A multicentre interventional study to assess blood-borne viral infections in Belgian prisons

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Abstract

Background

Prevalence data on viral hepatitis B (HBV), hepatitis C (HCV), and HIV infection in prison are often scarce or outdated. There is currently no systematic screening for these blood-borne viral infections (BBV) in Belgian prisons. There is an urgency to assess the prevalence of these BBV to inform policymakers and public healthcare.

Methods

This was a multicentre, interventional study to assess the prevalence of BBV using opt-in screening in prisons across Belgium, April 2019 – March 2020. Prisoners were tested using a finger prick and BBV risk factors were assessed using a questionnaire. A generalized linear mixed model was used to investigate the association between the various risk factors and HCV.

Results

In total, 886 prisoners from 11 Belgian prisons were screened. Study uptake ranged from 16.9 to 35.4% in long-term facilities. The prevalence of HCV antibodies (Ab), hepatitis B surface antigen (Ag) and HIV Ab/Ag was 5.0% (44/886), 0.8% (7/886), and 0.2% (2/886). The adjusted odds for HCV Ab were highest in prisoners who ever injected ( p < 0.001; AOR 24.6 CI 95% (5.5–215.2). The prevalence of detectable HCV RNA in the total cohort was 2.1% (19/886). Thirteen (68.4%) prisoners were redirected for follow-up of their HCV infection.

Conclusions

Opt-in testing for viral hepatitis B, C and HIV was relatively well-accepted in prisons. Compared with the general population, prisoners have a higher prevalence of infection with BBV, especially for HCV. Systematic screening for these BBV should be recommended in all prisons, preferably using opt-out to optimize screening uptake.

Trial registration

Retrospectively registered at clinical trials NCT04366492 April 29, 2020.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-021-06405-z.

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Most cited references 47

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Sample size calculation in medical studies

Mohamad Pourhoseingholi, Mohsen Vahedi, Mitra Rahimzadeh (2013)

Optimum sample size is an essential component of any research. The main purpose of the sample size calculation is to determine the number of samples needed to detect significant changes in clinical parameters, treatment effects or associations after data gathering. It is not uncommon for studies to be underpowered and thereby fail to detect the existing treatment effects due to inadequate sample size. In this paper, we explain briefly the basic principles of sample size calculations in medical studies.

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Global epidemiology and genotype distribution of the hepatitis C virus infection.

Erin Gower, Chris Estes, Sarah Blach … (2014)

The treatment of chronic hepatitis C virus (HCV) infection has the potential to change significantly over the next few years as therapeutic regimens are rapidly evolving. However, the burden of chronic infection has not been quantified at the global level using the most recent data. Updated estimates of HCV prevalence, viremia and genotypes are critical for developing strategies to manage or eliminate HCV infection. To achieve this, a comprehensive literature search was conducted for anti-HCV prevalence, viraemic prevalence and genotypes for all countries. Studies were included based on how well they could be extrapolated to the general population, sample size and the age of the study. Available country estimates were used to develop regional and global estimates. Eighty-seven countries reported anti-HCV prevalence, while HCV viraemic rates were available for fifty-four countries. Total global viraemic HCV infections were estimated at 80 (64-103) million infections. Genotype distribution was available for ninety-eight countries. Globally, genotype 1 (G1) was the most common (46%), followed by G3 (22%), G2 (13%), and G4 (13%). In conclusion, the total number of HCV infections reported here are lower than previous estimates. The exclusion of data from earlier studies conducted at the peak of the HCV epidemic, along with adjustments for reduced prevalence among children, are likely contributors. The results highlight the need for more robust surveillance studies to quantify the HCV disease burden more accurately. Copyright © 2014 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

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Global burden of HIV, viral hepatitis, and tuberculosis in prisoners and detainees.

Kate Dolan, Andrea L Wirtz, Babak Moazen … (2016)

The prison setting presents not only challenges, but also opportunities, for the prevention and treatment of HIV, viral hepatitis, and tuberculosis. We did a comprehensive literature search of data published between 2005 and 2015 to understand the global epidemiology of HIV, hepatitis C virus (HCV), hepatitis B virus (HBV), and tuberculosis in prisoners. We further modelled the contribution of imprisonment and the potential impact of prevention interventions on HIV transmission in this population. Of the estimated 10·2 million people incarcerated worldwide on any given day in 2014, we estimated that 3·8% have HIV (389 000 living with HIV), 15·1% have HCV (1 546 500), 4·8% have chronic HBV (491 500), and 2·8% have active tuberculosis (286 000). The few studies on incidence suggest that intraprison transmission is generally low, except for large-scale outbreaks. Our model indicates that decreasing the incarceration rate in people who inject drugs and providing opioid agonist therapy could reduce the burden of HIV in this population. The prevalence of HIV, HCV, HBV, and tuberculosis is higher in prison populations than in the general population, mainly because of the criminalisation of drug use and the detention of people who use drugs. The most effective way of controlling these infections in prisoners and the broader community is to reduce the incarceration of people who inject drugs.

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Author and article information

Contributors

Dana Busschots:

ORCID: https://orcid.org/0000-0003-0887-4119

dana.busschots@uhasselt.be

Journal

Journal ID (nlm-ta): BMC Infect Dis

Journal ID (iso-abbrev): BMC Infect Dis

Title: BMC Infectious Diseases

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2334

Publication date (Electronic): 27 July 2021

Publication date PMC-release: 27 July 2021

Publication date Collection: 2021

Volume: 21

Electronic Location Identifier: 708

Affiliations

[1 ]GRID grid.12155.32, ISNI 0000 0001 0604 5662, Faculty of Medicine and Life Sciences, , Hasselt University, ; Hasselt, Belgium

[2 ]GRID grid.470040.7, ISNI 0000 0004 0612 7379, Department of Gastroenterology and Hepatology, , Ziekenhuis Oost-Limburg, ; Genk, Belgium

[3 ]GRID grid.12155.32, ISNI 0000 0001 0604 5662, Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-Biostat), Data Science Institute, , Hasselt University, ; Diepenbeek, Belgium

[4 ]GRID grid.412966.e, ISNI 0000 0004 0480 1382, School of NUTRIM, , Maastricht University Medical Centre, ; Maastricht, the Netherlands

[5 ]GRID grid.413914.a, ISNI 0000 0004 0645 1582, Department of Gastroenterology and Hepatology, , CHR Citadelle, ; Liège, Belgium

[6 ]Dienst Coördinatie Medische Zorg, Federale Overheidsdienst Justitie, Brussel, Belgium

[7 ]GRID grid.420036.3, ISNI 0000 0004 0626 3792, Department of Gastroenterology and Hepatology, , AZ St-Jan, ; Bruges, Belgium

[8 ]GRID grid.410566.0, ISNI 0000 0004 0626 3303, Department of Gastroenterology and Hepatology, , UZ Gent, ; Ghent, Belgium

[9 ]GRID grid.508031.f, Epidemiology and Public Health, , Sciensano, ; Brussels, Belgium

[10 ]GRID grid.5284.b, ISNI 0000 0001 0790 3681, Centre for Health Economic Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, , University of Antwerp, ; Antwerp, Belgium

[11 ]GRID grid.410569.f, ISNI 0000 0004 0626 3338, Department of Gastroenterology and Hepatology, , University Hospitals KU Leuven, ; Leuven, Belgium

Author information

Dana Busschots https://orcid.org/0000-0003-0887-4119

Article

Publisher ID: 6405

DOI: 10.1186/s12879-021-06405-z

PMC ID: 8314587

PubMed ID: 34315415

SO-VID: 7f4ae8ce-b53b-4f02-8f0c-2b62908f3839

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 30 March 2021

Date accepted : 18 July 2021

Custom metadata

ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: prison,hepatitis c,hepatitis b,hiv,blood borne viral infections,screening,recommendations

Data availability:

ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: prison, hepatitis c, hepatitis b, hiv, blood borne viral infections, screening, recommendations

A multicentre interventional study to assess blood-borne viral infections in Belgian prisons

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Abstract

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Methods

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Conclusions

Trial registration

Supplementary Information

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HIV Self-Testing

Most cited references 47

Sample size calculation in medical studies

Global epidemiology and genotype distribution of the hepatitis C virus infection.

Global burden of HIV, viral hepatitis, and tuberculosis in prisoners and detainees.

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Contributors

Journal

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