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A comparison of the observed and expected prevalence of HIV in persons released from Ontario provincial prisons in 2010

  • Ryan Van Meer
  • Tony Antoniou
  • Daniel McCormack
  • Sumeet Khanna
  • Claire Kendall
  • Lori Kiefer
  • Fiona G. KouyoumdjianEmail author
Quantitative Research

Abstract

Objective

To estimate the prevalence of HIV infection in persons released from Ontario prisons in 2010 using administrative health data, and to compare this observed prevalence with the expected prevalence based on the most recently available biological sampling data.

Methods

We linked identifying data for all adults released from Ontario provincial prisons in 2010 with administrative health data, and applied a validated algorithm to determine the observed HIV prevalence. We calculated the expected HIV prevalence using 2003–2004 age stratum-specific data from a published study using salivary sampling. We calculated an indirect standardized prevalence ratio of the observed to expected prevalence and 95% confidence intervals. Finally, we conducted sensitivity analyses to adjust for the sensitivity of the algorithm to identify persons with HIV and for undiagnosed HIV infection.

Results

Of 52,313 persons released from Ontario prisons in 2010, we identified 363 persons with HIV, for an observed prevalence of 0.69%. The expected prevalence was 2.38%. Standardized for age, we found a prevalence ratio of 0.29 (95% CI, 0.17–0.77). Sensitivity analyses adjusting for the algorithm’s sensitivity and further adjusting for undiagnosed HIV infection produced standardized prevalence ratios of 0.30 and 0.38, respectively.

Conclusion

Our findings suggest that a high proportion of persons with HIV recently released from provincial prisons either do not know they have HIV infection or do know about their infection but are not engaged in care. Interventions are required to screen people for HIV in prison and to link persons with care following release.

Keywords

HIV Prisoners Diagnosis Canada 

Résumé

Objectif

Estimer la prévalence des infections à VIH chez les personnes libérées de prison en Ontario en 2010 à l’aide de données administratives sur la santé, et comparer cette prévalence observée à la prévalence attendue d’après les données d’échantillonnage biologique les plus récentes.

Méthode

Nous avons jumelé les données d’identification de tous les adultes libérés des prisons ontariennes en 2010 avec les données administratives sur la santé et appliqué un algorithme validé pour déterminer la prévalence observée du VIH. Nous avons calculé la prévalence attendue du VIH à l’aide des données de 2003-2004 différenciées par strate d’âge tirées d’une étude publiée ayant utilisé des échantillons de salive. Nous avons calculé le ratio de prévalence standardisé indirect de la prévalence observée à la prévalence attendue et l’intervalle de confiance de 95 %. Enfin, nous avons mené des analyses de sensibilité pour tenir compte de la sensibilité de l’algorithme à repérer les personnes atteintes du VIH et les infections à VIH non diagnostiquées.

Résultats

Sur les 52 313 personnes libérées de prison en Ontario en 2010, nous avons trouvé 363 personnes atteintes du VIH, soit une prévalence observée de 0,69 %. La prévalence attendue était de 2,38 %. En standardisant les données selon l’âge, nous avons obtenu un ratio de prévalence de 0,29 (IC de 95 % : 0,17-0,77). Des analyses de sensibilité ajustées selon la sensibilité de l’algorithme, puis selon les infections à VIH non diagnostiquées ont produit des ratios de prévalence standardisés de 0,30 et de 0,38, respectivement.

Conclusion

Nos constatations indiquent qu’une proportion élevée de personnes atteintes du VIH récemment libérées des prisons provinciales ignorent qu’elles ont une infection à VIH ou savent qu’elles sont infectées, mais ne sont pas soignées. Des interventions sont nécessaires pour dépister le VIH en prison et pour diriger les personnes infectées vers les soins appropriés après leur libération.

Mots-clés

VIH Prisonniers Diagnostic Canada 

Notes

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Copyright information

© The Canadian Public Health Association 2019

Authors and Affiliations

  • Ryan Van Meer
    • 1
  • Tony Antoniou
    • 2
    • 3
    • 4
  • Daniel McCormack
    • 2
  • Sumeet Khanna
    • 3
  • Claire Kendall
    • 2
    • 5
    • 6
  • Lori Kiefer
    • 7
    • 8
  • Fiona G. Kouyoumdjian
    • 2
    • 9
    • 10
    Email author
  1. 1.Department of Health Research Methods, Evidence and ImpactMcMaster UniversityHamiltonCanada
  2. 2.ICESTorontoCanada
  3. 3.Department of Family and Community MedicineSt. Michael’s Hospital and University of TorontoTorontoCanada
  4. 4.Li Ka Shing Knowledge Institute, St. Michael’s HospitalTorontoCanada
  5. 5.C.T. Lamont Primary Health Care Research Group, Bruyère Research InstituteOttawaCanada
  6. 6.Department of Family MedicineUniversity of OttawaOttawaCanada
  7. 7.Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada
  8. 8.Ministry of Community Safety and Correctional ServicesTorontoCanada
  9. 9.Department of Family MedicineMcMaster UniversityHamiltonCanada
  10. 10.MAP Centre for Urban Health Solutions, St. Michael’s HospitalTorontoCanada

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