Investigators

Associate Professor Stuart Kinner, Professor Michael Levy, Dina Paulo, Kathryn Snow


Background

Following the introduction of a HCV treatment program in AMC in 2011 there was an increase in HCV testing. At the same time there was an increase in the identification of cases of newly acquired HCV infection from one (2009-2010) to 11 in 2011.  Preliminary investigations suggest that a number of these cases may have been acquired in custody although not from a point source outbreak (genotypes 1, 2, and 3 are represented).

Despite incarceration being a well-recognised risk setting for HCV transmission, in Australia outside of occasional case reports there is little accurate information on HCV transmission amongst people who inject drugs (PWID) in the prison setting.  The identification of over ten newly acquired cases of HCV in AMC provides an opportunity to better characterise HCV transmission in a prison setting.


Aims

The aims of this project are:

·  To accurately describe an in-prison case series of HCV infection

·  To determine the strength of evidence for in-prison HCV transmission for each suspected incident case

·  To identify possible modes of transmission for each suspected incident case


Who Will Benefit?

The project outcomes will

1.  Inform the establishment of the AMC needle and syringe program.

2.  Inform the broader policy debate on NSPs and infection control in custodial settings in Australia.


Methods

1.  All prisoners with newly acquired HCV that was identified in the AMC between 2009 and 2012 will be invited to participate in the study. The identities of these individuals will be provided either by investigator ML or by ACT Pathology.

2.  Prisoners agreeing to participate in the study will be asked to provide written informed consent.

3.  Based on existing test results and existing serum samples, clinical data will be collected including HCV antibody testing, HCV RNA testing, genotyping and sequencing (core, NS5B and E1 regions).  Other relevant clinical information (e.g. use of opiate substitution therapy, HIV testing and treatment, HCV treatment) will be obtained from AMC medical records.

4.  Semi-structured interviews will be conducted with each participant – information to be collected includes risk behaviours both within and outside of prison that could lead to HCV transmission.

5.  A molecular epidemiological tree will be constructed to assess if cases of in prison transmission were from a single point source or a number of independent sources.


Timeline

2013

Contact

For more information relating to this project, please contact Michael Levy:


Collaborators

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