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BackgroundPeople who inject drugs (PWID) experience a high prevalence of incarceration and might be at high risk of HIV and hepatitis C virus (HCV) infection during or after incarceration. We aimed to assess whether incarceration history elevates HIV or HCV acquisition risk among PWID.MethodsIn this systematic review and meta-analysis, we searched MEDLINE, Embase, and PsycINFO databases for studies in any language published from Jan 1, 2000 until June 13, 2017 assessing HIV or HCV incidence among PWID. We included studies that measured HIV or HCV incidence among community-recruited PWID. We included only studies reporting original results and excluded studies that evaluated incident infections by self-report. We contacted authors of cohort studies that met the inclusion or exclusion criteria, but that did not report on the outcomes of interest, to request data. We extracted and pooled data from the included studies using random-effects meta-analyses to quantify the associations between recent (past 3, 6, or 12 months or since last follow-up) or past incarceration and HIV or HCV acquisition (primary infection or reinfection) risk among PWID. We assessed the risk of bias of included studies using the Newcastle-Ottawa Scale. Between-study heterogeneity was evaluated using the I2 statistic and the P-value for heterogeneity.FindingsWe included published results from 20 studies and unpublished results from 21 studies. These studies originated from Australasia, western and eastern Europe, North and Latin America, and east and southeast Asia. Recent incarceration was associated with an 81% (relative risk [RR] 1·81, 95% CI 1·40-2·34) increase in HIV acquisition risk, with moderate heterogeneity between studies (I2=63·5%; p=0·001), and a 62% (RR 1·62, 95% CI 1·28-2·05) increase in HCV acquisition risk, also with moderate heterogeneity between studies (I2=57·3%; p=0·002). Past incarceration was associated with a 25% increase in HIV (RR 1·25, 95% CI 0·94-1·65) and a 21% increase in HCV (1·21, 1·02-1·43) acquisition risk.InterpretationIncarceration is associated with substantial short-term increases in HIV and HCV acquisition risk among PWID and could be a significant driver of HCV and HIV transmission among PWID. These findings support the need for developing novel interventions to minimise the risk of HCV and HIV acquisition, including addressing structural risks associated with drug laws and excessive incarceration of PWID.FundingEngineering and Physical Sciences Research Council, National Institute for Health Research, National Institutes of Health.

Coverage is an important dimension in measuring the effectiveness of needle and syringe programmes in providing sterile injecting equipment for people who inject drugs. The World Health Organization (WHO), the United Nations Office on Drugs and Crime (UNODC) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) currently recommend methods for measuring coverage at the population level, that is, across an estimated population of people who inject drugs within a given geographical area. However, populationlevel measures of coverage rely on highly uncertain population estimates and cannot capture the different levels of syringe acquisition and injecting episodes among individual users. Consequently, such measures only broadly evaluate the extent of programme service delivery, rather than describe how people who inject drugs as individuals and sub-groups interact with needle and syringe programmes. In response to these limitations, several researchers have proposed measuring coverage at the individual level, by the percentage of injecting episodes in relation to the number of sterile needles and syringes acquired. These measures evaluate coverage according to each individual's needs. Such measures provide enhanced information for planning and monitoring of harm reduction programmes and have now been used in multiple international research studies. We advise that WHO, UNODC and UNAIDS add individual-level coverage measurement methods to their international monitoring guidelines for harm reduction programmes. By doing this, more responsive and effective programmes can be created to better reduce injecting risk behaviours and blood-borne virus transmission among people who inject drugs. La couverture est une dimension importante lorsque I'on veut mesurer l'efficacite des programmes de distribution d'aiguilles et de seringues a fournir du materiel d'injection sterile aux consommateurs de drogues par injection. L'Organisation mondiale de la Sante (OMS), l'Office des Nations Unies contre la drogue et le crime (ONUDC) et le Programme commun des Nations Unies sur le VIH/sida (ONUSIDA) recommandent actuellement des methodes pour mesurer la couverture au niveau de la population, c'est-a-dire sur une population estimee de consommateurs de drogues par injection dans une zone geographique donnee. Or, les mesures de la couverture au niveau de la population se fondent sur des estimations tres incertaines de la population et ne permettent pas de refleter les differents degres d'acquisition de seringues et d'episodes d'injection chez les usagers. Par consequent, ces mesures n'evaluent que globalement la portee des programmes au lieu de decrire la maniere dont les consommateurs de drogues par injection interagissent, individuellement et en sous-groupes, avec les programmes de distribution d'aiguilles et de seringues. En reponse a ces limitations, plusieurs chercheurs ont propose de mesurer la couverture au niveau individuel, en calculant le pourcentage d'episodes d'injection par rapport au nombre d'aiguilles et de seringues steriles acquises. Ces mesures permettent d'evaluer la couverture en fonction des besoins de chaque personne. Ce type de mesures offre des informations plus fiables pour la planification et le suivi des programmes de reduction des risques et il est aujourd'hui utilise dans plusieurs etudes de recherche internationales. Nous suggerons a l'OMS, a l'ONUDC et a l'ONUSIDA d'ajouter des methodes de mesure de la couverture au niveau individuel a leurs directives internationales pour le suivi des programmes de reduction des risques. Cela permettra de mettre au point des programmes plus adaptes et efficaces afin de mieux reduire les comportements a risque lies aux injections ainsi que la transmission de virus par le sang chez les consommateurs de drogues par injection. La cobertura es un factor importante para medir la eficacia de los programas de agujas y jeringas en el suministro de equipo de inyeccion esteril para las personas que se inyectan drogas. La Organizacion Mundial de la Salud (OMS), la Oficina de las Naciones Unidas contra la Droga y el Delito (ONUDD) y el Programa Conjunto de las Naciones Unidas sobre el VIH/SIDA (ONUSIDA) recomiendan actualmente metodos para medir la cobertura a nivel poblacional, es decir, a traves de una poblacion estimada de consumidores de drogas inyectables dentro de una zona geografica determinada. Sin embargo, las medidas de cobertura a nivel poblacional se basan en estimaciones poblacionales altamente inciertas y no pueden captar los diferentes niveles de adquisicion de jeringas y episodios de inyeccion entre los usuarios individuales. En consecuencia, esas medidas solo miden en terminos generales el alcance de la prestacion de servicios de los programas, en lugar de describir la forma en que las personas que se inyectan drogas como individuos y subgrupos interactuan con los programas de suministro de agujas y jeringas. En respuesta a estas limitaciones, varios investigadores han propuesto medir la cobertura a nivel individual, por el porcentaje de episodios de inyeccion en relacion con el numero de agujas y jeringas esteriles adquiridas. Estas medidas miden la cobertura de acuerdo a las necesidades de cada individuo. Estas medidas proporcionan una mejor informacion para la planificacion y el seguimiento de los programas de reduccion de danos y se han utilizado actualmente en multiples estudios de investigacion internacionales. Aconsejamos que la OMS, la ONUDD y el ONUSIDA incorporen metodos de medicion de la cobertura a nivel individual a sus directrices internacionales de vigilancia de los programas de reduccion de danos. De este modo, se pueden crear programas mas receptivos y eficaces para reducir mejor los comportamientos de riesgo en el uso de drogas inyectables y la transmision de virus transmitidos por la sangre entre las personas que se inyectan drogas., Introduction Coverage is an important concept in the evaluation of any public health intervention and coverage has been defined as 'the proportion of the population at risk reached by an [...]

Background: Community reintegration from prison is typically stressful, with several health and social outcomes impacting psychiatric well-being during this time, often exacerbated among individuals with histories of drug use. Longitudinal data was used to assess change in psychiatric well-being over 2 years following release from prison among men who reported a recent history of injecting drug use. Methods: Data for this study come from the Prison and Transition Health cohort study of 400 men recruited in prison prior to release and followed up over three time points. Psychiatric well-being was assessed using the 12-item General Health Questionnaire. We calculated change in individual General Health Questionnaire scores between interviews and identified covariates associated with General Health Questionnaire score using linear mixed-effects regression. Results: Data from 690 follow-up interviews among 326 participants were included in analyses. There was considerable variation in individuals' General Health Questionnaire scores. Moving accommodation frequently and frequent illicit drug injections were associated with an increase in General Health Questionnaire score (i.e. decline in psychiatric well-being). Two or more prior adult imprisonment episodes, social supports and past month primary healthcare attendance were associated with a decrease in General Health Questionnaire score. Conclusion: Our findings identify health, social and structural influences on psychiatric well-being after release from prison that can inform re-entry programmes to support community reintegration. [ABSTRACT FROM AUTHOR]