Abstract
Background
Little is known about the relationship between short-term incarceration and risk of hepatitis C virus (HCV) infection among people who inject drugs (PWID). We investigated whether varying patterns of recent incarceration lasting less than two years are associated with HCV acquisition risk in this population.
Methods
We followed prospectively PWID at risk of acquiring HCV infection in Montréal (2004–2019). At 6-month (up until 2011), then 3-month intervals, participants were tested for HCV antibodies or RNA, and self-reported whether they have been incarcerated in each of the previous 6 or 3 months. If incarcerated, they reported the setting and time spent in incarceration. We fit three separate multivariable time-updated Cox regression models, one for each measure of incarceration: any incarceration lasting less than two years (yes/no), incarceration stratified by setting (local police station/provincial prison/no) and incarceration stratified by time in incarceration (≤1 week/>1 week and ≤1 month/>1 month and <2 years/no).
Results
Among 709 PWID followed over 2315.2 person-years, HCV incidence was 9.9/100 person-years (95% confidence interval (CI): 8.7-11.2)]. During follow-up, 248 PWID (35.0%) reported at least one recent incarceration episode of less than two years. Overall, compared to PWID who did not experience incarceration in the prior 6 or 3 months, PWID who did were 1.56 (95% CI: 1.13, 2.17) times more likely to acquire HCV. We found no statistically significant difference in the magnitude of associations across categories of setting and time in incarceration (likelihood ratio test P= 0.53 and 0.44, respectively).
Conclusion
Any recent incarceration lasting less than two years, regardless of the setting and time in incarceration, was associated with an elevated risk of HCV acquisition among PWID. Findings support the need to expand access to harm-reduction programs in short-term incarceration settings and, in parallel, to prioritise public health-oriented alternatives to incarcerating PWID where possible.
Little is known about the relationship between short-term incarceration and risk of hepatitis C virus (HCV) infection among people who inject drugs (PWID). We investigated whether varying patterns of recent incarceration lasting less than two years are associated with HCV acquisition risk in this population.
Methods
We followed prospectively PWID at risk of acquiring HCV infection in Montréal (2004–2019). At 6-month (up until 2011), then 3-month intervals, participants were tested for HCV antibodies or RNA, and self-reported whether they have been incarcerated in each of the previous 6 or 3 months. If incarcerated, they reported the setting and time spent in incarceration. We fit three separate multivariable time-updated Cox regression models, one for each measure of incarceration: any incarceration lasting less than two years (yes/no), incarceration stratified by setting (local police station/provincial prison/no) and incarceration stratified by time in incarceration (≤1 week/>1 week and ≤1 month/>1 month and <2 years/no).
Results
Among 709 PWID followed over 2315.2 person-years, HCV incidence was 9.9/100 person-years (95% confidence interval (CI): 8.7-11.2)]. During follow-up, 248 PWID (35.0%) reported at least one recent incarceration episode of less than two years. Overall, compared to PWID who did not experience incarceration in the prior 6 or 3 months, PWID who did were 1.56 (95% CI: 1.13, 2.17) times more likely to acquire HCV. We found no statistically significant difference in the magnitude of associations across categories of setting and time in incarceration (likelihood ratio test P= 0.53 and 0.44, respectively).
Conclusion
Any recent incarceration lasting less than two years, regardless of the setting and time in incarceration, was associated with an elevated risk of HCV acquisition among PWID. Findings support the need to expand access to harm-reduction programs in short-term incarceration settings and, in parallel, to prioritise public health-oriented alternatives to incarcerating PWID where possible.
| Original language | English |
|---|---|
| Article number | 103419 |
| Journal | International Journal of Drug Policy |
| Volume | 96 |
| Early online date | 24 Aug 2021 |
| DOIs | |
| Publication status | Published - 30 Oct 2021 |
Bibliographical note
Funding Information:The Hepatitis Cohort (HEPCO) is supported through the Canadian Institute of Health Research (CIHR, grants MOP135260, MOP210232 and SMN139149) and the Réseau Sida et Maladies Infectieuses du Fonds de recherche du Québec – Santé (FRQ-S, grant FRSQ5227). AAA is supported through postdoctoral fellowships from CIHR, FRQ-S and the Canadian Network on Hepatitis C. MH, PV and JS acknowledge funding from NIHR Health Protection Research Unit in Behavioural Science and Evaluation and the National Institute on Drug Abuse. JG is supported by an Australian National Health and Medical Research Council (NHMRC) Investigator Grant (1176131) and reports grants and personal fees from AbbVie, Gilead Sciences, Merck, and Cepheid and grants from Hologic and Indivior outside the submitted work. JB holds the Canada Research Chair in Addiction Medicine and reporting having received advisor fees from Gilead Sciences and AbbVie and a research grant from Gilead Sciences, outside of the current work. All other authors report no potential conflicts.
Funding Information:
JG reports grants and personal fees from AbbVie, Gilead Sciences, Merck, and Cepheid and grants from Hologic and Indivior outside the submitted work. JB reports having received advisor fees from Gilead Sciences and AbbVie and a research grant from Gilead Sciences, outside of the current work. All other authors report no potential conflicts.
Publisher Copyright:
© 2021
Keywords
- harm reduction
- HCV
- hepatitis C
- incarceration
- injection drug use
Access to Document
- Full-text PDF (author’s accepted manuscript)
This is the accepted author manuscript (AAM). The final published version (version of record) is available online via Elsevier at10.1016/j.drugpo.2021.103419. Please refer to any applicable terms of use of the publisher.