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Q J Med 1999; 92: 25-32
© 1999 Association of Physicians

Prevalence of hepatitis C in prisons: WASH-C surveillance linked to self-reported risk behaviours

S.M. Gore, A.G. Bird1, S.O. Cameron2, S.J. Hutchinson3, S.M. Burns4 and D.J. Goldberg5

From the MRC Biostatistics Unit, Cambridge, 1 Department of Immunology, John Radcliffe Hospital, Oxford, 2 Regional Virus Laboratory, Glasgow, 3 MRC-BIAS, Edinburgh, 4 Regional Virus Laboratory, Edinburgh and 5 Scottish Centre for Infection and Environmental Health, Glasgow, UK

Received 11 September 1998 and in revised form 9 November 1998

We used cross-sectional willing anonymous salivary hepatitis C (WASH-C) surveillance linked to self-completed risk-factor questionnaires to estimate the prevalence of salivary hepatitis C antibodies (HepCAbS) in five Scottish prisons from 1994 to 1996. Of 2121 available inmates, 1864 (88%) participated and 1532/1864 (82%) stored samples were suitable for testing. Overall 311/1532 (20.3%, prevalence 95%CI 18.3–22.3%) were HepCAbS-positive: 265/536 (49%, 95%CI 45–54%) injector-inmates but only 27/899 (3%, 95%CI 2–4%) non-injector-inmates. Among injectors, HepCAbS positivity was only slightly higher (p=0.03) in those who had injected inside prison (53%, 162/305) than in those who had not (44%, 98/224). Those who began injecting in 1992–96 were much less likely to be HepCAbS-positive than those who started pre-1992 (31%, 35/114 vs. 55%, 230/422; p<0.001). Even with injectors who began in 1992–96 but had never injected inside prison, the prevalence of hepatitis C carriage was 17/63 (95%CI 16–38%). The prevalence and potential transmissibility of hepatitis C in injector-inmates are both high. Promoting `off injecting' before `off drugs' (both inside and outside prison), methadone prescription during short incarcerations, alternatives to prison, and support of HepCAbS-positive inmates in becoming eligible for treatment, all warrant urgent consideration.

Address correspondence to Dr S.M. Gore, MRC Biostatistics Unit, Institute of Public Health, Robinson Way, Cambridge CB2 2SR


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