BHIVA Spring Conference 2023

The proceedings contain 159 papers. The topics discussed include: microelimination of hepatitis C among people living with diagnosed HIV in England;laboratory implementation of emergency department blood-borne virus (EDBBV) opt-out screening in a London tertiary center;a review of sexual health and blood-borne virus care provided to inmates at admission into UK prisons and secure facilities;implementation of routine opt-out blood-borne virus (BBV) screening in 34 emergency departments (EDs) in areas of extremely high HIV prevalence in England;impact and experiences of offering HIV testing across the whole city population through primary care clusters and GP surgeries in the texting 4 Testing (T4T) project;'Not PrEPared': barriers to accessing PrEP in England;HIV care during the SARS-COV-2 pandemic for Black people with HIV in the UK;clinical presentation of mpox in people with and without HIV;and 'if you don't know, how can you know?': a qualitative investigation of HIV pre-exposure prophylaxis knowledge and perceptions among women in England.

Micro-eliminating HCV in 8 diverse prisons that serve a general population of 3.7 million in the Yorkshire region of England

Background: National Health Service England (NHSE) plans to eliminate Hepatitis C (HCV) by 2025. With a reported HCV prevalence of about 6% in male prisons, and about 12% in female prisons, secure environments are an essential component of this elimination plan. Yorkshire is a region in England with a general population of about 3.7 M. PPG is the provider of healthcare to 9 prisons in Yorkshire, with approximately 6,000 residents, many of whom are current, or previous, substance users. Description of model of care/intervention: To support NHSE in the elimination of HCV, a partnership between Gilead Sciences, Practice Plus Group (PPG) and the Hepatitis C Trust (HCT) was formed in 2019. This partnership works with prison and hospital teams to optimise test and treat pathways for new prison admissions. In addition, whole prison HCV Intensive Test and Treat events (HITT programmes) were run in targeted prisons to ensure testing of residents who were incarcerated before these optimisations were implemented. Effectiveness: HCV screening, within 7 days of prison entry, increased from 27% in May 2019 to 93% in January 2022. This increase was achieved despite COVID-19 restrictions remaining in place since March 2020 across all English prisons. In addition, HITT programmes were used to test residents who were missed at prison entry. The overall result is that 8/9 prisons have achieved microelimination status, as defined by: >= 95% of prison residents tested within the previous 12 months, >= 90% of RNA positive patients treated or initiated on treatment and presence of a robust system to review ongoing testing and treatment performance to ensure these targets are maintained. Conclusion and next steps: Micro-elimination of HCV will now need to be maintained in these prisons by ensuring the uptake of HCV testing remains>95%. Plans are in place to micro-eliminate the final prison-which is a high-security prison presenting unique challenges to HCV micro-elimination.

SARS-CoV-2 WASTEWATER SURVEILLANCE IN A US JAIL: CORRELATION, FEASIBILITY, NEXT STEPS

Background: Jails house vulnerable persons. Crowded conditions, restricted access to medical care, and limited resources facilitate infectious disease outbreaks, particularly for airborne, highly transmissible diseases like COVID-19 (C19). Wastewater-Based Surveillance (WBS) is a low-cost, highly sensitive, non-invasive method that can provide an early warning of C19 surges in communities. We examined the value of SARS-CoV-2 WBS for a mega-jail. Method(s): 28-week study period: 10/20/21- 5/5/22. Wastewater samples were collected x 25 weeks;SARS-CoV-2 RNA was measured using RT-qPCR. We sampled one manhole serving multiple housing units. C19 rapid test data on jail entrants were summarized daily by the jail;16 mass PCR screenings using selfcollected nasal swabs were conducted by the study team. Individual diagnostic tests were collated and analyzed on a weekly basis. Data were summarized by % of the tested jailed individuals found infected. The Spearman correlation coefficient between weekly SARS-CoV-2 RNA in wastewater and % of positive (pos) C19 diagnostic tests were calculated;we also used linear regression to assess the predictability between paired Ct values and weekly % of pos diagnostic tests. Result(s): Weekly WBS coupled with periodic mass testing of jailed individuals was feasible. The efficiency of gathering individual nasal swabs increased to 3 tests collected per minute through a CQI process. PCR signal strength for SARSCoV- 2 RNA in jail wastewater correlated with the % of jail residents tested who had C19. The mean RT-qPCR Cycle threshold (Ct) value was 35.2. Overall, 3.4% of nasal swabs were pos. A strong inverse correlation was observed between % nasal swab pos and WBS Ct value (Figure.) The Spearman correlation coefficient was r= 0.628;linear regression likewise showed a similar correlation. Conclusion(s): Weekly WBS results for C19 correlated with the proportion of C19 individual test results. WBS proved to be a practical strategy to surveil for C19 in this jail setting. We are developing means to identify exact source, by housing unit, of wastewater with positive signal. Future studies will explore WBS for Mpox and HIV in correctional facilities. HIV RNA can be found in wastewater specimens;whether WBS for HIV in congregate facilities is feasible remains an open question.

Results of an Automatic Alert System from Microbiology to Link Diagnosis to Treatment in Patients with Chronic Hepatitis C

Introduction and Objectives: Strategies to simplify the care circuit for patients with the hepatitis C virus (HCV) are vital to achieving its eradication. To achieve this aim, we introduced an electronic system of HCV serology detection to link diagnosis with specialized assistance in order to minimize the loss of patients. Material(s) and Method(s): A retrospective single-center study of HCV patients developed by Microbiology Department from February 15th, 2020, to December 15th, 2021. In the event of a positive HCV antibody, the anti-HCV core was directly measured by the electronic system. If positive, an encrypted e-mail with the patient data was automatically sent to HCV specialized physicians, who, after evaluating the benefits of antiviral therapy in each patient, contacted them by phone for an appointment. In the first face-to-face consultation FibroScan, HCV genotype and viral load measurement were performed, and antiviral therapy was prescribed. Patient diagnosis origin and public health characteristics were recorded. We analyzed the association between antiviral therapy prescription and these variables. Statistical significance was set at p<0.005. Result(s): Of 171 patients identified, with a mean age of 59.6 +/- 15.9, 61.5 % of males and 81.2% of Spanish nationals. HCV origin from out-of-hospital settings predominated (50.9%, 87/171), particularly primary care (28.7%), penitentiary (11.6%) and addiction units (8.2%). In all, 43.3% (74/171) were aware of their diagnosis, but 64.9% (48/74) hadn't previously received antiviral therapy. Genotype 1 predominated. We recorded 19.4% (20/103) of patients F3 fibrosis and 27.2% (26/103) F4. Finally, 58.5% (100/171) attended a physician consultation. They were all treated with pangenotypic interferon-free therapy. A 100% rate of sustained viral response was achieved. The main reasons for not being treated were high comorbidity (43.7%,31/71), not located (23.9%, 17/71), patient refusal to treatment (23.9%,17/71) and death (8.5%,6/71). The sole association found between antiviral therapy and patient variables was that of comorbidities with being untreated (OR=7.14, p<0.001). Conclusion(s): Our alert system is simple and easily reproducible. It allows for minimizing the loss of HCV patients, even considering it was performed during the COVID-19 pandemic.Copyright © 2023

Addiction Treatment Facilities under Special Circumstances/Settings

Background: There has been a rampant increase in substance abuse in Kashmir valley for the last few years. Department of Psychiatry SKIMS Medical College Srinagar has extended its services to cater to the needs of the substance users in the valley even during the COVID -19 pandemic. In 2021, de-addiction services were also started among prison inmates of central jail Srinagar. This was the first of its kind of services provided in the valley. The management of substance users with Hepatitis infections had also been challenging. Purpose(s): To describe the management of substance users under special circumstances(COVID-19), special settings(Central Jail Srinagar), high-risk groups(substance users with blood-borne infections). Method(s): Semi-structured proformas were used to collect data from special groups of participants a) those who were seeking treatment during COVID-19 times from the De-addiction center, SKIMS Medical College b) Prison in-mates on treatment for substance-use disorders c) substance users who are hepatitis B and/or positive. This included Socio-demographic details, clinical profile, the pattern of substance use, coping strategies, and treatment seeking. Preliminary Findings: More than 25 percent of the prison in-mates are substance dependent and relapse rate is very high. Psychiatric comorbidity like mood disorders and or personality disorders are present among most of the prison-inmates. During COVID-19 times, 90% patients reported average to very high level of importance and value given to their own health and health of family and friends and focussed on treatment of their illness(85%). Substance users with blood-borne infections were associated with highrisk behavior in the form of needle-sharing. Conclusion(s): The findings provide a voice that there is a need for backup plans that cater to the needs of substance users during in-evitable circumstances like the COVID-19 pandemic. Policymakers should focus on prison mental health for the functioning of a better society. Substance users with blood-borne infections should be rigorously treated to prevent them from taking the shape of an epidemic.

Evaluation of wastewater surveillance for SARS-CoV-2 in Massachusetts correctional facilities, 2020–2022

Introduction: Correctional facilities have environmental, resource, and organizational factors that facilitate SARS-CoV-2 transmission and challenge clinical testing of staff and residents. In Massachusetts, multiple state prisons implemented wastewater surveillance for strategic testing of individuals and isolation of COVID-19 cases early in the course of infection, as recommended by the Centers for Disease Control and Prevention (CDC). Our objective was to quantify the correlation of COVID-19 cases with facility-level wastewater surveillance compared to standard case surveillance in towns in closest geographic proximity to participating correctional facilities. Materials and methods: Available data included number of reported COVID-19 cases in residents from each of eight participating facilities (labeled A-H for anonymity), wastewater viral concentrations at each facility, and COVID-19 cases reported to routine surveillance in towns geographically nearest each facility. We selected data from December 2020-February 2022. Spearman's rank correlation was calculated at each facility to assess agreement between town cases and facility resident cases, and between wastewater concentrations and facility resident cases. We considered a correlation of ≤0.3 as weak and ≥0.6 as strong. Results: Facilities housed a mean of 502 individuals (range 54–1,184) with mean staffing of 341 (range 53–547). In 7/8 facilities, the town/resident cases correlation coefficients (ρ) were statistically significant (range 0.22–0.65);in all facilities, the wastewater/facility resident cases correlations were statistically significant (range 0.57–0.82). Consistently, ρ values were higher for facility-specific wastewater/resident cases than for town/resident cases: A (0.65, 0.80), B (0.59, 0.81), C (0.55, 0.70), D (0.61, 0.82), E (0.46, 0.62), F (0.51, 0.70), and H (0.22, 0.57). Conclusion: We conclude that wastewater surveillance for SARS-CoV-2 can provide an additional signal to objectively supplement existing COVID-19 clinical surveillance for the early detection of cases and infection control efforts at correctional facilities. Copyright © 2023 Klevens, Young, Olesen, Osinski, Church, Muten, Chou, Segal and Cranston.

Covid-19 vaccine acceptance among individuals incarcerated in Connecticut state jails.

BACKGROUND: Vaccine hesitancy is common among incarcerated populations and, despite vaccination programs, vaccine acceptance within residents remains low, especially within jails. With the goal of assessing the Connecticut DOC's COVID-19 vaccine program within jails we examined if residents of DOC operated jails were more likely to become vaccinated following incarceration than in the community. Specifically, we conducted a retrospective cohort analysis among people who spent at least one night in a DOC-operated jail between February 2 and November 8, 2021, and were eligible for vaccination at the time of incarceration (intake). We compared the vaccination rates before and after incarceration using an age-adjusted survival analysis with a time-varying exposure of incarceration and an outcome of vaccination. RESULTS: During the study period, 3,716 people spent at least one night in jail and were eligible for vaccination at intake. Of these residents, 136 were vaccinated prior to incarceration, 2,265 had a recorded vaccine offer, and 479 were vaccinated while incarcerated. The age-adjusted hazard of vaccination following incarceration was significantly higher than prior to incarceration (12.5; 95% Confidence Intervals: 10.2-15.3). CONCLUSIONS: We found that residents were more likely to become vaccinated in jail than in the community. Though these findings highlight the utility of vaccination programs within jails, the low level of vaccination in this population speaks to the need for additional program development within jails and the community.

COVID-19 in Carceral Systems: A Review

As with past pandemics of influenza, COVID-19 tore through US prisons and jails;however, the COVID-19 pandemic, uniquely, has led to more health research on carceral systems than has been seen to date. Herein, we review the data on its impact on incarcerated people, correctional officers, health systems, and surrounding communities. We searched medical, sociological, and criminology databases from March 2020 through February 2022 for studies examining the intersection of COVID-19, prisons and jails, and health outcomes, including COVID-19 incidence, prevalence, hospitalizations, and vaccination. Our scoping review identified 77 studies-the bulk of which focus on disease epidemiology in carceral systems, with a small minority that focuses on the efficacy or effectiveness of prevention and mitigation efforts, including testing, vaccination, and efforts to depopulate correctional facilities. We highlight areas for future research, including the experiences of incarcerated people and correctional staff, unanticipated health effects of prolonged quarantine, excess deaths due to delays in healthcare, and experimental studies on vaccine uptake and testing in correctional staff. These studies will enable a fuller understanding ofCOVID-19 and help stem future pandemics.

Dynamics of Respiratory Infectious Diseases in Incarcerated and Free-Living Populations: A Simulation Modeling Study.

BACKGROUND: Historically, correctional facilities have had large outbreaks of respiratory infectious diseases like COVID-19. Hence, importation and exportation of such diseases from correctional facilities raises substantial concern. METHODS: We developed a stochastic simulation model of transmission of respiratory infectious diseases within and between correctional facilities and the community. We investigated the infection dynamics, key governing factors, and relative importance of different infection routes (e.g., incarcerations and releases versus correctional staff). We also developed machine-learning meta-models of the simulation model, which allowed us to examine how our findings depended on different disease, correctional facility, and community characteristics. RESULTS: We find a magnification-reflection dynamic: a small outbreak in the community can cause a larger outbreak in the correction facility, which can then cause a second, larger outbreak in the community. This dynamic is strongest when community size is relatively small as compared with the size of the correctional population, the initial community R-effective is near 1, and initial prevalence of immunity in the correctional population is low. The timing of the correctional magnification and community reflection peaks in infection prevalence are primarily governed by the initial R-effective for each setting. Because the release rates from prisons are low, our model suggests correctional staff may be a more important infection entry route into prisons than incarcerations and releases; in jails, where incarceration and release rates are much higher, our model suggests the opposite. CONCLUSIONS: We find that across many combinations of respiratory pathogens, correctional settings, and communities, there can be substantial magnification-reflection dynamics, which are governed by several key factors. Our goal was to derive theoretical insights relevant to many contexts; our findings should be interpreted accordingly. HIGHLIGHTS: We find a magnification-reflection dynamic: a small outbreak in a community can cause a larger outbreak in a correctional facility, which can then cause a second, larger outbreak in the community.For public health decision makers considering contexts most susceptible to this dynamic, we find that the dynamic is strongest when the community size is relatively small, initial community R-effective is near 1, and the initial prevalence of immunity in the correctional population is low; the timing of the correctional magnification and community reflection peaks in infection prevalence are primarily governed by the initial R-effective for each setting.We find that correctional staff may be a more important infection entry route into prisons than incarcerations and releases; however, for jails, the relative importance of the entry routes may be reversed.For modelers, we combine simulation modeling, machine-learning meta-modeling, and interpretable machine learning to examine how our findings depend on different disease, correctional facility, and community characteristics; we find they are generally robust.

Testing Frequency Matters | An Evaluation of the Diagnostic Performance of a SARS-CoV-2 Rapid Antigen Test in United States Correctional Facilities.

BACKGROUND: The CDC recommends serial rapid antigen assay collection within congregate facilities. Though modeling and observational studies from communities and long-term care facilities have shown serial collection provides adequate sensitivity and specificity, the accuracy within correctional facilities remains unknown. METHODS: Using Connecticut Department of Corrections (DOC) data from November 21st 2020 to June 15th 2021, we estimated the accuracy of a rapid assay, BinaxNOW, under three collection strategies, single test collection and serial collection of two and three tests separated by 1-4 days. The sensitivity and specificity of the first (including single), second, and third serially collected BinaxNOW tests were estimated relative to RT-PCRs collected within one day of the BinaxNOW test. The accuracy metrics of the testing strategies were then estimated as the sum (sensitivity) and product (specificity) of tests in each strategy. RESULTS: Of the 13,112 residents who contributed ≥1 BinaxNOW test during the study period, 3,825 contributed ≥1 RT-PCR paired BinaxNOW test. In relation to RT-PCR, the three-rapid antigen test strategy had a sensitivity of 95.9% (95% confidence intervals (CI): 93.6-97.5%) and specificity of 98.3% (CI: 96.7-99.1%). The sensitivity of the two- and one-rapid antigen test strategies were 88.8% and 66.8%, respectively, and the specificities were 98.5% and 99.4%, respectively. The sensitivity was higher among symptomatic residents and when RT-PCRs were collected before BinaxNOW tests. CONCLUSIONS: We found serial antigen test collection resulted in high diagnostic accuracy. These findings support serial collection for outbreak investigation, screening, and when rapid detection is required (such as intakes or transfers).

Experience in managing action research on hepatitis C survey in the prison community

We aimed to report the experience in managing action research on hepatitis C investi-gation in the prison community in the Triangulo Mineiro region, Minas Gerais, Brazil. The proposal was developed from March 2019 to March 2020, reaching 240 people to contain the spread of the disease through a survey, testing, and mo-nitoring of positive cases. We adopted intersecto-ral action with articulation between Universities, Medical Society, Teaching Hospital, and State Secretariat for Justice and Public Security. Strategies for the management of action research are descri-bed: study settings and stakeholders, registration and formalization of the activity, application of tests, and management of reagent inmates. We identified difficulties regarding the accommoda-tion of routines among the research team and the proper functioning of the penitentiary, which required extensive training between the parties and managerial articulations. We consider that the report collaborates with the organization of future research aimed at accessing this still invi-sible population, the prison community when it highlights the strategies adopted to conduct the research. Copyright © 2022, Associacao Brasileira de Pos - Graduacao em Saude Coletiva. All rights reserved.

Regional Buvidal Care Pathway for Northern Ireland

Introduction: Due to an increase in heroin use and subsequent high demand for treatment services, community pharmacies are nearing saturation for opioid supervision services for patients on buprenorphine. The Covid-19 pandemic exacerbated this issue, highlighting the need for alternative forms of opioid substitution therapy (OST). Buvidal is a long-acting injectable form of buprenorphine for the treatment of opioid dependence. It comes in two formulations - weekly or monthly subcutaneous injection. The availability and use of Buvidal would help to reduce pressure on community pharmacy and provide an alternative treatment option to assist patients in their recovery journey. Aim(s): To provide safe and consistent service for the administration of Buvidal across Northern Ireland (NI). Objective(s): The development of a regional pathway to provide a framework to: ** Better support clinicians to initiate and use Buvidal safely and effectively. ** To ensure adequate physical health checks are carried out at initiation. ** To improve documentation. ** To ensure equitable care for all patients prescribed Buvidal across Northern Ireland. Method(s): ** Mental Health Pharmacists from each trust in NI met to determine the feasibility of introducing Buvidal . ** The group met with the Department of Health regarding the CD regulatory requirements in outpatient settings. ** The group met with the Health and Social Care Board (HSCB) to secure funding for Buvidal ** A regional pathway and kardex were developed to ensure consistency of prescribing across trusts. ** The pathway was shared with the addiction teams and prison services across NI for agreement. ** Adjustments were made and the pathway was piloted in different regions. Result(s): ** An agreed regional pathway for Buvidal developed. ** A regional kardex for Buvidal was developed. ** Funding was approved for each trust. ** A mixture of stock orders and individual patient prescriptions are used for the ordering of Buvidal across trusts. ** An electronic care record alert was developed for all forms of OST. ** Feedback was requested from those prescribed Buvidal and of those who responded 95% stated their life has improved on Buvidal and would recommend it to a friend. Discussion(s): Following initial reluctance for the need of a regional pathway and kardex it has now been established ensuring consistency across all trusts with regards to prescribing, baseline tests and advice a patient receives prior to the commencement of Buvidal . Staff have fed back that Buvidal use has been a positive service development and particularly beneficial for chaotic patients who struggled to go to the community pharmacy each day. They find the assessment page useful but the kardex can cumbersome at initiation and as such work is ongoing to streamline this. Conclusion(s): Buvidal is now prescribed across NI providing an alternative form of OST to patients. The regional mental health pharmacist group played a strategic role in developing this new service. This has exposed the addictions teams to the potential a pharmacist can play within their team resulting in the recruitment of addictions pharmacists in some trusts. The initial forecasted numbers were quickly exceeded resulting in ongoing service expansion. Consideration is now being given to the administration of Buvidal by community pharmacies in NI. The OST alert now available on NIECR improves communication at interfaces to highlight those patients prescribed OST.

COVID-19 Vaccine Distribution in Massachusetts Jails

Background. Vaccination is one of the main mitigation strategies to protect people from COVID19 mortality. People incarcerated in jails experienced disparate rates of COVID19 infection compared to people in the community, thus operationalization of COVID19 vaccine delivery in jails was prioritized in several states, including Massachusetts (MA). The goal of this project was to track COVID19 vaccine ordering in MA jails and compare numbers and types of COVID19 vaccines ordered by MA jails to those in the MA community, with specific attention to the Centers for Disease Control and Prevention's (CDC) guidelines for COVID19 vaccines. Methods. MA jails received COVID19 vaccines free of charge through the MA Department of Public Health. We requested de-identified, facility-level data from the MA DPH including: number of vaccines ordered by each jail, type of vaccine, and date of the vaccine order from December 2020 - January 2022. We obtained COVID19 vaccines distribution data for the MA general population from the CDC. Results. Vaccine orders were available for 13/14 MA jails. A total of 23,060 vaccines were ordered from the MA DPH between December 2020 - January 2022. January 2021 marked the highest number of vaccine orders by the jails, and all other months were orders < 33% of the January 2021 order. Moderna COVID vaccines were most frequently ordered by the MA jails (88%), followed by Janssen (11%) then Pfizer (1%). In the general population, Pfizer was the most frequently distributed vaccine type (59%), followed by Moderna (37%), then Janssen (4%). Conclusion. Prioritization of jails in MA led to a strong initial push for vaccine distribution which then waned. Potential reasons for the drop in orders include: the initial vaccine orders in January 2021 may have lasted several months, people entering jail after spring 2021 may have received vaccines in the community, and clinical and administrative fatigue may have limited continued robust vaccine protocols. Tracking COVID-19 vaccine orders by jails is a way to assess equitable vaccine operationalization. As recommendations for vaccination evolve, public health and carceral leaders should collaborate to ensure consistent low-barrier COVID19 vaccine access in jails.

Routine Opt out Hepatitis C Testing Upon Intake in the Philadelphia Jail System

Background: Hepatitis C (HCV) infection disproportionately affects those in United States' correctional institutions with seroprevalence rates from 17.4-23.1%. Jails have represented a particularly challenging setting for HCV testing and treatment given the short duration of stay and uncertainty of the timing of prisoners' release. Despite recommendations that all incarcerated persons undergo HCV testing, screening is not universally performed. In the Philadelphia jails, 1463 (7.5%) of the 19395 prisoners in 2018 were screened at sentencing. Method(s): On September 3, 2019 the Philadelphia jail partnered with Philadelphia FIGHT Community Health Centers to implement routine opt out HCV testing upon intake. Protocols for testing, result delivery and provider follow up were developed in a collaborative manner between the jail and FIGHT and subsequently adapted to ensure success in response to the COVID-19 pandemic. Herein, we report the findings of the first thirty-two months of routine opt out screening at intake. Result(s): Between September 3, 2019 and April 30, 2022, 27633 individuals entered the jail. 25206 (91.22%) individuals were tested for HCV antibody (ab) upon entry. 2639 (95.72%) of 2757 ab+ individuals had reflexive RNA confirmatory testing and 1892 (68.63%) were chronically infected. Of those, 950 (50.21%) were seen by a linkage coordinator from FIGHT while incarcerated, 1338 (70.72%) were seen by a jail-based HCV provider, and 619 individuals were prescribed HCV treatment. Of the treated persons, 304 (65.84%) were released from jail before completing HCV treatment, but all left jail with a full course of treatment;linkage to care to determine treatment response and ongoing medical care is in progress. Conclusion(s): Establishment of routine opt out HCV screening in a jail setting resulted in more than 90% of individuals entering the jail being screened for HCV and 32% of those with chronic infection initiating treatment. Short duration of incarceration, the need for rapid result delivery, increased linkage coordinator visits, and coordination of treatment between the jail and the community are challenges that must be addressed for successful program implementation in a jail setting. Collaboration between health care providers in the correctional system and community is necessary to coordinate HCV services in a high volume, high turnover urban jail.

Evaluation of antibody response to SARS-CoV-2 variants after 2 doses of mRNA COVID-19 vaccine in a correctional facility.

The SARS-CoV-2 pandemic has posed a challenge for correctional facilities worldwide. People in such settings are more vulnerable to severe forms of infection and it is impossible to completely isolate inmates from the outside world. This study aimed to assess the antibody-mediated immune response in terms of neutralizing antibodies against Alpha, Beta, Gamma and Omicron (sub-lineage BA.1) variants of concern after two doses of mRNA vaccine in correctional officers and inmates from an Italian correctional facility. Most of the correctional officers (56.5%) and inmates (52.3% and 63.6%) retained their neutralizing activity toward the Alpha and Gamma variants, respectively. By contrast, the most striking reduction in comparison with the ancestral virus was found in the antibody response toward the Beta and Omicron variants, in both correctional officers (91.2% and 93.9%) and inmates (85.1% and 92.8%). In addition, subjects who had undergone primary vaccination and had previously been naturally infected had higher neutralizing antibody titers toward the 4 variants than negative subjects. Overall, our findings indicate that primary mRNA vaccination is able to induce neutralizing antibodies toward the ancestral virus, while titers toward variants may vary, depending on the mutations harboring by the variants. Although the correctional setting is often considered distinct or isolated from the wider society and sanitary system, the health of correctional workers and prisoners is inexorably linked to the public health of the country as a whole and it is of paramount importance to monitor the antibody response in these settings.

Government actions for COVID-19 control and prevention in prisons: a scoping review

This is a scoping review of the literature on actions taken by countries during 2020 regarding the care for people living in the prison environment during the COVID-19 pandemic. We selected 54 publications for data mining and found data from 45 countries, which were orga-nized into categories. Most of the literature ad-dressed strategies adopted by countries with ad-vanced economies. All of them mentioned some strategies to reduce viral transmission - the major ones were restricted/suspended family visits and desincarceration - and interventions to improve infrastructures in prisons, the provision of a tele-phone or other devices for calls or video calls being the most mentioned. Policies to mitigate the effects of the epidemic and interventions were found in publications referencing 33 countries, with the main focus on keeping family contact and reviewing the public safety policy. Concerning governance policies, measures from 11 countries were reported, and the most cited was national authority reinforcement. This study highlights the need for research on the success of each strategy and the differences among those countries. Copyright © 2022, Associacao Brasileira de Pos - Graduacao em Saude Coletiva. All rights reserved.

Results of Pilot Study before Starting of Hepatitis C Screening Program in Lithuania

Introduction: In 2016, WHO announced a plan to eliminate viral hepatitis C as a public health threat by 2030. However, for achieving this goal, not only access to highly effective drugs, but also the ability to detect hidden infections by launching national screening programs is important. Lithuanian health authorities decided as a first step of the program, to pay general practitioners (GPs) a special fee for a service of promoting and performing serological tests for hepatitis C virus (HCV) antibodies (14.3 per screened person): 1. For the population born in 1945-1994 (once per life), and;2. For persons who inject drugs and AIDS patients (annual HCV testing). The program will start in July 1st, 2022. Here we present the results of pilot study in the primary health care centre of seaport Klaipeda conducted before starting of hepatitis C screening program in Lithuania. Aims & Methods: Patients were invited to participate in the HCV screening by GPs during the visits. Additionally, regional media, social networking sites, and leaflets were used to inform about the possibility of being tested free of charge. Screening involved a blood test for the presence of antibodies to HCV (TOYO rapid test, Turklab Tibbi Malzemeler A.S., Turkey). Patients who tested positive were referred to a gastroenterologist for further examination. A case-control study was performed to identify risk factors for hepatitis C infection. All seropositive patients (case group) were invited to participate in a telephone interview, and 65 out of 81 (80.2%) responded. The control group (n=130) matched by gender and age with the cases was randomly selected from seronegative patients and interviewed by telephone using the same questionnaire as the case group. The associations of possible risk factors with HCV infection were analysed using univariable and multivariable logistic regression analysis. Result(s): From November 2020 to February 2022, 4867 patients were screened in the primary health care centre in Klaipeda. Positive test results were found in 81 (1.7%) patients. Of all screened patients, 4167 (85.6%) were born in 1945-1994, and 79 (1.9%) of them were seropositive. Seroprevalence of HCV antibodies was higher among men than women, 49 out of 2363 (2.1%) and 32 out of 2504 (1.3%) respectively (p=0.03). In men, the highest HCV seroprevalence was found in age groups of 30-39 years (3.6%) and 40-49 years (3.5%), in women - in 50-59 years (1.9%). In case-control study, injection of illegal drugs was reported by 23.8% of HCV positive patients;27.0% of seropositive patients were in prison for more than 3 months. The odds ratio (OR) of HCV infection in patients who reported blood transfusions before 1993 was 6.8 (95% CI 2.0-23.2) compared to those who did not have a blood transfusion or had it later. HCV infection was diagnosed more often among patients who were blood donors before 1993 compared to those who were not donors or were later (OR 4.6;95% CI 2.1-10.2). Having a tattoo increased the odds of HCV infection by 6.5 times (95% CI 2.8-14.8). Conclusion(s): Despite the COVID 19 pandemic, the pilot study revealed active participation of individuals in HCV screening organised by the primary health care centre. Although adults > = 18 years of age were invited to the pilot study, all serologically positive cases of hepatitis C fell into the following categories: 1) born in 1945-1994;and 2) persons who inject drugs.

Dialogic Health Education to Reduce COVID-19 Disparities and Increase Health Literacy in Community and Correctional Settings: Protocol for a Two-Pronged Health Education Program.

BACKGROUND: COVID-19 vaccines significantly reduce rates of hospitalization and death for those infected with the SARS-CoV-2 virus. Those facing social oppression, including people of color, experience heightened risk for COVID-19 and comorbidities, but are often mistrustful of governmental agencies and initiatives, contributing to low vaccine uptake and a reluctance to access vital health care services. Dialogue-based health literacy interventions may mitigate mistrust and increase access to health services and information, subsequently increasing rates of vaccination and other behaviors that reduce COVID-19 risk. OBJECTIVE: To improve health literacy and reduce COVID-19 disparities, the Westchester County Department of Health, in partnership with two universities, community- and faith-based organizations, and the Westchester County Department of Correction, co-developed a health education program for community members, correctional officers, and incarcerated jail residents in Westchester, New York. Specific objectives are to increase preventative health behaviors, positive attitudes toward use of public health protocols, full vaccination or intentions to vaccinate, health care information understanding, health provider care access, clear communication with health care providers, and personal health care decision-making. METHODS: Grounded in dialogic learning, the program entails training community-based "trusted messengers" and correctional officers to lead health information sessions in community and correctional settings. During the grant period, the program intends for 80 community-based trusted messengers to receive training from the Department of Health and will be expected to reach a goal of 100 members (N=8000) of their communities. Correctional staff with experience delivering educational programs will be trained to facilitate sessions among 400 correctional facility residents and 600 correctional staff. RESULTS: Pre-post surveys will assess changes in health behaviors, attitudes, and perceptions. The program has been administered in the correctional facility since February 2022, with information sessions expected to cease for correctional staff and residents in June 2022 and November 2022, respectively. An initial cohort of community-based trusted messengers began training in February 2022, and information sessions have been scheduled in various virtual and community settings since March 2022. As of April 2022, the two-pronged health education program has reached 439 correctional officers, 98 jail residents, and 201 community members countywide. Program evaluation findings will be released in future publications after study implementation is complete. CONCLUSIONS: Few studies have evaluated the combined effects of training-of-trainers (ToT) and dialogical learning models on behavior and health literacy. As the first known COVID-19-specific dialogue-based health education program that applies a ToT model in the community-based, correctional, and virtual settings simultaneously, this study fills a gap in current knowledge about health literacy and health behavior in marginalized populations. Thus, this evidence-based framework can remedy COVID-19 disparities while also addressing risks for a host of health-related issues at the community level, potentially serving as a best-practice model for future health programs. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/37713.

Health Rights of Prisoners and Prison Law Reforms during COVID-19 Pandemic in India

Background: The National Crime Record Bureau and the Prison Statistics India, 2020 report on the overcrowding and occupancy in jails has ripple effect on the spread of the COVID-19.The protection to health freedoms of detainees and prisoners reflected in the World Health Organization (WHO) Guidance on COVID-19 for Prisons and Detention, 2020. The Indian jails have congestion and inhabitance and prone to contagion disease. The COVID-19 has an expanding transmission among detainees in prisons, jails and detention homes. Objectives: The WHO Guidance on COVID-19 for Prisons and Detention, 2020 standardizes the essential instrument to manage the COVID-19 difficulties in penitentiaries and confinement homes. The direction secures the strength of detainees and convicts living in encased conditions. The ostensible purpose is to contain the COVID-19 disease from spreading to general population and release the under trials for the safe healthy conditions. Methodology: The methodology applied the canons of statutory interpretation of United Nations Principles of the Protection of Prisoners, 1982 and Basic Principles for the Treatment of Prisoners, 1990 alongside the Moscow Declaration on Prisons and Health, 2003 and Nelson Mandela Rules, 2015 in fostering the health equity and criminal justice during COVID-19 pandemic. The mandate of the WHO Interim Guidance on COVID-19 in Prisons and Other Places of Detention, 2020 is straight out in preventive and medicinal measures for the penitentiaries and confinement homes in the virus of COVID-19. Results: The paper tracks the salubrious results of the international legal norms and national precedents of High Courts and Supreme Court in heralding systemic prison reform. The compliance of WHO Interim Guidance on Preparedness, Prevention and Control of COVID-19 In Prisons and Other Places of Detention, 2020 cultivated robust criminal administration during COVID-19 pandemic and the lockdown in India.Conclusion: The judgment of High Courts and Supreme Court on prison reform during the COVID-19 pandemic in India has resulted in Health Rights of Prisoners and Prison Law Reforms during COVID-19 Pandemic in India. It also refurbished the medical services in correctional facilities and confinement homes in criminal justice system.