Theme: Epidemiology & Public Health Research Year: 2025
Background:
People detained in carceral settings experience disproportionately high rates of injecting drug use
and infectious diseases (HIV, viral hepatitis, tuberculosis), yet data on the availability and coverage
of related services remain scarce and outdated. We provide the first systematic review to
comprehensively examine the availability and coverage of infectious disease prevention, treatment,
and harm reduction services for incarcerated populations globally.
Methods:
We conducted a systematic review of evidence for provision of opioid agonist treatment (OAT),
needle syringe programs (NSPs), HIV testing and antiretroviral therapy (ART), HCV testing and directacting antiviral (DAA) treatment, tuberculosis screening and treatment, HBV testing, treatment, and vaccination in carceral settings. We searched from peer-reviewed and grey literature databases 2000 and 2024 and used the most recent data available for each indicator.
Results:
Among 207 countries, OAT was documented in 59 countries (29%) and NSPs in ten (5%) and
universal in three. HIV testing and ART were reported in 79 (38%) and 78 (38%) countries, and HCV
testing and DAA treatment were reported in 53 (26%) and 47 (23%) countries. HBV testing,
treatment, and vaccination were available in 50 (24%), 36 (17%), and 39 (19%). Tuberculosis
screening appeared in 94 (45%) and treatment in 79 (38%). Fewer than 2% (~171,500) of 11.3 million
incarcerated individuals live in countries offering all seven services in one or more facility; ~600
people in one country (Luxembourg) have universal access across all sites. Programmatic coverage
data were rarely reported.
Conclusion:
Coverage of interventions for injecting drug use and infectious diseases in carceral settings is
alarmingly low, falling far below community standards and WHO/UNAIDS/UNODC targets. Urgent
policy reform, integration of prison health with national systems, and investment in scaling up and
monitoring are critical to improving health equity for incarcerated populations.
Disclosure of Interest Statement:
Australian National Health and Medical Research Council.