Background: People who inject drugs (PWID) experience a high prevalence of incarceration and might be at high risk of HIV and hepatitis C virus (HCV) infection during or after incarceration. We aimed to assess whether incarceration history elevates HIV or HCV acquisition risk among PWID. Methods: In this systematic review and meta-analysis, we searched MEDLINE, Embase, and PsycINFO databases for studies in any language published from Jan 1, 2000 until June 13, 2017 assessing HIV or HCV incidence among PWID. We included studies that measured HIV or HCV incidence among community-recruited PWID. We included only studies reporting original results and excluded studies that evaluated incident infections by self-report. We contacted authors of cohort studies that met the inclusion or exclusion criteria, but that did not report on the outcomes of interest, to request data. We extracted and pooled data from the included studies using random-effects meta-analyses to quantify the associations between recent (past 3, 6, or 12 months or since last follow-up) or past incarceration and HIV or HCV acquisition (primary infection or reinfection) risk among PWID. We assessed the risk of bias of included studies using the Newcastle-Ottawa Scale. Between-study heterogeneity was evaluated using the I2 statistic and the P-value for heterogeneity. Findings: We included published results from 20 studies and unpublished results from 21 studies. These studies originated from Australasia, western and eastern Europe, North and Latin America, and east and southeast Asia. Recent incarceration was associated with an 81% (relative risk [RR] 1·81, 95% CI 1·40–2·34) increase in HIV acquisition risk, with moderate heterogeneity between studies (I2=63·5%; p=0·001), and a 62% (RR 1·62, 95% CI 1·28–2·05) increase in HCV acquisition risk, also with moderate heterogeneity between studies (I2=57·3%; p=0·002). Past incarceration was associated with a 25% increase in HIV (RR 1·25, 95% CI 0·94–1·65) and a 21% increase in HCV (1·21, 1·02–1·43) acquisition risk. Interpretation: Incarceration is associated with substantial short-term increases in HIV and HCV acquisition risk among PWID and could be a significant driver of HCV and HIV transmission among PWID. These findings support the need for developing novel interventions to minimise the risk of HCV and HIV acquisition, including addressing structural risks associated with drug laws and excessive incarceration of PWID. Funding: Engineering and Physical Sciences Research Council, National Institute for Health Research, National Institutes of Health.
Bibliographical noteFunding Information:
JS acknowledges funding from a PhD scholarship from the Engineering and Physical Sciences Research Council (EPSRC). HF, PV, and NKM acknowledge funding from the National Institute for Drug Abuse (NIDA; R01DA03773). JGW acknowledges funding from the CDC Foundation. AT's PhD has been funded by the National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Evaluation of Interventions at the University of Bristol in partnership with Public Health England. VM acknowledges institutional support from Charles University, PROGRES Programme number Q06/LF1 and by the Project number LO1611 with financial support from the Czech Ministry of Youth and Sport under the National Heitage Institute (NPU) I programme. JB acknowledges funding from the Canadian Institutes of Health Research and from the Fonds de la Recherche en Santé du Québec. SAS acknowledges funding from NIDA (R37DA019829). ER and MAlar acknowledge the support from the Public Health Agency of Canada and the Ministère de la santé et des services sociaux du Québec. AMY and JRH were supported by the National Institute of Health (R01DA024598 and R01DA033862). RSG was supported by the National Institutes for Health (R01-DA031074). RS-D and MEH acknowledge fellowship support from the Australian National Health and Medical Research Council and funding from the Victorian Operational Infrastructure Support Program to the Burnet Institute. LMah and JI acknowledge fellowship support from the Australian National Health and Medical Research Council (NHMRC); the Australian Needle and Syringe Program Survey is funded by the Australian Government Department of Health and the Hepatitis Incidence and Transmission Study—community was funded by the Australian NHMRC (project grant number 630483). LMac acknowledges funding from a PhD scholarship from the EPSRC. SHM acknowledges funding from the National Institutes of Health (R01DA012568 and U01DA036297) for the ALIVE cohort. TA acknowledges funding from AusAID (GR-00376 to icddr,b). NKM acknowledges funding from the University of California San Diego Center for AIDS Research, a National Institute of Health funded programme (P30 AI036214). FLA acknowledges funding from NIDA (K24 DA017072, R01 DA043125, R01 DA029910, R01 DA033679, R01 DA041271, R21 DA042702, R21 DA041953 and R01 DA030762). PV and MH acknowledge support from the NIHR HPRU in Evaluation of Interventions. MEH acknowledges NIHR Biomedical Research Centre at University of Bristol and NIHR School of Public Health Research. The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR, the Department of Health and Social Care, or Public Health England.
JS reports non-financial support from Gilead Sciences, outside the submitted work. JB reports grants from Canadian Institute on Health Research and Fonds de Recherche du Québec en Santé, during the conduct of the study, and personal fees from Merck, Sharp & Dohme (MSD) and Gilead Sciences, outside the submitted work. MEH reports grants from Gilead Sciences, AbbVie, and GlaxoSmithKline, outside the submitted work. MAlar reports grants from Ministère de la santé et des services sociaux du Québec, during the conduct of the study, and grants from Canadian Institutes of Health Research and the Bill & Melinda Gates Foundation, outside the submitted work. CA reports grants from the National Health and Medical Research Council and from the Colonial Foundation Trust, during the conduct of the study. HF reports receiving an honorarium from MSD, outside the submitted work. PMD reports grants from National Health and Medical Research Council and Colonial Foundation Trust, during the conduct of the study, and grants from Gilead Sciences and Indivior, outside the submitted work. MH reports personal fees from Gilead Sciences, AbbVie, and MSD, outside the submitted work. NKM reports grants and other from Gilead Sciences and MSD, outside the submitted work. AMY reports grants from the National Institute on Drug Abuse, during the conduct of the study. GZ reports grants from the Canadian Institutes on Health Research and Fonds de Recherche en Santé du Québec, during the conduct of the study. FLA reports personal fees from MSD, Gilead Sciences, Simply Speaking HIV, and Clinical Care Options, outside the submitted work, and grants awarded to Yale University from Gilead Sciences, MSD, National Institutes of Health, the National Institute on Drug Abuse, the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration. PV reports grants from National Institute of Drug Abuse and National Institute of Health Research, during the conduct of the study. JGW reports grants from CDC Foundation, during the conduct of the study All other authors declare no competing interests.
© 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license