Modelling the impact of incarceration and prison-based HCV treatment on HCV transmission among people who inject drugs in Scotland

Jack  Stone; Natasha K. Martin; Matthew  Hickman; Sharon Hutchinson; Esther  Aspinall; Avril Taylor; Alison Munro; Karen Dunleavy; Erica  Peters; Peter  Bramley; Peter C.  Hayes; David J.  Goldberg; Peter  Vickerman

doi:10.1111/add.13783

Modelling the impact of incarceration and prison-based HCV treatment on HCV transmission among people who inject drugs in Scotland

Jack Stone, Natasha K. Martin, Matthew Hickman, Sharon Hutchinson, Esther Aspinall, Avril Taylor, Alison Munro, Karen Dunleavy, Erica Peters, Peter Bramley, Peter C. Hayes, David J. Goldberg, Peter Vickerman

Research output: Contribution to journal › Article › peer-review

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Abstract

Background/Aims: People who inject drugs (PWID) experience high incarceration rates, and previous incarceration is associated with elevated hepatitis C virus (HCV) transmission risk. We evaluate the contribution of incarceration to HCV transmission amongst PWID, and the impact of prison-related prevention interventions, including scaling-up direct-acting antivirals (DAAs) in prison.
Design: Dynamic mathematical modelling of incarceration and HCV transmission, using approximate Bayesian computation for model calibration.
Setting: Scotland; where national survey data indicates lower HCV incidence in prison than the community (4.3 vs 7.3 per 100py), but a 2.3-fold elevated transmission risk amongst recently released (<6 months) PWID.
Participants: PWID
Measurements: Population attributable fraction of incarceration (PAF) to HCV transmission among PWID. Decrease in HCV incidence and chronic prevalence due to current levels of prison opiate substitution therapy (OST; 57% coverage) and HCV treatment; as well as scaling-up DAAs in prison and/or preventing the elevated risk associated with prison-release.
Findings: Incarceration contributes 27.7% (PAF; 95%CrI -3.1-51.1%) of HCV transmission amongst PWID in Scotland. Over the next 15 years, current HCV treatment rates (10.4/6.8 per 1000 incarcerated/community PWID annually), with existing prison OST, could reduce incidence and chronic prevalence among all PWID by a relative 10.7% (95%CrI 8.4-13.3%) and 9.7% (95%CrI 7.7-12.1%), respectively. Conversely, without prison OST, HCV incidence and chronic prevalence would decrease by 3.1% (95%CrI -28.5-18.0%) and 4.7% (95%CrI -11.3-14.5%). Additionally, preventing the heightened risk among recently released PWID could reduce incidence and chronic prevalence by 45.0% (95%CrI 19.7-57.5%) and 33.3% (95%CrI 15.6-43.6%) or scaling-up prison HCV treatments to 80% of chronic PWID prison entrants with sufficient sentences (>16 weeks) could reduce incidence and prevalence by 45.6% (95%CrI 38.0-51.3%) and 45.5% (95%CrI 39.3-51.0%), respectively.
Conclusions: Incarceration and the elevated transmission risk following prison-release can contribute significantly to HCV transmission amongst PWID. Scaling-up HCV treatment in prison can provide important prevention benefits.

Original language	English
Journal	Addiction
Early online date	3 Mar 2017
DOIs	https://doi.org/10.1111/add.13783
Publication status	E-pub ahead of print - 3 Mar 2017

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Stone, J., Martin, N. K., Hickman, M., Hutchinson, S., Aspinall, E., Taylor, A., Munro, A., Dunleavy, K., Peters, E., Bramley, P., Hayes, P. C., Goldberg, D. J., & Vickerman, P. (2017). Modelling the impact of incarceration and prison-based HCV treatment on HCV transmission among people who inject drugs in Scotland. Addiction. Advance online publication. https://doi.org/10.1111/add.13783

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title = "Modelling the impact of incarceration and prison-based HCV treatment on HCV transmission among people who inject drugs in Scotland",

abstract = "Background/Aims: People who inject drugs (PWID) experience high incarceration rates, and previous incarceration is associated with elevated hepatitis C virus (HCV) transmission risk. We evaluate the contribution of incarceration to HCV transmission amongst PWID, and the impact of prison-related prevention interventions, including scaling-up direct-acting antivirals (DAAs) in prison. Design: Dynamic mathematical modelling of incarceration and HCV transmission, using approximate Bayesian computation for model calibration.Setting: Scotland; where national survey data indicates lower HCV incidence in prison than the community (4.3 vs 7.3 per 100py), but a 2.3-fold elevated transmission risk amongst recently released (<6 months) PWID.Participants: PWIDMeasurements: Population attributable fraction of incarceration (PAF) to HCV transmission among PWID. Decrease in HCV incidence and chronic prevalence due to current levels of prison opiate substitution therapy (OST; 57% coverage) and HCV treatment; as well as scaling-up DAAs in prison and/or preventing the elevated risk associated with prison-release.Findings: Incarceration contributes 27.7% (PAF; 95%CrI -3.1-51.1%) of HCV transmission amongst PWID in Scotland. Over the next 15 years, current HCV treatment rates (10.4/6.8 per 1000 incarcerated/community PWID annually), with existing prison OST, could reduce incidence and chronic prevalence among all PWID by a relative 10.7% (95%CrI 8.4-13.3%) and 9.7% (95%CrI 7.7-12.1%), respectively. Conversely, without prison OST, HCV incidence and chronic prevalence would decrease by 3.1% (95%CrI -28.5-18.0%) and 4.7% (95%CrI -11.3-14.5%). Additionally, preventing the heightened risk among recently released PWID could reduce incidence and chronic prevalence by 45.0% (95%CrI 19.7-57.5%) and 33.3% (95%CrI 15.6-43.6%) or scaling-up prison HCV treatments to 80% of chronic PWID prison entrants with sufficient sentences (>16 weeks) could reduce incidence and prevalence by 45.6% (95%CrI 38.0-51.3%) and 45.5% (95%CrI 39.3-51.0%), respectively.Conclusions: Incarceration and the elevated transmission risk following prison-release can contribute significantly to HCV transmission amongst PWID. Scaling-up HCV treatment in prison can provide important prevention benefits.",

author = "Jack Stone and Martin, {Natasha K.} and Matthew Hickman and Sharon Hutchinson and Esther Aspinall and Avril Taylor and Alison Munro and Karen Dunleavy and Erica Peters and Peter Bramley and Hayes, {Peter C.} and Goldberg, {David J.} and Peter Vickerman",

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T1 - Modelling the impact of incarceration and prison-based HCV treatment on HCV transmission among people who inject drugs in Scotland

AU - Stone, Jack

AU - Martin, Natasha K.

AU - Hickman, Matthew

AU - Hutchinson, Sharon

AU - Aspinall, Esther

AU - Taylor, Avril

AU - Munro, Alison

AU - Dunleavy, Karen

AU - Peters, Erica

AU - Bramley, Peter

AU - Hayes, Peter C.

AU - Goldberg, David J.

AU - Vickerman, Peter

N1 - 12 months embargo

PY - 2017/3/3

Y1 - 2017/3/3

N2 - Background/Aims: People who inject drugs (PWID) experience high incarceration rates, and previous incarceration is associated with elevated hepatitis C virus (HCV) transmission risk. We evaluate the contribution of incarceration to HCV transmission amongst PWID, and the impact of prison-related prevention interventions, including scaling-up direct-acting antivirals (DAAs) in prison. Design: Dynamic mathematical modelling of incarceration and HCV transmission, using approximate Bayesian computation for model calibration.Setting: Scotland; where national survey data indicates lower HCV incidence in prison than the community (4.3 vs 7.3 per 100py), but a 2.3-fold elevated transmission risk amongst recently released (<6 months) PWID.Participants: PWIDMeasurements: Population attributable fraction of incarceration (PAF) to HCV transmission among PWID. Decrease in HCV incidence and chronic prevalence due to current levels of prison opiate substitution therapy (OST; 57% coverage) and HCV treatment; as well as scaling-up DAAs in prison and/or preventing the elevated risk associated with prison-release.Findings: Incarceration contributes 27.7% (PAF; 95%CrI -3.1-51.1%) of HCV transmission amongst PWID in Scotland. Over the next 15 years, current HCV treatment rates (10.4/6.8 per 1000 incarcerated/community PWID annually), with existing prison OST, could reduce incidence and chronic prevalence among all PWID by a relative 10.7% (95%CrI 8.4-13.3%) and 9.7% (95%CrI 7.7-12.1%), respectively. Conversely, without prison OST, HCV incidence and chronic prevalence would decrease by 3.1% (95%CrI -28.5-18.0%) and 4.7% (95%CrI -11.3-14.5%). Additionally, preventing the heightened risk among recently released PWID could reduce incidence and chronic prevalence by 45.0% (95%CrI 19.7-57.5%) and 33.3% (95%CrI 15.6-43.6%) or scaling-up prison HCV treatments to 80% of chronic PWID prison entrants with sufficient sentences (>16 weeks) could reduce incidence and prevalence by 45.6% (95%CrI 38.0-51.3%) and 45.5% (95%CrI 39.3-51.0%), respectively.Conclusions: Incarceration and the elevated transmission risk following prison-release can contribute significantly to HCV transmission amongst PWID. Scaling-up HCV treatment in prison can provide important prevention benefits.

AB - Background/Aims: People who inject drugs (PWID) experience high incarceration rates, and previous incarceration is associated with elevated hepatitis C virus (HCV) transmission risk. We evaluate the contribution of incarceration to HCV transmission amongst PWID, and the impact of prison-related prevention interventions, including scaling-up direct-acting antivirals (DAAs) in prison. Design: Dynamic mathematical modelling of incarceration and HCV transmission, using approximate Bayesian computation for model calibration.Setting: Scotland; where national survey data indicates lower HCV incidence in prison than the community (4.3 vs 7.3 per 100py), but a 2.3-fold elevated transmission risk amongst recently released (<6 months) PWID.Participants: PWIDMeasurements: Population attributable fraction of incarceration (PAF) to HCV transmission among PWID. Decrease in HCV incidence and chronic prevalence due to current levels of prison opiate substitution therapy (OST; 57% coverage) and HCV treatment; as well as scaling-up DAAs in prison and/or preventing the elevated risk associated with prison-release.Findings: Incarceration contributes 27.7% (PAF; 95%CrI -3.1-51.1%) of HCV transmission amongst PWID in Scotland. Over the next 15 years, current HCV treatment rates (10.4/6.8 per 1000 incarcerated/community PWID annually), with existing prison OST, could reduce incidence and chronic prevalence among all PWID by a relative 10.7% (95%CrI 8.4-13.3%) and 9.7% (95%CrI 7.7-12.1%), respectively. Conversely, without prison OST, HCV incidence and chronic prevalence would decrease by 3.1% (95%CrI -28.5-18.0%) and 4.7% (95%CrI -11.3-14.5%). Additionally, preventing the heightened risk among recently released PWID could reduce incidence and chronic prevalence by 45.0% (95%CrI 19.7-57.5%) and 33.3% (95%CrI 15.6-43.6%) or scaling-up prison HCV treatments to 80% of chronic PWID prison entrants with sufficient sentences (>16 weeks) could reduce incidence and prevalence by 45.6% (95%CrI 38.0-51.3%) and 45.5% (95%CrI 39.3-51.0%), respectively.Conclusions: Incarceration and the elevated transmission risk following prison-release can contribute significantly to HCV transmission amongst PWID. Scaling-up HCV treatment in prison can provide important prevention benefits.

U2 - 10.1111/add.13783

DO - 10.1111/add.13783

M3 - Article

SN - 0965-2140

JO - Addiction

JF - Addiction

ER -

Modelling the impact of incarceration and prison-based HCV treatment on HCV transmission among people who inject drugs in Scotland

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