Volume 388, Issue 10049, Pages (September 2016)

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Volume 388, Issue 10049, Pages 1089-1102 (September 2016) Global burden of HIV, viral hepatitis, and tuberculosis in prisoners and detainees Prof Kate Dolan, PhD, Andrea L Wirtz, PhD, Babak Moazen, MScIH, Martial Ndeffo-mbah, PhD, Prof Alison Galvani, PhD, Prof Stuart A Kinner, PhD, Ryan Courtney, PhD, Prof Martin McKee, DSc, Joseph J Amon, PhD, Prof Lisa Maher, PhD, Prof Margaret Hellard, PhD, Prof Chris Beyrer, MD, Prof Fredrick L Altice, MD The Lancet Volume 388, Issue 10049, Pages 1089-1102 (September 2016) DOI: 10.1016/S0140-6736(16)30466-4 Copyright © 2016 Elsevier Ltd Terms and Conditions

Figure 1 Regional prevalence of HIV, hepatitis C, HBsAg, and active tuberculosis in prisoners, published between 2005 and 2015 HCV=hepatitis C antibodies. The Lancet 2016 388, 1089-1102DOI: (10.1016/S0140-6736(16)30466-4) Copyright © 2016 Elsevier Ltd Terms and Conditions

Figure 2 Global and regional burden of HIV in prison inmates, published between 2005 and 2015 The Lancet 2016 388, 1089-1102DOI: (10.1016/S0140-6736(16)30466-4) Copyright © 2016 Elsevier Ltd Terms and Conditions

Figure 3 Global and regional prevalence of viral hepatitis in prison inmates, published between 2005 and 2015 (A) Prevalence of HCV antibodies. (B) Prevalence of HBsAg. The Lancet 2016 388, 1089-1102DOI: (10.1016/S0140-6736(16)30466-4) Copyright © 2016 Elsevier Ltd Terms and Conditions

Figure 4 Global and regional prevalence of active tuberculosis in prison inmates, published between 2005 and 2015 Data are per 100 000. The Lancet 2016 388, 1089-1102DOI: (10.1016/S0140-6736(16)30466-4) Copyright © 2016 Elsevier Ltd Terms and Conditions

Figure 5 Incidence of tuberculosis in prisons and closed settings *Cumulative over this period. †Average over this period. ‡Estimated annual risk 1996–2001. The Lancet 2016 388, 1089-1102DOI: (10.1016/S0140-6736(16)30466-4) Copyright © 2016 Elsevier Ltd Terms and Conditions

Figure 6 Deterministic compartmental model of drug injection transmission of HIV in the general community and incarcerated populations ART=antiretroviral therapy. PWID=people who inject drugs. The Lancet 2016 388, 1089-1102DOI: (10.1016/S0140-6736(16)30466-4) Copyright © 2016 Elsevier Ltd Terms and Conditions

Figure 7 Contribution of antiretroviral therapy discontinuation and temporary sharers to cumulative HIV incidence in people who inject drugs (A) Contribution of ART discontinuation. (B) Contribution of temporary sharers. Contribution accounts for transmission in prison and during the transitory period of elevated risk behaviour after release from prison. Contributions were evaluated relative to the scenario of no antiretroviral therapy discontinuation or no temporary sharers, and were assessed for a varying proportion of temporary sharers who share syringes after incarceration versus those who only share syringes while incarcerated, from epidemic onset to 2015. Bars show median (middle cross line) and range of contribution estimated for different HIV epidemics modelled (error bars show upper and lower 95% credible interval). Prevalence of HIV in people who inject drugs was varied from 5–20% (moderate prevalence communities) and 20–60% (high prevalence communities). The Lancet 2016 388, 1089-1102DOI: (10.1016/S0140-6736(16)30466-4) Copyright © 2016 Elsevier Ltd Terms and Conditions