Incarceration history and risk of HIV and hepatitis C virus acquisition among people who inject drugs: a systematic review and meta-analysis

Abstract

Background: People who inject drugs (PWID) experience high rates of incarceration and may be at high risk of HIV and hepatitis C (HCV) virus infection during or after incarceration. We conducted a systematic review and meta-analysis to assess whether incarceration history elevates HIV or HCV acquisition risk among PWID.Methods: MEDLINE, Embase and PsycINFO databases were searched for studies in any language published since 2000 assessing HIV or HCV incidence among PWID. Studies were included if they reported the association between recent (in last 3, 6 or 12 months or since last follow-up) or past incarceration and HIV or HCV (primary or reinfection) incidence. Authors of incidence studies not reporting these outcomes were contacted for data. Data were extracted and pooled using random-effects meta-analyses. Findings: Twenty published and 21 unpublished studies were included, originating from Australasia, Western and Eastern Europe, North and Latin America and East and Southeast Asia. Recent incarceration was associated with an 81% (rate ratio (RR):1.81, 95%CI: 1.40-2.34) and 62% (RR:1.62, 95%CI:1.28-2.05) increase in HIV and HCV acquisition risk, respectively. Past incarceration was associated with a 25% and 21% increase in HIV (RR:1.25, 95%CI:0.94-1.66) and HCV (RR:1.21, 95%CI:1.02-1.43) and acquisition risk, respectively.Interpretation: Incarceration is associated with substantial short-term HIV and HCV acquisition risk among PWID and could be a significant driver for HCV and HIV transmission among PWID. These findings support the need for developing novel interventions to minimise the risk of HCV acquisition – including addressing structural risks associated with drug laws and excessive incarceration of PWID