Hepatitis C virus reinfection following direct acting antiviral treatment in the prison setting: the SToP-C studyby WEPHREN
Implementation of novel and conventional outbreak control measures in managing COVID-19 outbreaks in a large UK prisonby WEPHREN
Process and impact of implementing a smoke-free policy in prisons in Scotland: TIPs mixed-methods studyby WEPHREN
EMCDDA Trendspotter briefing: impact of COVID-19 on patterns of drug use and drug-related harms in Europeby WEPHREN
With over 11 million people incarcerated globally, prevention and control of COVID-19 in custodial settings is a critical component of the public health response. Given the risk of rapid transmission in these settings, it is important to know what guidance existed for responding to COVID-19 in the early stages of the pandemic. We sought to identify, collate, and summarise guidance for the prevention and control of COVID-19 in custodial settings in the first six months of 2020.
Many prisoners still struggle to access hospital services despite their significant health care needs and early data suggests the pandemic has worsened access further. In this report, we consider new evidence relating to pre-existing health conditions before prison, the use of remote consultation, different ethnic groups' use of health services and the early impact of the Covid-19 pandemic.
Outbreak of SARS-CoV-2 B.1.617.2 (Delta) Variant Infections Among Incarcerated Persons in a Federal Prison — Texas, July–August 2021by WEPHREN
During a COVID-19 outbreak involving the Delta variant in a highly vaccinated incarcerated population, transmission rates were high, even among vaccinated persons.
Prevalence of human papillomavirus infection, cervical intraepithelial neoplasia and cervical cancer in imprisoned women worldwide: a systematic review and meta-analysisby Emma Plugge
Challenges in ensuring robust research and reporting of health outcomes in sub-Saharan African prisonsby WEPHREN
The seroprevalence of untreated chronic hepatitis C virus (HCV) infection and associated risk factors in male Irish prisoners: a cross-sectional study, 2017by WEPHREN
Words matter: a call for humanizing and respectful language to describe people who experience incarcerationby ejomoore
A systematic review on models of care effectiveness and barriers to Hepatitis C treatment in prison settings in the EU/EEAby WEPHREN
Incidence and predictors of non-fatal drug overdose after release from prison among people who inject drugs in Queensland, Australiaby WEPHREN
Non-fatal overdose among adult prisoners with a history of injecting drug use in two Australian states.by WEPHREN
Incidence and risk factors for non-fatal overdose among a cohort of recently incarcerated illicit drug usersby WEPHREN
Incidence and risk factors for mortality after release from prison in Australia: a prospective cohort studyby WEPHREN
Effectiveness of treatment for opioid use disorder: A national, five-year, prospective, observational study in Englandby WEPHREN
Radio interview with Jesse Young on dual diagnosis of mental illness and substance use disorder and injury in adults recently released from prisonby Jesse Young
General practitioner contributions to achieving sustained healthcare for offenders: a qualitative studyby WEPHREN
Modelling the impact of incarceration and prison‐based hepatitis C virus (HCV) treatment on HCV transmission among people who inject drugs in Scotlandby WEPHREN
Active case finding is a key prevention measure to promote early diagnosis, treatment and to prevent further disease transmission. European Centre for Disease Prevention and Control (ECDC) and the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) have performed a systematic review of the published and grey literature on active case finding in prison settings.
Systematic review on the diagnosis, treatment, care and prevention of tuberculosis in prison settingsby WEPHREN
The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysisby WEPHREN
This publication sheds light on the situation of drug users among criminal justice populations and corresponding health care responses in nine countries in Eastern and South-East Europe and Kosovo.
Worldwide prison health research and engagement network: a vehicle for capacity-building in prison healthby Emma Plugge
This article in the WHO Public Health Panorama publication outlines WEPHREN's ambitions in supporting capacity building, including professional development for those working in a prison healthcare setting.
Short but not sweet: A study on the impact of short custodial sentences on mothers and their childrenby Lucy Baldwin and Rhona Epstein
This research report bears powerful witness to the harsh impact on women and their children of the short custodial sentences too often meted out in the name of justice. It draws attention to the ripple effects of imprisoning mothers, and the turbulence it causes in the lives of their families.
This paper considers how maternal emotions and the maternal role are assembled and challenged through carceral space, and more specifically, how mothers themselves assimilate this experience whilst navigating motherhood post incarceration.
Substance use disorders in prisoners: an updated systematic review and meta-regression analysis in recently incarcerated men and womenby The Editorial Team
Aims The aims were to (1) estimate the prevalence of alcohol and drug use disorders in prisoners on reception to prison and (2) estimate and test sources of between study heterogeneity.
Almost from the beginning of the HIV epidemic in 1981, an association with tuberculosis (TB) was recognized. This association between HIV and TB co-infection has been particularly evident amongst prisoners. However, despite this, few studies of TB in prisons have stratified results by HIV status. Given the high prevalence of HIV-positive persons and TB-infected persons in prisons and the documented risk of TB in those infected with HIV, it is of interest to determine how co-infection varies amongst prison populations worldwide. For this reason we have undertaken a systematic review of studies of co-infected prisoners to determine the incidence and/or prevalence of HIV/TB co-infection in prisons, as well as outcomes in this group, measured as treatment success or death.
Perinatal Health Care Services for Imprisoned Pregnant Women and Associated Outcomes: A Systematic Reviewby The Editorial Team
Women are a small but increasing minority of the 10 · 2 million people imprisoned worldwide. There are around 100 000 women in prison in Europe on any 1 day, representing 5 % of the total prison population. In the United States (US) there are nearly 215 000 women in prisons and jails, representing 9 % of the incarcerated population and an absolute increase of 30 % since 2000. Despite growing numbers, women’s minority status means that their specific health care needs and those of their children may be overlooked or remain unmet. A review from the United States found that 38 states had inadequate or no prenatal care in their prisons, and a 2008 report from US Department of Justice notes that 46 % of pregnant imprisoned women reported they received no pregnancy care. The World Health Organisation’s (WHO) 2003 Moscow declaration recognises prison health as an important public health issue, and a 2009 WHO declaration acknowledges that current arrangements for dealing with women
The Perfect Storm: Incarceration and the high-risk environment perpetuating transmission of HIV, hepatitis C virus, and tuberculosis in Eastern Europe and Central Asia.by The Editorial Team
Despite global reductions in HIV incidence and mortality, the 15 UNAIDS-designated countries of Eastern Europe and Central Asia (EECA) that gained independence from the Soviet Union in 1991 constitute the only region where both continue to rise. HIV transmission in EECA is fuelled primarily by injection of opioids, with harsh criminalisation of drug use that has resulted in extraordinarily high levels of incarceration. Consequently, people who inject drugs, including those with HIV, hepatitis C virus, and tuberculosis, are concentrated within prisons. Evidence-based primary and secondary prevention of HIV using opioid agonist therapies such as methadone and buprenorphine is available in prisons in only a handful of EECA countries (methadone or buprenorphine in five countries and needle and syringe programmes in three countries), with none of them meeting recommended coverage levels. Similarly, antiretroviral therapy coverage, especially among people who inject drugs, is markedly under-scaled. Russia completely bans opioid agonist therapies and does not support needle and syringe programmes—with neither available in prisons—despite the country's high incarceration rate and having the largest burden of people with HIV who inject drugs in the region.
The prison setting presents not only challenges, but also opportunities, for the prevention and treatment of HIV, viral hepatitis, and tuberculosis. We did a comprehensive literature search of data published between 2005 and 2015 to understand the global epidemiology of HIV, hepatitis C virus (HCV), hepatitis B virus (HBV), and tuberculosis in prisoners. We further modelled the contribution of imprisonment and the potential impact of prevention interventions on HIV transmission in this population. Of the estimated 10·2 million people incarcerated worldwide on any given day in 2014, we estimated that 3·8% have HIV (389 000 living with HIV), 15·1% have HCV (1 546 500), 4·8% have chronic HBV (491 500), and 2·8% have active tuberculosis (286 000). The few studies on incidence suggest that intraprison transmission is generally low, except for large-sc
Prevention of Transmission of HIV, Hepatitis B Virus, Hepatitis C Virus and Tuberculosis in Prisoners.by The Editorial Team
The prevalence of HIV, hepatitis B virus, hepatitis C virus, and tuberculosis are higher in prisons than in the general population in most countries worldwide. Prisons have emerged as a risk environment for these infections to be further concentrated, amplified, and then transmitted to the community after prisoners are released. In the absence of alternatives to incarceration, prisons and detention facilities could be leveraged to promote primary and secondary prevention strategies for these infections to improve prisoners health and reduce risk throughout
Worldwide, more than 10 million individuals are in prison at any given time, and more than 30 million individuals circulate through prison each year. Research has consistently shown that prisoners have high rates of psychiatric disorders, and in some countries more people with severe mental illness are in prisons than in psychiatric hospitals. Despite the high level of need, these disorders are frequently underdiagnosed and poorly treated. In this structured review, we provide an overview of the epidemiology of psychiatric disorders in prison, summarise information on rates of suicide and violence victimisation and risk factors for these outcomes, and outline evidence-based interventions for mental health care. Based on this review, we propose a series of clinical, research, and policy recommendations. The aim is to provide a broad synthesis of the main issues related to the mental health of adult prisoners, and highlight gaps in evidence and practice. Two special populations are briefly discussed, namely women and older adults. Juveniles in prison have distinct mental health needs, and an overview of these is outside the scope of this Review.
A Systematic Review on the Prevalence and Incidence of Latent Tuberculosis Infection among prison populationby The Editorial Team
SETTING: We conducted a systematic review of literatures on the prevalence and incidence of latent tuberculosis infection in correctional settings, with the aim of offering one of the resources to guide establishment of policies on screening for and treating LTBI among prisoners in Japan. OBJECTIVE: Using the keywords "latent tuberculosis AND (prison OR jail OR correctional)" and "tuberculosis infection AND (prison OR jail OR correctional)", we conducted a systematic review of relevant literatures on PubMed and secondary searches from the reference list of primary sources. We limited our search to those original articles published since 1980, and in English.
The effectiveness and cost effectiveness of diversion and aftercare programmes for offenders using Class A drugs: A Systematic Review and Economic Evaluationby The Editorial Team
The prison setting has been often cited as a possible reservoir of tuberculosis (TB) including multidrug-resistant (MDR)-TB. This is particularly true in low-income, high TB prevalence countries in Sub-Saharan Africa. A systemic literature review was done to assess the prevalence, drug resistance and risk factors for acquiring TB in the prison population. Our review indicated a high prevalence of TB in prisons which is reported to be 3- to 1000-fold higher than that found in the civilian population, indicating evidence and the need for public health policy formulation. In addition, high levels of MDR and extensively drug-resistant (XDR)-TB have been reported from prisons, which is a warning call to review prison TB control strategy. Multiple risk factors such as overcrowding, poor ventilation, malnutrition, human immunodeficiency virus (HIV), and others have fuelled the spread of TB in prisons.
As bipolar disorder is a mental disorder particularly associated with elevated risk of suicide compared to the general population, with reviews suggesting standardized mortality ratios of above 20 and a large population-based study reporting a mortality ratio of 15, one might expect that the combination of imprisonment and the presence of bipolar disorder might be additive or even multiplicative in terms of suicide risk. The previous systematic review did not specifically examine the association between bipolar disorder and prison suicide and thus it remains uncertain if bipolar disorder is a particular risk factor for suicide and suicidal behavior in prisoners.
Prevalence of Risk Factors for Non-Communicable Diseases in Prison Populations Worldwide: A Systematic Reviewby The Editorial Team
Non-communicable diseases (NCDs) are increasingly viewed as a global health crisis, demonstrated by an escalating prevalence of diseases such as heart disease, stroke, diabetes, cancer, and respiratory disease. The four key modifiable risk factors identified for NCDs are smoking, alcohol, inadequate physical activity, and unhealthy diet. In 2008, 36 million of 57 million deaths worldwide were attributable to NCDs. Of these, 14 million were attributable to unhealthy diet, 3 million to insufficient physical activity, and 3 million to obesity
Tobacco-smoking prevalence has been decreasing in many high-income countries, but not in prison. We provide a summary of recent data on smoking in prison (United States, Australia, and Europe), and discuss examples of implemented policies for responding to environmental tobacco smoke (ETS), their health, humanitarian, and ethical aspects. We gathered data through a systematic literature review, and added the authors’ ongoing experience in the implementation of smoking policies outside and inside prisons in Australia and Europe. Detainees’ smoking prevalence varies between 64 per cent and 91.8 per cent, and can be more than three times as high as in the general population.
A Literature Review of International Implementation of Opioid Substitution Treatment in Prisons: Equivalence of Care?by The Editorial Team
Heroin dependence is associated with severe negative outcomes such as HIV and hepatitis C transmission, criminal activity, imprisonment and death from opioid overdose. Opioid substitution treatment (OST) is the most effective treatment available for heroin dependence, resulting in reduced heroin use, HIV transmission, criminal activity and mortality. It is cost-effective and has higher retention rates than other forms of treatment for drug dependence. OST is available in at least 66 countries and territories, including low- and middle-income nations such as China, Indonesia and Iran. The World Health Organization, the Joint United Nations Programme on HIV/AIDS and the United Nations Office on Drugs and Crime have recommended the implementation of OST in prisons as an essential part of HIV prevention programming. It is argued that, as in the community, heroin-using inmates treated with opioid substitution will inject drugs less often, thus reducing the risk of HIV transmission between prisoners sharing needles and syringes. Other grounds for implementing OST in prisons include improvements in inmate manageability and prison safety and reductions in postrelease criminal activity and re-incarceration.
Suicide rates in prisoners are considerably higher than in the general population, both in the United States and the United Kingdom and internationally. In the United States, the rate of suicide in jails is estimated to be 8 times higher than in the general population, and in England and Wales, the age-standardized rate of suicide among all male prisoners is 5 times higher than in the general population - a proportionate excess that has been increasing since 1978. In addition, these rates remain high after leaving prison - a recent study of all inmates released in 1 U.S state found an increased suicide risk 3- to 4- fold higher than in the general population after adjustment for age, sex, and race.
Mental Disorders among Adolescents in Juvenile Detention and Correctional Facilities: A Systematic Review and Metaregression Analysis of 25 Surveysby The Editorial Team
Adolescents younger than 19 years constitute 5% of all those detained in custody in Western countries, including about 100,000 individuals in the United States. They are usually detained in separate closed facilities or prisons. High prevalence of both undiagnosed and untreated physical and mental health problems have been reported, with current mental disorders estimated to affect 40% to 70% of the adolescents who come into contact with the justice system. Deliberate self-harm and repeat offending are common,and some of these disorders, such as substance misuse and conduct disorder, are risk factors for criminal recidivism. In the United States and the United Kingdom, it has been argued that there is insufficient screening for mental disorders, that sentencing does not account for mental health issues, and that custodial and secure facilities lack qualified staff and appropriate treatment.
High prevalence of HIV infection and the over-representation of injecting drug users (IDUs) in prisons combined with HIV risk behaviour create a crucial public-health issue for correctional institutions and, at a broader level, the communities in which they are situated. However, data relevant to this problem are limited and difficult to access. We reviewed imprisonment, HIV prevalence, and the proportion of prisoners who are IDUs in 152 low-income and middle-income countries. Information on imprisonment was obtained for 142 countries. Imprisonment rates ranged from 23 per 100 000 population in Burkina Faso to 532 per 100 000 in Belarus and Russia. Information on HIV prevalence in prisons was found for 75 countries.
Although women make up only a small proportion of the 9 million people imprisoned worldwide, their numbers are increasing rapidly and consistently across a number of countries. For example, the number of women imprisoned in England and Wales has risen almost threefold over the past decade. Most of these women will be of childbearing age and an estimated 6% of imprisoned women are pregnant. This implies that in England and Wales alone there are about 240 pregnant women in prison at any one time, and in the United States of America over 6,000.
A Randomised Controlled Trial of Methadone Maintenance Treatment Versus Wait List Control in an Australian Prison Systemby The Editorial Team
Objectives: The aim was to determine whether methadone maintenance treatment reduced heroin use, syringe sharing and HIV or hepatitis C incidence among prisoners. Methods: All eligible prisoners seeking drug treatment were randomised to methadone or a waitlist control group from 1997 to 1998 and followed up after 4 months. Heroin use was measured by hair analysis and self report; drugs used and injected and syringe sharing were measured by self report. Hepatitis C and HIV incidence was measured by serology. Results: Of 593 eligible prisoners, 382 (64%) were randomised to MMT (n=191) or control (n=191). 129 treated and 124 control subjects were followed up at 5 months. Heroin use was significantly lower among treated than control subjects at follow up. Treated subjects reported lower levels of drug injection and syringe sharing at follow up. There was no difference in HIV or hepatitis C incidence. Conclusions: Consideration should be given to the introduction of prison methadone programs particular where community based programs exist.