide.

Seroprevalence and Associated Factors of Hepatitis B and Hepatitis C Viral Infections Among Prisoners in Tigrai, Northern Ethiopia

Background

Hepatitis B and C viruses are important health and socioeconomic problem across the globe, with a remarkable number of diseases and deaths in sub-Saharan African countries. The burden of hepatitis is unknown in the prison settings of Tigrai. Therefore, we aimed to describe the seroprevalence and associated factors of hepatitis B and C viruses among prisoners in Tigrai, Ethiopia.

Methods

A cross-sectional study was carried out from February 2020 to May 2020 at the prison facilities of Tigrai. Demographics and associated factors were collected from 315 prisoners prospectively. Five milliliters of blood was collected and tested using rapid tests kits of HBsAg (Zhejiang orient Gene Biotech Co., Ltd., China) and HCV antibodies (Volkan Kozmetik Sanayi Ve Ticaret Ltd. STI, Turkey). Positive samples were confirmed using enzyme-linked immunosorbent assay (ELISA) (Beijing Wantai Biological Pharmacy Enterprise Co. Ltd). Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 20 and p<0.05 was considered statistically significant.

Results

The overall seroprevalence of HBV and HCV were 25 (7.9%) and 1 (0.3%), respectively. The majority of hepatitis B viral infections were identified from the age groups of 18-25 years (10.7%) and unmarried prisoners (11.8%). Prisoners greater than 100 per cell (AOR=3.95, 95% CI=1.15-13.6, p=0.029) and with a history of alcohol consumption (AOR=3.01, 95% CI=1.17-7.74, p=0.022) were significantly associated with HBV infections.

Conclusion

The seroprevalence of HBV among prisoners was nearly high or borderline (7.9%) with a very low HCV prevalence (0.3%). HBV was most prevalent among young adults, those housed with a large number of prisoners per cell, and those who had a history of alcohol consumption. This study recommends that there should be prison-focused intervention, including regular health education, with the emphasis on the mode of transmission and introducing HBV screening policy for prisoners, especially when they enter the prison.

Current status of disparity in liver disease

Disparities have emerged as an important issue in many aspects of healthcare in developed countries and may be based on race, ethnicity, sex, geographical location, and socioeconomic status. For liver disease specifically, these potential disparities can affect access to care and outcome in viral hepatitis, chronic liver disease, and hepatocellular carcinoma. Shortages in hepatologists and medical providers versed in liver disease may amplify these disparities by compromising early detection of liver disease, surveillance for hepatocellular carcinoma, and prompt referral to subspecialists and transplant centers. In the United States, continued efforts have been made to address some of these disparities with better education of healthcare providers, use of telehealth to enhance access to specialists, reminders in electronic medical records, and modifying organ allocation systems for liver transplantation. This review will detail the current status of disparities in liver disease and describe current efforts to minimize these disparities.

Diagnosis, Treatment, and Prevention of HIV Infection among Detainees: A Review of the Literature

Detainees are one of the most vulnerable populations to human immunodeficiency virus (HIV). This is mostly caused by the lack of knowledge on the topic among the inmates; the lack of prophylaxis; the high percentage of risky behaviors in jail, such as sexual abuse, unprotected sexual intercourses, and injective drug use; and the generally low perception of the risk of transmission. It has also been observed that the problem does not cease to exist at the moment of release, but it also may be aggravated by the weak support system or the total absence of programs for people living with HIV/AIDS (PLWHA) to avoid discontinuation of antiretroviral drugs. Difficulty in providing housing and jobs and, therefore, a form of stability for ex-detainees, also contributes to none adherence to antiretroviral therapy. Among the detainees, there are also categories of people more susceptible to discrimination and violence and, therefore, to risky behaviors, such as black people, Hispanics, transgender people, and men who have sex with men (MSM). We reviewed the literature in order to provide a more complete picture on the situation of PLWHA in jail and to also analyze the difficulties of ex-detainees in adhering to HIV therapy.

Hepatitis C testing, treatment and prevention in low- and middle-income country prisons

Hepatitis C virus (HCV) infection is common among people who are incarcerated in low- and middle-income countries. Prison policy changes towards HCV testing and treatment are pivotal for social justice and can be a crucial step for achieving HCV global elimination targets.