Prevalence and Risk Factors of MASLD and Liver Fibrosis amongst the Penitentiary Population in Catalonia: The PRISONAFLD Study.

BACKGROUND AND AIMS: The prevalence of chronic non-communicable diseases, particularly metabolic syndrome (MetS), has increased among the prison population. Nevertheless, we have limited data on metabolic dysfunction-associated steatotic liver disease (MASLD), the hepatic manifestation of this syndrome. We aimed to investigate the prevalence and risk factors of MASLD and MASLD-associated liver fibrosis in the penitentiary population in Catalonia, Spain. METHOD: A cross-sectional observational study involving eight penitentiary centers. Participants had at least one metabolic disorder and were at a closed-regimen penitentiary. Individuals with concomitant liver diseases and/or alcohol risk consumption were excluded. Significant fibrosis and MASLD were defined as liver stiffness ≥8 kPa and a controlled attenuation parameter ≥275 dB/m by vibration-controlled transient elastography (VCTE), respectively. After exclusions, metabolic inmates with VCTE were analyzed. Logistic regression analysis was performed to identify predictors of MASLD and MASLD-associated significant fibrosis. RESULTS: Out of the 4338 inmates studied, 1290 (29.7%) had metabolic disorders, and 646 (14.9%) underwent VCTE. The mean age was 48.0 years (SD 12.1), and 89.5% were male. MASLD prevalence was 33.9%. Significant fibrosis and MASLD-associated significant fibrosis were found in 16.4% and 9.4% of inmates, respectively. In the multivariate analysis, T2D, waist circumference, MetS, and higher ALT values were identified as independent risk factors for MASLD and MASLD-associated significant fibrosis amongst the prison population. CONCLUSIONS: Metabolic disorders including MASLD are highly prevalent among inmates. The prevalence of significant fibrosis seems notably higher than that of the general population, underscoring the need for targeted screening programs and therapeutic interventions in the incarcerated population.

Incidence and molecular epidemiology of hepatitis C virus reinfection in prisons in Catalonia, Spain (Re-HCV study).

Hepatitis C virus (HCV) reinfection may hamper HCV elimination in prisons. We aimed to (i) determine the reinfection rate in people treated for HCV in Catalan prisons, (ii) measure reinfection in people entering prisons, and (iii) characterize the molecular epidemiology of HCV in prisons and people who inject drugs (PWID) in the community. Re-HCV was a prospective study in eight prisons (2019-2020) including two groups: (1) people cured with treatment in prison and followed-up every 6 months, and (2) people testing HCV-RNA positive at incarceration. Bio-behavioral data were collected. HCV isolates were sequenced and phylogenetically analyzed with those of PWID in the community. Reinfection follow-up after treatment was achieved in 97 individuals (103.05 person-years). Two reinfections were detected, resulting in an incidence ≤ 10/100 person-years. Among people entering prison, 2% (359/17,732) were viremic, of which 334 (93.0%) were included, and 44 (13.5%) presented with reinfection (84.7% being PWID). Frequently, HCV isolates in prisons and PWID in the community were phylogenetically related. Although HCV reinfection is low after treatment, it is common in people entering Catalan prisons. To maintain a low HCV prevalence in prisons, harm-reduction services and test-and-treat programs for PWID should be strengthened both inside and outside prisons.

Reinfection in a large cohort of prison inmates with sustained virological response after treatment of chronic hepatitis C in Catalonia (Spain), 2002-2016.

BACKGROUND: Prisoners and other high-risk patients who show a sustained virological response (SVR) after treatment for hepatitis C virus (HCV) can become reinfected. We aimed to calculate the rate of HCV reinfection in a large cohort of inmates with SVR and to determine factors that predict reinfection. METHODS: We included all inmates treated for hepatitis C in Catalonia (Spain) from January 2002 to December 2016 who achieved SVR and in whom viral load was subsequently determined. The incidence rate was calculated per 100 person-years (100 py) of follow up. Risk factors associated with reinfection were evaluated by bivariate log-rank test and multivariate Cox regression. Hazard ratio (HR) and their 95% confidence intervals (CI) were calculated. RESULTS: 602 patients were included, with a mean age of 37.9 years: 95% were men, 74.1% had a history of intravenous drug use (IDU) and 28.7% were HIV-infected. Patients were followed for a total of 2154.9 years (average 3.58 ± 3.1 years). 63 (10.5%) had HCV reinfection. 41 (65.1%) presented different genotype/subgenotype, 8 the initial genotype/subgenotype, and in 14 (22.2%) the genotype could not be determined. Of the 21 reinfected patients who were interviewed, 20 (95.2%) reported IDU after antiviral treatment, and 7 (33.3%) during treatment. The overall incidence of reinfection was 2.9 cases per 100 py. All reinfections occurred in patients with IDU history. At multivariate level, HIV infection was associated with reinfection (HR = 3.03; CI:1.82-5.04). CONCLUSION: In HIV-infected inmates with IDU history, the rate of reinfection of HCV post-SVR is very high. Prisons play a key role in the detection and treatment of infection and reinfection by HCV and in the post-treatment monitoring in these patients, which should be combined with counseling and the optimization of the harm reduction programs. Effective control of these vulnerable groups favours the elimination of the HCV infection.

Continuidad asistencial y terapéutica tras la excarcelación: un problema urgente que precisa soluciones. El modelo aplicado en las prisiones de Cataluña / Continuity of care and treatment after release from prison: an urgent problem that requires solutions. The model applied in Catalonian prisons

Los déficits en salud tras la excarcelación son habituales, incluso con mayor riesgo de muerte. En estos casos, la principal causa de muerte es el uso de heroína y de otros opioides, pero hay otras posibles causas, muchas de ellas potencialmente prevenibles. Los grupos más vulnerables al incremento de la morbimortalidad tras la excarcelación son los consumidores de drogas, los enfermos mentales y los internos extranjeros que proceden de países con pocos recursos económicos. Es urgente implementar intervenciones que optimicen el acceso a los dispositivos sanitarios después de la excarcelación, eviten interrupciones de la continuidad de la atención y del tratamiento prescrito en prisión, y reduzcan la morbimortalidad. Para ello, se precisa coordinar de forma efectiva la atención dentro y fuera de la prisión y aplicar medidas de apoyo. En este trabajo, se presenta el proyecto implementado en las prisiones de Cataluña, que ha utilizado el "enfermero de enlace" (EE) como figura clave del proceso, y el procedimiento interno y externo utilizado para facilitar el adecuado traspaso de información sanitaria y terapéutica, vincular a los pacientes excarcelados a los dispositivos sanitarios y asegurarse de que estos los reciben en el tiempo y la forma adecuados

Deficits in health after being released are common, and even include a higher risk of death. In these cases, the main cause of death is the use of heroin and other opioids, but there are other causes and most of them are potentially preventable. The most vulnerable groups to the increase in post-release morbidity and mortality are drug users, the mentally ill and foreign inmates from countries with fewer economic resources. What is urgently needed is to implement interventions that optimize access to health devices after prison release, avoid interruptions in the continuity of care and treatment prescribed in prison and reduce morbidity and mortality. To achieve this, it is necessary to coordinate effective forms of care inside and outside prison and apply support measures. We present the project implemented in prisons in Catalonia, where the "liaison nurse" was used as a key figure in the process. We also present the internal and external procedure used to facilitate the transfer of sanitary and therapeutic information, to link released patients to health devices and to ensure that they are received in a timely and appropriate manner