ABSTRACT
Background: People in prison are at increased risk of SARS-CoV-2 infection due to overcrowding and the challenges in implementing infection prevention and control measures;however, seroprevalence studies are lacking in correctional settings. We examined the seroprevalence of SARS-CoV-2 and associated modifiable risk factors among incarcerated adult men in Quebec, Canada. Methods: We conducted a cross-sectional seroprevalence study in three provincial prisons, representing 45% of Quebec's incarcerated male provincial population. The primary outcome was SARS-CoV-2 antibody seropositivity, detected by the Roche Elecsys® anti-SARS-CoV-2 serology test. Participants completed self-administered questionnaires on sociodemographic, clinical, and carceral characteristics. The association of carceral variables with SARS-CoV-2 seropositivity was examined using Poisson regression models with robust standard error. Crude and adjusted prevalence ratios (aPR) with 95% confidence intervals (95%CI) were calculated. Results: Between January 19 and September 15, 2021, 246 of 1,100 (22%) recruited individuals tested positive across three prisons (range 15-27%). Of these, 192 (78%) reported having at least one previous SARS-CoV-2 PCR test, with 122 (64%) testing positive and 70 (36%) testing negative;73 (30%) individuals with a positive serology test were asymptomatic. Seropositivity increased with time spent in prison since March 2020 (aPR 2.17, 95%CI 1.53-3.07 for all vs. little), employment during incarceration (aPR 1.64, 95%CI 1.28-2.11 vs. not), shared meal consumption during incarceration (with cellmates: aPR 1.46, 95%CI 1.08-1.97 vs. alone;with sector: aPR 1.34, 95%CI 1.03-1.74 vs. alone), and incarceration post-prison outbreak (aPR 2.32, 95% CI 1.69-3.18 vs. pre-outbreak) (see Table). Shared (vs. single) cells were not associated with increased seropositivity. Conclusion: The seroprevalence of SARS-CoV-2 among incarcerated individuals was high and varied between prisons. Several modifiable carceral factors were associated with seropositivity, underscoring the importance of decarceration and occupational safety measures, individual meal consumption, and enhanced infection prevention and control measures including vaccination during incarceration.
ABSTRACT
Background: In Yaoundé, Cameroon, coverage of HIV prevention and treatment services has increased with an estimated 50% of people living with HIV accessing antiretroviral treatment (ART) in 2018. The HIV burden remains high among key populations, despite increases in condom use and ART among men who have sex with men (MSM), female sex workers (FSW) and their clients. The COVID-19 pandemic may temporarily alter sexual behaviours and disrupt HIV services, including ART initiation and condom distribution (with reduced outreach). We explored the potential effects of these changes on the HIV epidemic among key populations in Yaoundé. Methods: We used a deterministic mathematical model of HIV transmission calibrated to local demographic, behavioural, and HIV epidemiology data. We estimated the relative difference in cumulative new HIV infections and HIVrelated deaths from 04/2020 to 03/2021 (median, 95% uncertainty interval), under scenarios assuming individual temporary 6-month reductions in HIV prevention/treatment services or changes in sexual risk behaviour in all or some risk groups compared to a base-case scenario assuming no COVID-19-related disruptions. Results: A 6-month cessation of ART initiation alongside a 50% reduction of viral suppression among ART-users for 6-month could increase annual HIV infections by 21% (18-25%) and HIV-related deaths by 9% (7-10%): half of these impacts are attributable to ART discontinuations among key populations. A 50% reduction in condom use across all partnerships would lead to 23% (15-31%) more infections overall and 36% (20-55%) more infections among key populations (Figure). Reducing condom use among key populations (initially >80% for FSW, ∼65% for MSM) to the levels of use among lower-risk populations (∼30%), would result in 14% (9-23%) more infections overall, and 20% (8-36%), 44% (26-97%), and 29% (15-56%) more infections among MSM, FSW and their clients, respectively. A 75% reduction in paid sex due to closure of sex work-associated venues would have little effect on reducing infections overall: 4% (1-8%) if currently high condom-use and ART levels among FSW are maintained. Conclusion: Temporary disruptions in condom use and ART services, especially among key populations, may have a substantial impact on HIV in Yaoundé. Ensuring access to condoms among FSW and MSM despite reduced outreach during the COVID-19 pandemic should be a priority to minimise its potential impact.