Epidemiology of injecting drug use and injection related harms among people who are incarcerated

Background: We systematically reviewed the prevalence of injecting drug use (IDU) and injecting-related harm in the community, we estimate the prevalence of IDU and associated health risks, such as HIV and hepatitis C (HCV), among all individuals who are incarcerated.

Methods: We conducted a systematic search across databases of peer-reviewed literature and grey literature, including agency and organizational websites, and reached out to international experts for additional data to identify studies with data on the prevalence of injecting drug use, blood-borne viruses, injecting-related harms, and demographic data relevant to modelling our estimates. We extracted information about the prevalence, characteristics, and risks among the prison population engaging in IDU, including gender, age, HIV, HCV, and HBV infections, injecting and sexual risk behaviours, facility type, and other key sample characteristics. We will use random-effects meta-analyse to analyse the extracted data and produce estimates for each outcome by country, providing comprehensive regional and global insights. Additionally, stratified meta-analyses and meta-regressions will be used to identify key factors, such as sex and history of injecting drug use, associated with variation for each estimate.

Results: We identified a total of 1,457 studies with relevant data. Notably, 477 studies (33%) were from North America, 290 studies (20%) from Western Europe, and 139 studies (10%) from Latin America. Research output has grown over time, with 232 studies (16%) published between 2000-2005, 408 studies (28%) from 2016-2020, and 205 studies (14%) from 2021 to the present.

Conclusions: Our comprehensive analysis indicates a significantly elevated prevalence of injecting drug use and associated health complications within prison populations compared to community settings. Our findings confirm the critical need for targeted health interventions and policy reforms within correctional facilities to address the additional risks and can inform policy and provision. Specific estimates can inform the provision of comprehensive health services for injecting-related harm and blood-borne viruses in correctional health systems globally.