Prevalence and engagement with healthcare services for hepatitis B infection among people in prison in Australia: the AusHep study.

INTRODUCTION

People in prison are at increased risk of bloodborne virus (BBV) infections, including hepatitis B virus (HBV). This study evaluated HBV prevalence, and history of testing, treatment and vaccination among people in Australian prisons.

METHODOLOGY: The AusHep study was a bio-behavioral survey (2022-23) among randomly selected individuals from 23 representative Australian prisons. Participants were tested for BBVs, including HBV surface antigen (HBsAg). Demographics, risk behaviors, and previous HBV testing, treatment and vaccination data were collected through interview-based surveys.

RESULTS

Overall, 1599 participants were enrolled (89 % male; median age 35 years, 49 % First Nations people). National HBsAg prevalence (weighted estimate) was 0.52 % (95 %CI: 0.25-1.10), overall, including 1.03 % (95 %CI: 0.51-2.08) among First Nations people, 2.26 % (95 %CI: 0.44-10.75) among non-First Nations people born in moderate/high prevalence countries, and 0.02 % (95 %CI: 0.00-10.75) among non-First Nations people born in low prevalence countries (including Australia). The odds of HBV infection (i.e., HBsAg-positive) was greater among First Nations people [adjusted OR (aOR): 4.68, 95 %CI: 1.35-16.24], and lower among people with a history of injecting drug use (aOR: 0.15, 95 %CI: 0.04-0.54). Among all participants, 48.5 % (95 %CI: 45.3-51.7) reported a history of HBV testing (42.0 % in prison), with testing most likely among people with a history of injecting drugs (aOR: 3.82, 95 %CI: 2.80-5.23). Among 15 HBsAg-positive participants, four reported receiving HBV treatment. Among 1584 HBsAg-negative participants, 41.9 % (95 %CI: 38.8-45.1) reported receiving HBV vaccination (24.2 % received ≥3 doses, 28.9 % received their latest dose in prison).

CONCLUSION

HBsAg prevalence was low overall, but disproportionately higher among First Nations people and people born overseas. Lower likelihood of HBV in people injecting drugs might be explained by higher chance of spontaneous clearance in adulthood or high-coverage HBV vaccination programs for children and adolescents, and subsequent immunity in many people by the time they start injecting drugs. Prison-based HBV testing uptake and vaccination coverage were sub-optimal. Targeted, jurisdiction- and population-specific strategies are needed to improve prison-based HBV care.