|Titre :||Modelling the impact of incarceration and prison-based hepatitis C virus (HCV) treatment on HCV transmission among people who inject drugs in Scotland (2017)|
|Auteurs :||J. STONE ; N. K. MARTIN ; M. HICKMAN ; S. J. HUTCHINSON ; E. ASPINALL ; A. TAYLOR ; A. MUNRO ; K. DUNLEAVY ; E. PETERS ; P. BRAMLEY ; P. C. HAYES ; D. J. GOLDBERG ; P. VICKERMAN|
|Type de document :||Article : Périodique|
|Dans :||Addiction (Vol.112, n°7, July 2017)|
|Article en page(s) :||1302-1314|
|Discipline :||MAL (Maladies infectieuses / Infectious diseases)|
Thésaurus TOXIBASEHEPATITE ; PRISON ; INCARCERATION ; TRAITEMENT DE MAINTENANCE ; CONTAMINATION ; USAGER ; INJECTION ; MODELE STATISTIQUE
Thésaurus GéographiqueECOSSE ; ROYAUME-UNI
Background and Aims: People who inject drugs (PWID) experience high incarceration rates, and previous incarceration is associated with elevated hepatitis C virus (HCV) transmission risk. In Scotland, national survey data indicate lower HCV incidence in prison than the community (4.3 versus 7.3 per 100 person-years), but a 2.3-fold elevated transmission risk among recently released (
Design: Dynamic mathematical modelling of incarceration and HCV transmission, using approximate Bayesian computation for model calibration.
Setting: Scotland, UK.
Participants: A simulated population of PWID.
Measurements: Population-attributable fraction (PAF) of incarceration to HCV transmission among PWID. Decrease in HCV incidence and chronic prevalence due to current levels of prison opiate substitution therapy (OST; 57% coverage) and HCV treatment, as well as scaling-up DAAs in prison and/or preventing the elevated risk associated with prison release.
Findings: Incarceration contributes 27.7% [PAF; 95% credible interval (CrI) -3.1 to 51.1%] of HCV transmission among PWID in Scotland. During the next 15 years, current HCV treatment rates (10.4/6.8 per 1000 incarcerated/community PWID annually), with existing prison OST, could reduce incidence and chronic prevalence among all PWID by a relative 10.7% (95% CrI = 8.4-13.3%) and 9.7% (95% CrI = 7.7-12.1%), respectively. Conversely, without prison OST, HCV incidence and chronic prevalence would decrease by 3.1% (95% CrI = -28.5 to 18.0%) and 4.7% (95% CrI = -11.3 to 14.5%). Additionally, preventing the heightened risk among recently released PWID could reduce incidence and chronic prevalence by 45.0% (95% CrI = 19.7-57.5%) and 33.3% (95% CrI = 15.6-43.6%) or scaling-up prison HCV treatments to 80% of chronic PWID prison entrants with sufficient sentences (>16 weeks) could reduce incidence and prevalence by 45.6% (95% CrI = 38.0-51.3%) and 45.5% (95% CrI = 39.3-51.0%), respectively.
Conclusions: Incarceration and the elevated transmission risk following prison release can contribute significantly to hepatitis C virus transmission among people who inject drugs. Scaling-up hepatitis C virus treatment in prison can provide important prevention benefits.
|Domaine :||Drogues illicites / Illicit drugs|
|Refs biblio. :||47|
|Affiliation :||School of Social and Community Medicine, University of Bristol, Bristol, UK|