Theme: Epidemiology & Public Health Research Year: 2025
Background:
This global systematic review assesses the prevalence of injecting drug use (IDU) and key infectious diseases (HIV, hepatitis C virus [HCV], tuberculosis and hepatitis B virus [HBV]) among people who are incarcerated.
Methods:
We conducted a systematic search of peer-reviewed (Medline, Embase, PsycINFO), internet, and grey literature databases, from January 2000 through December 2024 and engaged international experts and relevant agencies liaising with key agencies focused on incarcerated populations (WHO, UNODC, UNAIDS and EUDA). Data on study methods, size of incarcerated populations and demographic characteristics, and prevalence of IDU, HIV, HCV, HBV and tuberculosis among incarcerated populations were extracted. Meta-analyses pooled data where multiple estimates were available for a country; regional and global estimates were calculated, weighted by incarcerated population size. We present overall country, regional and global prevalence estimates for each variable examined, stratified by sex. We then estimated the ratio of IDU, HIV, HCV, HBV and tuberculosis prevalence among incarcerated populations compared to the general population.
Results:
Of 71,981 screened documents, 2,740 were eligible for data extraction. There are approximately 11,323,000 people aged 15-64 years incarcerated globally with their incarceration rate being 221 per 100,000 (29 per 100,000 among women and 399 per 100,000 among men). Substantial variation in rates across countries and regions were observed with the highest regional rate being in North America. Globally, we estimate that 11·1% of people who are incarcerated have ever injected drugs (1,252,500; 95%CI 966,500-1,594,000), 52·9 times higher than the general population. We estimate that 3·2% (95%CI 2·1-4·6) of people who are incarcerated globally are living with HIV (12·2 times higher than the general population); 11% (95%CI 7·2-16·3) have current HCV infection (16·4 times higher); 4·5% (95%CI 2·4-8·1) have current HBV infection (2·3 times higher) and 2·0% (95%CI 1·3-2·9) have active tuberculosis (48·1 times higher than the general population). There is substantial variation geographically and among women and men.
Conclusions:
The substantial concentration of people with multiple risks and comorbidities requires improved strategies to screen, evaluate, treat and prevent these adverse consequences, which is crucial for global control efforts.
Disclosure of Interest Statement:
Declaration of Interests
Past three years, JG is a consultant or advisor and has received research grants from Abbvie, Abbott, bioLytical, Cepheid, Gilead Sciences, Hologic, and Roche. EBC has received funding from the Canadian Network on Hepatitis C. These companies or organisations had no knowledge of or role in the design, conduct, interpretation, or publication of these findings. All other authors have no conflicts of interest to declare.
Acknowledgements
This review was supported by the Australian National Health and Medical Research Council (NHMRC) ASCEND Program grant (1150078), a NHMRC Investigator Grant (2016825, 2034002) and NHMRC Senior Principal Research Fellowship (1135991) to LD, the US National Institute on Drug Abuse (NIDA) (1R01DA059822-01A1), the US National Institute of Allergy and Infectious Diseases (R01AI147490 RFA-AI-18-026) and the National Drug and Alcohol Research Centre (NDARC), UNSW Sydney. NDARC is funded by the Australian Government Department of Health. The views expressed in this publication do not necessarily represent the position of the Australian Government.
MH and PV acknowledge support from NIHR HPRU in in Behavioural Science and Evaluation and NIHR Programme Grant EPIToPe. FLA receives support from the U.S. National Institute of Health, including the National Institute on Drug Abuse (R01 DA029910, R01 DA025943, R21 DA041953, R01 DA054703, R01 DA054851), National Institute of Allergy and Infectious Diseases (R01 AI177082) and the Fogarty International Center (R01 TW012674, D43 TW011324, D43 TW012492). JG was supported by NHMRC Investigator Grants Award (1176131 and 2034002). PV and JS acknowledge support from the Wellcome Trust [WT 220866/Z/20/Z and 226619/Z/22/Z]. PW acknowledges support from an Australian Government Research Training Program (RTP) Scholarship as well as an NDARC Higher Degree Research scholarship. LT and OP acknowledge support from an NHMRC PhD scholarship as well as an NDARC Higher Degree Research scholarship. BH is supported by an NHMRC Investigator Grant (2026968). JB receives funding from the US National Institute on Drug Abuse (K23DA055695).
FAC worked as consultant for WHO Regional Office for Europe between 03/2020 and 12/2024 (or during the study period). The author alone is responsible for the views expressed in this publication, and these do not necessarily represent the decisions or the stated policy of the World Health Organization. She is affiliated with the WHO Regional Office for Europe and Research Institute for Medicines (iMED, University of Lisbon). AB was a staff member of the United Nations (Office of Drugs and Crime) between 10/2005 and 01/2025. The author alone is responsible for the views expressed in this publication, and these do not necessarily represent the decisions or the stated policy of the United Nations.