Hepatitis C virus transmission in the prison/inmate population

Introduction

The global occurrence of the hepatitis C virus (HCV) in correctional facilities has been well documented. The presence of HCV among inmates poses a serious threat to correctional staff, other offenders, and to their families and communities upon release⁽¹⁾.

Correctional facilities in Canada are administered at the federal level (for a sentence of >= 2 years) and provincial/territorial level (< 2 years)⁽²⁾. Correctional Services Canada (CSC) manages the 53 federal correctional facilities of varying security levels across Canada^(2,3). The adult prison population in 1999-2000 was reported to be 32,000, of whom 13,000 were serving time in federal facilities and 19,000 in provincial/territorial jails⁽⁴⁾.

Prison inmates are at greater risk of HCV exposure than the general population because inmates tend to engage in a variety of high-risk behaviours⁽⁵⁾. The sharing of drug injection equipment is considered to be a major risk behaviour frequently practised within correctional facilities. As of 2002, CSC estimates that 70% of the inmates who enter prison will have self-identified drug or alcohol abuse problems that warrant treatment^(4,6,7). Over 50% report that their criminal behaviour was associated with substance abuse⁽⁶⁾. Recently, CSC initiated a national drug strategy aimed at controlling the supply of drugs in federal institutions. Its goal is to reduce the demand for drugs among federal offenders through the implementation of prevention and treatment programs⁽¹⁾.

This paper reviews the literature on the risk factors and behaviours that place the inmate population at greater risk of HCV infection and the factors that lead to the transmission of HCV within these institutions.

Methods

The databases CAB Health, CINAHL, Current Contents, and Silver Platter MEDLINE were searched from 1990 to 2003 using the following search terms as keywords: hepatitis C, correctional institutions, risk behaviour, and prison. Articles appropriate to the review with reliable, valid designs and measures were retrieved using standardized methods. Articles selected for review were those that contributed information on HCV risk factors and behaviours as they pertain to the inmate population in addition to articles that describe the incidence and prevalence of HCV in Canada; 42 were selected. As well, seven reports commissioned by the CSC were also identified and selected for review.

Results

Canadian HCV incidence approximates 3.6 per 100 000 person years⁽⁸⁾ with a prevalence of approximately 0.8% in the general population, translating into approximately 250,000 infected individuals⁽⁹⁾. Currently, there is no vaccine against HCV⁽¹⁰⁾, although various treatment options are available, including chemotherapies and liver transplantation.