People in prison are at high risk of HCV given high injecting drug use prevalence. This study evaluated HCV incidence and associated injecting drug use characteristics in prison. The SToP-C study enrolled people incarcerated in four Australian prisons. Participants were tested for HCV at enrolment and then every 3–6 months (October-2014 to November-2019). Participants eligible for this analysis included those at-risk of HCV primary infection (anti-HCV negative) or re-infection (anti-HCV positive, HCV RNA negative) with follow-up assessment. A total of 1643 eligible participants were included in analyses (82% male; median age 33 years; 30% injected drugs in prison; 1818 person-years of follow-up). Overall HCV incidence was 6.11/100 person-years (95%CI: 5.07–7.35), with higher rate of re-infection (9.34/100 person-years; 95%CI: 7.15–12.19) than primary infection (4.60/100 person-years; 95%CI: 3.56–5.96). In total population (n = 1643), HCV risk was significantly higher among participants injecting drugs in prison [vs. no injecting; adjusted hazard ratio (aHR): 10.55, 95%CI: 5.88–18.92), and those who were released and re-incarcerated during follow-up (vs. remained incarcerated; aHR: 1.60, 95%CI: 1.03–2.49). Among participants who injected recently (during past month, n = 321), HCV risk was reduced among those receiving high-dosage opioid agonist therapy (OAT), i.e. methadone ≥60 mg/day or buprenorphine ≥16 mg/day, (vs. no OAT, aHR: 0.11, 95%CI: 0.02–0.80) and increased among those sharing needles/syringes without consistent use of disinfectant to clean injecting equipment (vs. no sharing, HR: 4.60, 95%CI: 1.35–15.66). This study demonstrated high HCV transmission risk in prison, particularly among people injecting drugs. High-dosage OAT was protective, but improved OAT coverage and needle/syringe programmes to reduce sharing injecting equipment are required.

中文翻译：

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监狱环境中丙型肝炎病毒感染的发生率：STOP-C 研究

由于注射吸毒流行率很高，监狱中的人感染丙肝病毒的风险很高。本研究评估了监狱中丙型肝炎病毒的发病率和相关的注射吸毒特征。SToP-C 研究纳入了澳大利亚四所监狱中被监禁的人。参与者在入组时接受 HCV 检测，然后每 3-6 个月（2014 年 10 月至 2019 年 11 月）进行一次检测。符合本分析条件的参与者包括那些有 HCV 原发感染（抗 HCV 阴性）或再次感染（抗 HCV 阳性、HCV RNA 阴性）风险并进行后续评估的参与者。共有 1643 名符合条件的参与者参与了分析（82% 为男性；中位年龄 33 岁；30% 在监狱中注射毒品；1818 人年的随访）。HCV 总体发病率为 6.11/100 人年（95%CI：5.07-7.35），再感染率（9.34/100 人年；95%CI：7.15-12.19）高于初次感染率（4.60/100）人年；95%CI：3.56–5.96）。在总人口中（n  = 1643），在监狱注射毒品的参与者中 HCV 风险明显高于在监狱中注射毒品的参与者。无需注射；调整后的风险比（aHR）：10.55，95%CI：5.88-18.92），以及在随访期间被释放并重新监禁的人（与继续监禁；aHR：1.60，95%CI：1.03-2.49）。在最近注射的参与者中（过去一个月，n  = 321），接受高剂量阿片类激动剂治疗（OAT）（即美沙酮≥60毫克/天或丁丙诺啡≥16毫克/天）的患者HCV风险降低（与对照组相比）。没有燕麦，aHR：0.11，95％CI：0.02–0.80），并且在共用针头/注射器而没有持续使用消毒剂清洁注射设备的情况下增加（与不共用相比，HR：4.60，95％CI：1.35–15.66） 。这项研究表明监狱中丙型肝炎病毒传播风险很高，特别是在注射吸毒者之间。高剂量 OAT 具有保护作用，但需要改善 OAT 覆盖范围和针头/注射器计划，以减少共用注射设备。