Seroprevalence and risk factors for hepatitis C infection among male prisoners in Karachi

Introduction Hepatitis C is a major health related issue throughout the world which is associated with significant mortality and morbidity. Inmates are the challenging population who are at higher risk of acquiring HCV due to their high risk activities. Concerns exist that jails and prisons could serve as reservoirs that could amplify transmission of HCV infection among themselves as well as in community. Pakistan where HCV is common and there is lack of awareness about HCV, very scare data is available about prevalence and risk factors of HCV in prisoners. Hence, there is need to determine the burden of HCV infection and associated risk factors among Pakistani prisoners. We conducted a study to estimate the prevalence of hepatitis C and risk factors associated with HCV among adult male inmates in central prison, Karachi, Pakistan. Subjects and Methods A community based cross-sectional study was conducted in central prison for men, Karachi from September 2008 to January 2009. Two-stage cluster survey technique was used to enroll the study participants. Our study population comprised of male inmates with age \u3e 18 years incarcerated for at least three months. A questionnaire was designed to evaluate the risk factors for HCV among inmates. Our trained data collectors administered structured questionnaire to the inmates and collected their blood samples to test anti-HCV antibody. Results We identified 775 male prison inmates aged 18 years or more, who had been incarcerated for more than 3 months at the time of the interview, did not pose a security threat to the study team and were not political prisoners. 750 (96.8%) of these inmates consented to participate in the study. The inmates included in the study ranged in age from 18-75 years and 321 (42.8%) of them had not received any formal education whatsoever. Inmates in this sample had, on average, been imprisoned twice prior to the current incarceration, with a median total duration of imprisonment during last ten years of 24 months (range 3-120 months). 161(%) were imprisoned for 3-24 months and 42(5.6%) imprisoned for 25-120 months beforehand. Of the 750 inmates tested for hepatitis C virus, 138 (18.4%) were found to be infected. On univariate analysis age, duration of imprisonment, education, number of family members in household, injections received during last one and five years before imprisonment, therapeutic injections given by glass syringes, therapeutic injections by used plastic syringes, prior hospitalization, prior surgeries, blood transfusions, exposure to contaminated blood, number of visits to dentist, use of unsterilized equipment by dentist, sharing tooth brush/miswak, visit to barber for shave, sharing used razors, ever had tattoos or body piercing, ever incarcerated, prior imprisonment, ever use of drugs, duration of illegal drug use, use of bhung, charas, injectable drugs, extramarital sexual contact, homosexual contact and sexual contact with hijras were found as significant factors associated with HCV. On multivariable analysis we found that therapeutic injections given by glass syringes (adjusted OR 83.55, 95% CI 36.03-193.72, P \u3c0.001), use of injectable drugs before imprisonment (adjusted OR 50.51, 95% CI 13.26-192.39, p \u3c0.001), sharing razors (adjusted OR 18.08, 95% CI 8.73-37.43, p \u3c0.001) and illiteracy(adjusted OR 2.76, 95% CI 1.26-6.05, p 0.01) were the risk factors that increase the risk of acquiring hepatitis C. Conclusion We have found that seroprevalence of hepatitis C among adult male inmates in central prison Karachi is 18.4% which is higher than the HCV prevalence in general population. We also found that the therapeutic injections given by glass syringes, use of injectable drugs prior to incarceration, sharing razors and illiteracy are associated with higher risk of acquiring hepatic C infection