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population). Data collection commenced in October2004 and was completed in January 2006.The SA HCV in Prisons Study is aimed at estimatingthe prevalence and transmission of HCV infection inthe incarcerated population. It will identify patterns ofrisk behaviour with respect to injecting drug use andtattooing at time of entry to prison and will evaluatethe impact of the prison environment on those riskbehaviours over time. The study has two main stages,the first of which is a cross-sectional study involvingcase note audits of all prisoners within the eightparticipating prisons. The other stage is a cohort study, inwhich prisoners were recruited as they entered prison,were offered HCV antibody tests and risk questionnairesand then were followed up over time.This study has formal approval from the following SouthAustralian ethics and research committees:• Aboriginal Health Research Ethics Committee• Department for Correctional Services ResearchManagement Committee• Department of Health Human Research EthicsCommittee• The Royal Adelaide Hospital Research EthicsCommittee• The University of Adelaide Human Research EthicsCommitteeEarly results of the SA HCV in Prisons studyOver 700 prison entrants were recruited to the cohortstudy over a period of ten months and the findings willbe available soon. Some of the findings from the crosssectionalstudy are already available online ahead of theirpublication later this year, 57 and are summarised here.The health records (or case notes) of 1347 prisonerswere available for auditing in January 2005. The auditcollected data on sex, age, Indigenous status and HCVantibody status at last test. The population included 1254males and 93 females, of whom approximately 30%overall had serological evidence of HCV infection. Ofthe 27% of prisoners who had no record of ever havingbeen tested, HCV prevalence increased to 41% overall40% of the males and 66% of the female prisoners(over 1.5 times the risk in females).Looking at age in groups based on thirds of the agedistribution of the population, those in the youngest agegroup (18 to 28 years) had the lowest risk for HCV (28%infected) and those in older age groups had significantlyhigher risk 52% of 29 to 36 years olds (1.8 times the riskin the lower age group) and 44% of those aged over 36years (over 1.5 times the risk) had tested HCV antibodypositive. Indigenous status was also associated withHCV antibody status, but with some prison specificvariation. Lower risk for Indigenous prisoners was seenin one prison in the north of the state (20%), whilesignificantly higher risk for Indigenous prisoners was inall other locations (57%). This difference is likely to bedue to the origins of the specific Indigenous populations,with many of the northern prison inmates originatingfrom more remote areas where IDU is less frequentthan in more urban Indigenous communities.Further findings from the cross sectional study willbe available soon, as will the first findings of thecohort study. In the meantime, these early findingsdemonstrate that the prevalence of HCV infection inthe SA prison system is very high overall, particularlyfor females, Indigenous prisoners in urban centresand those aged above 28 years. The findings clearlyunderscore the need to continue working with allstakeholders to ensure that acceptable solutions to thisserious public health problem are identified.Factors associated with HCV-antibody status in eight publicly operated prisons in South AustraliaJanuary 2005 (n=982**)* table adapted from Miller et al 57** excluding 362 individuals with no documented test history18
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