Testing and vaccination uptake among people who inject drugs with a history of incarceration, England, Wales, and Northern Ireland.


Author: Claire Edmundson, Helen Dwyer, Holly Mitchell, Jacquelyn Njoroge, Manchari Rajkumar, Monica Desai, Helen Dwyer

Theme: Epidemiology & Public Health Research Year: 2023

Background
Prisons offer a key opportunity to offer interventions to people who inject drugs (PWID). The COVID-19 pandemic negatively impacted opt-out testing and vaccination programmes in prisons. We investigated testing and vaccination uptake among those with a history of incarceration (IH) to highlight missed opportunities.

Methods
Data were extracted from an annual cross-sectional survey of PWID in England, Wales and Northern Ireland, where participants provided a blood sample and self-completed a questionnaire. Trends in hepatitis B (HBV) vaccination and HIV and hepatitis C (HCV) testing were reviewed over 2013-2020/21 and compared between those with IH vs. no IH for 2020/21 using multivariable logistic regression, adjusting for age, gender and region of recruitment.

Results
In 2020/21 a substantial proportion of PWID reported IH (62%). Although vaccination uptake among PWID testing negative for HBV was significantly higher among those reporting IH than no IH in 2020/21 (71% vs. 56%; aOR 2.10 95%CI:1.67-2.65), it has declined significantly in both groups between 2013 and 2020/21 (IH: 78% (aOR 0.69 95%CI:0.58-0.84), no IH: 60% (aOR 0.74 95%CI:0.59-0.93)).
Although no decline was seen in recent HCV testing (current or previous year) among those with IH between 2018 to 2020/21, recent HIV testing declined from 41% to 35% (aOR 0.79 95%CI 0.68-0.93). In 2020/21, when compared with those with no IH, PWID with IH had greater odds of testing recently for both HIV and HCV (aOR 1.28, 95%CI:1.05-1.56 and aOR 1.29; 95%CI:1.08-1.55 respectively). In 2020/21 there was no difference in the proportion reporting testing or vaccination uptake by length of prison stay.

Conclusion
Recent declines in HIV testing and HBV vaccination among PWID with IH are concerning as prisons offer a key opportunity for BBV prevention in this population. Opt-out testing and vaccination programmes should be strengthened in prison settings to reduce BBV transmission both within the prison and upon release.

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