Past Incarceration Experience and the Risk of Hepatitis C Infection among People Who Inject Drugs: Results from a Sero-Behavioral Survey among Current Injectors in Germany


Author: Gassowski M, Nielsen S, Wenz B, an der Heiden M, Hamouda O, Bremer V, Ross RS, Bock CT, Marcus U and Zimmermann R

Theme: Epidemiology & Public Health Research Year: 2016

PAST INCARCERATION EXPERIENCE AND THE RISK OF HEPATITIS C INFECTION AMONG PEOPLE WHO INJECT DRUGS: RESULTS FROM A SERO-BEHAVIORAL SURVEY AMONG CURRENT INJECTORS IN GERMANY

Gassowski M1, Nielsen S1,2, Wenz B1, an der Heiden M1, Hamouda O1, Bremer V1, Ross RS3, Bock CT4, Marcus U1 and Zimmermann R1

1 Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany

2 Charité University Medicine, Berlin, Germany

3 Institute of Virology, National Reference Centre for Hepatitis C, University Hospital Essen, University of Duisburg-Essen, Essen, Germany

4 Department of Infectious Diseases, Division for Viral Gastroenteritis and Hepatitis Pathogens and Enteroviruses, Robert Koch Institute, Berlin, Germany

Background: People who inject drugs (PWID) are at higher risk of incarceration as well as hepatitis C infection (HCV) than the general population in Germany. To examine whether past incarceration experience (PIE) and positive HCV serostatus are associated, data from the first large German sero-behavioral survey of PWID (DRUCK-study) was used.

Methods: Respondent driven sampling was used to recruit current injectors (IV-drug use in the last 12 months) in eight German cities in 2011-2014. PIE was differentiated by duration and frequency, including no experience. A multivariable logistic regression model was used to examine the association of HCV serostatus with PIE, correcting for known risk factors for HCV. In a second step, reported in-prison risk behaviors were included in the model.

Results: 1,998 participants were included in the analysis. Of these, 19.9% reported no PIE, 28.6% short and rare (SR), (3.5 year in total, ≤3 times) PIE, 12.1% short but frequent (SF) PIE, 7.1% long but rare (LS) PIE and 32.4% long and frequent (LF) PIE. After correcting for age, gender, region of origin, duration of IV-drug use, being unprofessionally tattooed/pierced outside of prison and study site the association between PIE and HCV serostatus remained statistically significant with following odds ratios (OR): SR 1.4 (95% confidence interval (CI) 1.0-1.9), SF 2.1 (95% CI 1.4-3.0), LR 3.3 (95% CI 2.0-5.4), LF 3.8 (95% CI 2.7-5.3). By adjusting the model for in-prison risk behaviors the OR of PIE were reduced but remained significant: SR 1.3 (95% CI 1.0-1.8), SF 1.8 (95% CI 1.3-2.7), LR 2.7 (95% CI 1.6-4.4), LF 2.8 (95% CI 1.9-4.1).

Conclusion: The proportion of HCV positive PWID seems to increase with both frequency and duration of incarceration, but this cannot fully be explained by in-prison risk behaviors. Further research is needed to investigate HCV-risks associated with the period upon release.

Disclosure of interest statement: The study was funded by the Robert Koch Institute and the German Ministry of Health (Bundesministerium für Gesundheit). All authors declare that they do not have any conflict of interest

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