Modeling the role of incarceration in HCV transmission and prevention amongst people who inject drugs in rural Kentucky

Jack Stone, Hannah Fraser, April M. Young, Jennifer R. Havens, Peter Vickerman

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

Background: People who inject drugs (PWID) experience high incarceration rates, with current/recent incarceration being associated with increased hepatitis C virus (HCV) transmission. We assess the contribution of incarceration to HCV transmission amongst PWID in Perry County (PC), Kentucky, USA, and the impact of scaling-up community and in-prison opioid substitution therapy (OST), including the potential for reducing incarceration. Methods: A dynamic model of incarceration and HCV transmission amongst PWID was calibrated in a Bayesian framework to epidemiological and incarceration data from PC, incorporating an empirically estimated 2.8-fold (95%CI: 1.36–5.77) elevated HCV acquisition risk amongst currently incarcerated or recently released (<6 months) PWID compared to other PWID. We projected the percentage of new HCV infections that would be prevented among PWID over 2020–2030 if incarceration no longer elevated HCV transmission risk, if needle and syringe programmes (NSP) and OST are scaled-up, and/or if drug use was decriminalized (incarceration/reincarceration rates are halved) with 50% of PWID that would have been imprisoned being diverted onto OST. We assume OST reduces reincarceration by 10–42%. Results: Over 2020–2030, removing the effect of incarceration on HCV transmission could prevent 42.7% (95% credibility interval: 15.0–67.4%) of new HCV infections amongst PWID. Conversely, scaling-up community OST and NSP to 50% coverage could prevent 28.5% (20.0–37.4%) of new infections, with this increasing to 32.7% (24.5–41.2%) if PWID are retained on OST upon incarceration, 36.4% (27.7–44.9%) if PWID initiate OST in prison, and 45.3% (35.9–54.1%) if PWID are retained on OST upon release. decriminalization (with diversion to OST) could further increase this impact, preventing 56.8% (45.3–64.5%) of new infections. The impact of these OST interventions decreases by 2.1–28.6% if OST does not reduce incarceration. Conclusion: Incarceration is likely to be an important contributor to HCV transmission amongst PWID in PC. Prison-based OST could be an important intervention for reducing this risk.

Original languageEnglish
Article number102707
JournalInternational Journal of Drug Policy
Volume88
DOIs
StatePublished - Feb 2021

Bibliographical note

Funding Information:
J.S. has received a conference attendance sponsorship from Gilead. P.V. has received unrestricted research grants from Gilead unrelated to this work and honorarium from Gilead and Abbvie unrelated to this work. H.F. has received an honorarium from MSD unrelated to this work. The other authors report no conflicts.

Funding Information:
This work was funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Evaluation of Interventions.

Funding Information:
JS acknowledges funding from a Ph.D. studentship from the Engineering and Physical Sciences Research Council (EPSRC award ref 1414884). JS and PV acknowledge support from the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Evaluation of Interventions at the University of Bristol in partnership with Public Health England (PHE). JS and PV also acknowledge support from the National Institute on Drug Abuse (NIDA), National Institutes of Health (NIH), through grant R01DA033679. PV, HF, AMY and JRH acknowledge support from the National Institute on Drug Abuse (NIDA), National Institutes of Health, through grant R01DA033862. HF acknowledges support from Contract No. 200-2013-M-53964B GS-10F-0097L from the Centers for Disease Control and Prevention (CDC) to RTI International and a subcontract from RTI International to the University of Bristol. JRH and AMY acknowledge support from NIDA, NIH, through grant R01DA024598. The opinions expressed in this paper are solely those of the authors and do not necessarily represent the opinions of the NIHR, NIH, CDC, RTI International, or the University of Bristol. Data collection for the SNAP study described in this manuscript is ongoing. Data used for this submission will be made available on request to the Principal Investigator, Jennifer Havens (jennifer.havens@uky.edu). This work was funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Evaluation of Interventions.

Funding Information:
JS acknowledges funding from a Ph.D. studentship from the Engineering and Physical Sciences Research Council (EPSRC). JS and PV acknowledge support from the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Evaluation of Interventions at the University of Bristol in partnership with Public Health England (PHE). JS and PV also acknowledge support from the National Institute on Drug Abuse (NIDA), National Institutes of Health (NIH), through grant R01DA033679. PV, HF, AMY and JRH acknowledge support from the National Institute on Drug Abuse (NIDA), National Institutes of Health, through grant R01DA033862. HF acknowledges support from Contract No. 200-2013-M-53964B GS-10F-0097L from the Centers for Disease Control and Prevention (CDC) to RTI International and a subcontract from RTI International to the University of Bristol. JRH and AMY acknowledge support from NIDA , NIH, through grant R01DA024598. The opinions expressed in this paper are solely those of the authors and do not necessarily represent the opinions of the NIHR, NIH, CDC, RTI International, or the University of Bristol.

Publisher Copyright:
© 2020

Keywords

  • Harm reduction
  • Hepatitis C virus
  • Incarceration
  • Mathematical modeling
  • People who inject drugs
  • Prison

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Health Policy

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