A history of IDU is common among detainees[7] and injecting may continue while detained,[8-10] with attendant disease find more transmission risks. Tattooing

in closed settings may also be a risk factor for HCV transmission.[11, 12] Finally, there is increasing evidence of a significant risk of HCV transmission among human immunodeficiency virus (HIV)-infected men who have sex with men[13]; given the often high background prevalence of both infections and the lack of condom access in closed settings, this is potentially a serious concern. Despite the evidence of risk, there have been limited efforts to examine the global extent of this problem. A clearer understanding of the epidemiology of HCV in closed settings is essential for determining the scale of the problem, providing a basis for public advocacy efforts, and the development of prevention and treatment interventions. This is particularly so in light of recent advances in HCV therapies and the promise of all-oral, interferon-free treatment in the near future.[14, 15] We

undertook a systematic review and meta-analysis with the aim of determining the Selleck ITF2357 rate of incident HCV infection and the prevalence of anti-HCV among detainees in closed settings. This study is reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist.[16] Throughout this article we use the term “”detainees”" to refer to the population of people detained in closed settings. This term was selected as it is inclusive of people who are incarcerated in prisons and jails, as well as those held in less common and less well-known types of closed settings. We used multiple search strategies to identify relevant literature.

Four databases of peer-reviewed literature (Medline, Embase, Criminal Justice Abstracts, and the National Criminal Justice Reference Service) were searched in July 2012. Search strings were developed in consultation with a librarian at the National Drug and Alcohol Research Centre, University of New South Wales. Search strings for Medline and Embase were adapted from Nelson et al.[5] (see Supporting Materials for additional details). Additionally, reference lists of prior reviews on this topic[17-19] were examined and the literature database of the HCV Synthesis Project[20] medchemexpress was searched for citations potentially relevant to closed settings. Gray literature, defined as publications and communications that are not formally published by commercial publishers or peer-reviewed journals, was identified through searches of websites of relevant organizations (e.g., European Monitoring Centre for Drugs and Drug Addiction), regional literature databases (e.g., Latin American and Caribbean Health Sciences), online conference archives (e.g., International AIDS Society conferences), and country-specific government departments.