Grant: CIHR Fellowship

Drug use is criminalized at various degrees globally. Incarceration and the period post-release can increase risk for HIV and hepatitis C virus (HCV) infections and overdose among people who inject drugs (PWID). Thus, over time, incarceration is likely to be "responsible" for a significant proportion of the total new cases of these health-harms among PWID. Yet, no study has attempted to estimate its potential contribution over time. In addition, access to prison-based strategies such as opioid agonist treatment, needle and syringe provision and naloxone kits, with continuation upon release, can prevent the occurrence of these health harms but no study has yet estimated their potential long-term prevention benefit. This study seeks to address these gaps using mathematical modeling. This technique enables the forecasting of the future burden of an epidemic and of the potential impact of introducing an intervention on its course. Such modelling outputs are widely used by policy-makers to inform their decisions regarding the control of diseases. Given that different global settings have distinct incarceration levels and distinct realistic scenarios of future scale-up of prevention strategies within prisons, these simulations must be tailored to specific settings. In this study, we will carry out the simulations in two distinct settings, Montreal, Canada and Nairobi and Mombasa, Kenya. For each setting, the model parameters will be informed by data collected through two studies (HEPCO, Montreal and TLC-IDU, Nairobi and Mombasa, Kenya). Altogether, this study has the potential to provide estimates on the extent to which incarceration may be fueling HIV and HCV transmission and overdose among PWID, and the necessary scale-up levels of prison-based prevention interventions to achieve meaningful reductions in these health harms over time. In the long-run, findings could inform appropriate public health and policy changes to reduce the burden of HIV, HCV and overdose.