The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #68081

Kelly L. Muck, MPH¹, Colin Flynn, ScM¹, John F. Vertefeuille, MHS, PhD², Anthony Swetz, PhD³, and Liza Solomon, MHS, DrPH¹. (1) Maryland Department of Health and Mental Hygiene, AIDS Administration, 500 N. Calvert Street, 5th Floor, Baltimore, MD 21202, (2) Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland, 725 West Lombard Street, Room N454, Baltimore, MD 21201, (3) Director of Inmate Health Care, Department of Public Safety and Correctional Services, Suite 315, Plaza Office Center, 6776 Reisterstown Road, Baltimore, MD 21215

BACKGROUND: It is important to understand the infectious disease burden in prison populations since prisoners are often characterized by high-risk behaviors and, without appropriate screening and treatment available, are released untreated to their home communities. Our study examines incidence and prevalence of HIV, and prevalence of Syphilis, Hepatitis B (HBV), and Hepatitis C (HCV) in Maryland prisons. METHODS: This blinded serostudy occurred between 1/28/02 and 03/28/02 and involved collecting excess sera from venipuncture for routine syphilis screening during intake on 1081 inmates (10% female). RESULTS: Five percent (4.6%) were HIV infected (12.5% for females, 3.7% for males, p<0.0001). HIV incidence was 0.9%, based on the Serological Testing Algorithm for Recent HIV Seroconversion. Syphilis was present in 1.0% of males and 8.6% of females (p<0.0001). HCV seroprevalence rate was 25.1% for males and 38.5% for females (p<0.01). Of HCV infected inmates, 88.7% have sentences > 1 year. HBV infection rate was 2.4%, and 70.5% were identified as HBV susceptible. Of the HIV positive, 64.6% were co-infected with HCV. Eleven percent of the HCV infected are HIV positive. CONCLUSIONS: High infection and co-infection rates, especially among female inmates, underscore the need for appropriate screening and treatment. Most inmates would benefit from HBV vaccination. Most HCV infected have sufficiently long sentences to complete treatment. HIV/HCV co-infected are important candidates for HCV treatment, but targeting only HIV positives would miss most HCV positives. Prisons offer an opportunity to control infectious disease in a high-risk population and reduce the public health impact in surrounding communities.

Learning Objectives:

• Describe the barriers to and public health implications of screening and treating prison populations.
• Develop a similar study to identify the extent of disease in other prison populations.
• Identify appropriate prevention and treatment policies for a prison based on incidence and prevalence rates and population characteristics.

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.