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A systematic review of hepatitis C virus prevalence and incidence in closed settings

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Date Commenced:
Project Supporters:

World Health Organisation

Project Members: 
image - Sarah Larney
Adjunct Senior Lecturer
Ph +61 (2) 9385 0333
Project Main Description: 

Hepatitis C virus (HCV) is highly prevalent among incarcerated people around the world, largely due to the high concentration in correctional settings of people who inject drugs. Tattooing and injecting drug use while incarcerated contribute to further transmission of HCV; however, responses to HCV in correctional settings are sub-optimal.

To date there has been no effort to systematically review and consolidate data on HCV prevalence and incidence among incarcerated populations at a global level. This review will provide evidence to support the case for improved screening, prevention and treatment of HCV in correctional institutions. This is particularly relevant in light of recent advances that make HCV treatment while incarcerated a more realistic option than in the past.

Project Collaborators: External: 

Prof Josiah Rich (Alpert Medical School, Brown University & Center for Prisoner Health and Human Rights)

To conduct a systematic review of hepatitis C virus prevalence and incidence in closed settings and prepare a paper for submission to a peer reviewed journal. Specifically, to systematically summarise and, where appropriate, undertake meta-analyses of the literature on:
  1. HCV prevalence in correctional institutions
  2. HCV incidence in continuously incarcerated persons
Data on all types of closed settings will be searched, including pre-trial detention and compulsory drug treatment centres. If data permit an attempt will be made to characterise HCV among these settings separately.
Design and Method: 

Both peer-reviewed publications and grey literature will be eligible for inclusion in the review. Translation will be sought for papers in languages other than English if they are deemed promising. Collected documents will be catalogued and assessed for inclusion in the review.  Included studies will be graded on their quality, and the grades and data from each study will be compiled. Data will be processed and reported in line with previous global systematic reviews of the epidemiology of infectious diseases in high-risk populations.


HCV transmission occurs in prisons, albeit at a lower rate than occurs among non-detained people who inject drugs. One in four detainees globally, and two-thirds of detainees with a history of injecting drug use, is anti-HCV positive, equating to an estimated 2.2 million persons.


Larney, S., Kopinski, H., Beckwith, C. G., Zaller, N. D., Jarlais, D. D., Hagan, H., Rich, J. D., van den Bergh, B. J. and Degenhardt, L. (2013), Incidence and prevalence of hepatitis C in prisons and other closed settings: Results of a systematic review and meta-analysis. Hepatology, 58: 1215–1224. doi: 10.1002/hep.26387


This study has enumerated global HCV incidence and prevalence in prison at a time when significant advancements are being made in the treatment of this disease. Our findings highlight the importance of giving greater attention to HCV prevention, diagnosis and treatment in closed settings.

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