Characterizing hepatitis B/C prevalence and substance use patterns among incarcerated men initiating preexposure prophylaxis for HIV prevention in the US

Author: Matthew Murphy, Brooke Rogers, Emily Toma, Drew Galipeau , Alexi Almonte, Nyx Gomes, Siena Napoleon, Philip Chan

Theme: Clinical Research Year: 2023

Introduction: Individuals experiencing incarceration are at higher risk for viral illnesses like HIV, hepatitis B, and hepatitis C compared to the general population. Prior to initiating HIV prevention medication, pre-exposure prophylaxis (PrEP), patients should be screened for substance use and hepatitis B/C when appropriate. Yet, little is known about the prevalence of substance use and hepatitis B/C among incarcerated men seeking PrEP care. The focus of this study was to characterize the prevalence of hepatitis B/C and associated substance use behaviors, in a sample of incarcerated men interested in initiating PrEP.

Methods: Men at risk for HIV were referred for PrEP initiation evaluation within Rhode Island’s statewide correctional system from November 2019 to July 2022 (N=300). Men who agreed to initiate PrEP (N=100) completed a clinical evaluation including Hepatitis B (surface antigen and antibody) and C (antibody) testing prior to PrEP initiation.

Results: Among those who agreed to initiate PrEP while incarcerated, 30 individuals had a positive hepatitis B antibody result, and one was indeterminate. Only 2 individuals had a positive hepatitis B antigen test result. Eleven individuals who completed testing had a positive hepatitis C antibody test result. Individuals also reported a history of behaviors associated with contraction of hepatitis B/C including injection drug use (n=32; 32%), shared needles (n=29; 29%), and sex work (n=18; 18%). Individuals reported a wide range of substances used in the months prior to incarceration including daily use of cannabis (55%), cocaine (21%), methamphetamine (10%), heroin (15%), and other opioids (17%).

Conclusions: In the sample of men screened for PrEP eligibility within a carceral setting, two individuals were identified as having hepatitis B while none were diagnosed with HIV. Hepatitis C seroprevalence (13%) was also notable. Additional research is needed to better adapt HIV and hepatitis prevention services for this uniquely vulnerable population.

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