The Kirby Institute is pleased to present:
Mr Neil Bretana – PhD Candidate, Surveillance Evaluation an Research Program, The Kirby Institute
“Transmission of hepatitis C virus among people who inject drugs in a prison setting"
HCV is mainly transmitted between people who inject drugs in developed countries. In this population, HCV prevalence is high and incarceration is recognised to be an independent risk factor for infection. To examine HCV transmission among inmates in a prison setting, this research have integrated epidemiology, molecular epidemiology, and computational modelling.
In the first study, HCV incidence and associated risk behaviours were calculated in a prospective cohort of inmates in NSW prisons. Thirty-eight HCV incident cases were identified in 269.94 person-years of follow-up yielding an estimated HCV incidence of 14.08 (95% CI: 9.96-19.32) per 100 person-years. Indigenous identity, injecting daily or more often, and injecting heroin were found to be associated with an increased risk of HCV infection.
The second study integrated virus sequences with risk behaviour and spatio-temporal data in order to reveal transmission clusters among inmates in NSW. Three clusters of recent HCV transmission were detected consisting of four in-custody transmission events involving drug injecting and sharing between source/recipient pairs located in the same prison at the same time. Despite a large background population of prisoners with chronic HCV, transmission events from recently infected individuals were identified in the prison setting.
In the third study, a computational model was developed to simulate the ongoing HCV epidemics in the NSW prisons. The model was used to predict future epidemiological trends and investigate scenarios of altered risk affecting the epidemic. The projected incidence of HCV was stable at 9.72 (95% CI: 9.36-10.08) per 100 person-years until 2020. The potential impact of changes in incarceration rates, and HCV prevention strategies to reduce HCV transmission in NSW prisons were explored.
This approach of integrated epidemiological, molecular epidemiological and modeling methods to study HCV transmissions has clear capacity to inform policy and public health practice in the prison setting. Future work includes consideration of social network information, assessment of new antiviral treatment strategies in NSW prisons, and enhancing linkage with community-based research.
Neil Bretana is a Research Associate at the Surveillance and Evaluation Research Program (SERP) at the Kirby Institute at the University of New South Wales. He is focused on understanding the dynamics of infectious disease transmission in high-risk settings, and is dedicated in informing public health policy through scientific evidence. Dr. Bretana’s scientific training includes a B.Sc. in Computer Science, an M.S. in Biomedical Informatics, and a Ph.D. and Pathology.