population). Data collection commenced in October2004 <strong>and</strong> was completed in January 2006.The <strong>SA</strong> HCV in Prisons Study is aimed at estimatingthe prevalence <strong>and</strong> transmission of HCV infection inthe incarcerated population. It will identify patterns ofrisk behaviour with respect to injecting drug use <strong>and</strong>tattooing at time of entry to prison <strong>and</strong> will evaluatethe impact of the prison environment on those riskbehaviours over time. The study has two main stages,the first of which is a cross-sectional study involvingcase note <strong>au</strong>dits of all prisoners within the eightparticipating prisons. The other stage is a cohort study, inwhich prisoners were recruited as they entered prison,were offered HCV antibody tests <strong>and</strong> risk questionnaires<strong>and</strong> then were followed up over time.This study has formal approval from the following SouthAustralian ethics <strong>and</strong> research committees:• Aboriginal <strong>Health</strong> Research Ethics Committee• Department for Correctional Services ResearchManagement Committee• Department of <strong>Health</strong> Human Research EthicsCommittee• The Royal Adelaide Hospital Research EthicsCommittee• The University of Adelaide Human Research EthicsCommitteeEarly results of the <strong>SA</strong> HCV in Prisons studyOver 700 prison entrants were recruited to the cohortstudy over a period of ten months <strong>and</strong> the findings willbe available soon. Some of the findings from the crosssectionalstudy are already available online ahead of theirpublication later this year, 57 <strong>and</strong> are summarised here.The health records (or case notes) of 1347 prisonerswere available for <strong>au</strong>diting in January 2005. The <strong>au</strong>ditcollected data on sex, age, Indigenous status <strong>and</strong> HCVantibody status at last test. The population included 1254males <strong>and</strong> 93 females, of whom approximately 30%overall had serological evidence of HCV infection. Ofthe 27% of prisoners who had no record of ever havingbeen tested, HCV prevalence increased to 41% overall40% of the males <strong>and</strong> 66% of the female prisoners(over 1.5 times the risk in females).Looking at age in groups based on thirds of the agedistribution of the population, those in the youngest agegroup (18 to 28 years) had the lowest risk for HCV (28%infected) <strong>and</strong> those in older age groups had significantlyhigher risk 52% of 29 to 36 years olds (1.8 times the riskin the lower age group) <strong>and</strong> 44% of those aged over 36years (over 1.5 times the risk) had tested HCV antibodypositive. Indigenous status was also associated withHCV antibody status, but with some prison specificvariation. Lower risk for Indigenous prisoners was seenin one prison in the north of the state (20%), whilesignificantly higher risk for Indigenous prisoners was inall other locations (57%). This difference is likely to bedue to the origins of the specific Indigenous populations,with many of the northern prison inmates originatingfrom more remote areas where IDU is less frequentthan in more urban Indigenous communities.Further findings from the cross sectional study willbe available soon, as will the first findings of thecohort study. In the meantime, these early findingsdemonstrate that the prevalence of HCV infection inthe <strong>SA</strong> prison system is very high overall, particularlyfor females, Indigenous prisoners in urban centres<strong>and</strong> those aged above 28 years. The findings clearlyunderscore the need to continue working with allstakeholders to ensure that acceptable solutions to thisserious public health problem are identified.Factors associated with HCV-antibody status in eight publicly operated prisons in South AustraliaJanuary 2005 (n=982**)* table adapted from Miller et al 57** excluding 362 individuals with no documented test history18
References1 Dore GJ, MacDonald M, Law MG, Kaldor JM.Epidemiology of hepatitis C virus infection inAustralia, Chapter 1 in Hepatitis C: an update. AustFam Physician. 2003;32 (Special feature) (10):2-5.2 <strong>Communicable</strong> <strong>Diseases</strong> Australia. National Notifiable<strong>Diseases</strong> Surveillance System [on line database].2006; Commonwealth Department of <strong>Health</strong> <strong>and</strong>Ageing (Accessed March 15 2006). Available from:http://www1.health.gov.<strong>au</strong>/cda/Source/CDA-index.cfm3 Sanchez JL, Sjogren MH, Callahan JD, Watts DM,et al. Hepatitis C in Peru: risk factors for infection,potential iatrogenic transmission, <strong>and</strong> genotypedistribution. Am J Trop Med Hyg. 2000;63:242-8.4 L<strong>au</strong>er GM, Walker BD. Medical progress: hepatitis Cvirus infection. N Engl J Med. 2001;345 (1):41-52.5 Keeffe EB. Peginterferons in hepatitis C virus:virological, pharmacokinetic, <strong>and</strong> clinical implications[editorial]. Semin Liver Dis. 2003;23 (Supplement 1):1-2.6 Tillmann HL, Manns MP. Mode of hepatitis C virusinfection, epidemiology <strong>and</strong> chronicity rate in thegeneral population <strong>and</strong> risk groups. Dig Dis Sci.1996;41 (Supplement):27S-40S.7 Hoofnagle JH. Hepatitis C: the clinical spectrum ofdisease. Hepatology. 1997;26 (Supplement 1) (3):15S-20S.8 Farrell GC. Hepatitis C, other liver disorders, <strong>and</strong> liverhealth. NSW: MacLennan <strong>and</strong> Petty; 2002.9 Batey RG. Chronic Hepatitis C, Chapter 4 in HepatitisC an update. Aust Fam Physician. 2003;32 (Specialfeature) (10):15-20.10 Keefe EB, Hollinger B. The Consensus InterferonStudy Group. Therapy of hepatitis C: consensusinterferon trials. Hepatology. 1997;26 (Supplement1):101S-107S.11 Isaacson AH, Davis GL, L<strong>au</strong> JY. Should we testhepatitis C virus genotype <strong>and</strong> viraemia level inpatients with chronic hepatitis C? J Viral Hepat.1997;4:285-92.12 Flamm SL. Chronic hepatitis C virus infection. JAMA.2003;289(18):2413-7.13 Crofts N, Thompson S, Wale E, Hernberger F. Riskbehaviours for blood-borne viruses in a Victorianprison. Aust N Z J Criminol. 1996;29:20-8.14 Stark K, Bienzle U, Vonk R, Guggenmoos-HolzmannI. History of syringe sharing in prison <strong>and</strong> risk ofhepatitis B virus, hepatitis C virus, <strong>and</strong> humanimmunodeficiency virus infection among injecting drugusers in Berlin. Int J Epidemiol. 1997;26(6):1359-66.15 Dolan K. The epidemiology of hepatitis C infection inprison populations. In: Commonwealth Departmentof Heath <strong>and</strong> Aged Care, editor. Hepatitis C:Informing Australia’s National Response. Canberra;2000, 61-93.1916 Dolan K. Surveillance <strong>and</strong> Prevention of Hepatitis CInfection in Australian Prisons. A discussion paper.Sydney. National Drug <strong>and</strong> Alcohol Research Centre,University of New South Wales; 2000; NDARCTechnical Report No. 95.17 STD Services of <strong>SA</strong>. Source of HCV Notifications. In.Adelaide; 2002.18 Dolan K. Why is there conflicting evidence of hepatitistransmission in prison? First Australasian Conferenceon Hepatitis C. Sydney;1997 March 16-18.19 Macalino GE, Hou JC, Kumar MS, Taylor LE, et al.Hepatitis C infection <strong>and</strong> incarcerated populations. IntJ Drug Policy. 2004;15:103-114.20 Ford PM, Pearson M, Sankar-Mistry P, Stevenson T, etal. HIV, hepatitis C <strong>and</strong> risk behaviour in a Canadianmedium-security federal penitentiary. Queen’sUniversity HIV Prison Study Group. Q J Med.2000;93(2):113-9.21 Post JJ, Dolan KA, Whybin LR, Carter IW, et al. Acutehepatitis C virus infection in an Australian prisoninmate: tattooing as a possible transmission route.Med J Aust. 2001;174(4):183-4.22 Hellard ME, Hocking JS, Crofts N. The prevalence <strong>and</strong>the risk behaviours associated with the transmissionof hepatitis C virus in Australian correctional facilities.Epidemiol Infect. 2004;132:409-15.23 Seamark R, G<strong>au</strong>ghwin M. Jabs in the dark: injectingequipment found in prisons, <strong>and</strong> the risks of viraltransmission. Aust J <strong>Public</strong> <strong>Health</strong>. 1994;18(1):113-6.24 Haber PS, Parsons SJ, Harper SE, White PA, et al.Transmission of hepatitis C within Australian prisons.Med J Aust. 1999;171(1):31-3.25 Hughes RA. Drug injectors <strong>and</strong> the cleaning of needles<strong>and</strong> syringes. Eur Addict Res. 2000;6(1):20-30.26 Gore SM, Bird AG, Burns SM, Goldberg DJ, et al.Drug injection <strong>and</strong> HIV prevalence in inmates ofGlenochil prison. Br Med J. 1995;310:293-6.27 Allwright S, Bradley F, Long J, Barry J, et al.Prevalence of antibodies to hepatitis B, hepatitis C,<strong>and</strong> HIV <strong>and</strong> risk factors in Irish prisoners: resultsof a national cross sectional survey. Br Med J.2000;321(7253):78-82.28 Danahar D. Louisiana update. Delta to explore newvenues in 1999. Faculty Notes - Delta Region AIDSEducation & Training Center. 1999;11(2):4.29 Dolan KA, Wodak AD, Hall WD. A bleach program forinmates in NSW: an HIV prevention strategy. Aust NZ J <strong>Public</strong> <strong>Health</strong>. 1998;22(7):838-40.30 MacDonald M, Zhou J, Buddle M. National needle<strong>and</strong> syringe program survey - Chapter 3. In: ANCD,editor. Dealing with risk: a multidisciplinary study ofinjecting drug use, hepatitis C <strong>and</strong> other blood-borneviruses in Australia. Canberra: Australian NationalCouncil on Drugs; 2003, 9-19.