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Addressing the challenges of chronic viral infections and addiction in prisons: the PRODEPIST study

Christine Jacomet, Angeline Guyot-Lénat, Corinne Bonny, Cécile Henquell, Morgane Rude, Sylviane Dydymski, Jean-Alexandre Lesturgeon, Céline Lambert, Bruno Pereira, Jeannot Schmidt
DOI: http://dx.doi.org/10.1093/eurpub/ckv183 122-128 First published online: 9 October 2015


Objectives: In 2010 only 30.9%, of the Puy-de-Dome prison detainees were screened for human immunodeficiency virus (HIV), hepatitis C virus (HCV) and hepatitis B virus (HBV). Our goal was then to promote these assesments, as well as to identify addictive behaviour using FAGERSTROM, Cannabis Abuse Screening Test and CAGE tests, diagnose fibrosis by means of Fibrometer or Fibroscan in hepatic virus carriers and heavy drinkers, and perform HBV vaccinations. Setting: This prospective study of adult detainees in the prisons of Puy-de-Dome, France, took place from June 2012 to December 2013. Results: Of the 702 incarcerated individuals, 396(56.4%) were screened and 357(50.9%) enrolled. HIV prevalence was 0.3%, HCV 4.7% and HBV 0.6%. While 234/294(79.6%) smokers and 115/145(79.3%) cannabis users were screened for dependence, excessive alcohol consumption was tested for in 91/179(50.8%) cases. Fibrosis was screened for in 75/80(93.7%) individuals selected with 16.0% presenting with moderate to severe fibrosis, 4/9(44.4%) HCV carriers and 8/65(12.3%) excessive alcohol consumers. HBV vaccination was given to 81/149(54.4%) individuals with no serological markers. A total of nine HIV tests were conducted at the 57 discharge consultations, involving 215 detainees being released, all of which were negative. Conclusion: The promotion of these evaluations proved beneficial, although viral screening could be achieved for only approaching half of the detainees, as could alcohol consumption assessment and HBV vaccination for those concerned. Fibrosis screening revealed lesions in HCV carriers yet also in heavy drinkers, who are typically less likely to be assessed. Consultations and HIV screening on release were found to be rarely possible.


In France, each detention establishment is connected to a hospital and patient care is provided by three structures: (i) medical units (MUs), where medical examinations of detainees take place, offering management concerning sexually transmitted infections (STIs) jointly with free anonymous screening centres; (ii) regional psychological services; (iii) drug and alcohol addiction treatment centres and prevention services (CSAPA: Centre de Soins, d’Accompagnement et de Prévention en Addictologie).1

The consultations conducted on entry to prison are carried out to manage pathologies for which the prevalence in prison was recently surveyed.2 More particularly, the PREVACAR survey, carried out in France in 2010, reported that 93% (i.e. 135 of 145) of all MUs declared that they offered systematic human immunodeficiency virus (HIV), hepatitis C virus (HCV) and hepatitis B virus (HBV) screenings. However, repeated surveys of actual screenings in prison report that only a maximum of 50% of patients are actually screened.3 Nonetheless, in the Puy-de-Dome prisons in 2010, 114/368 (30.9%) incoming Clermont-Ferrand and Riom prison inmates had accepted this screening, two of whom were discovered to be infected with HCV.

Another crucial aspect of the entry consultation was to screen for and manage addictions. According to the survey reviewed in 2000, all substances that were smoked, sniffed, injected or swallowed prior to entering prison continued to be used during imprisonment, albeit to a lesser degree.4 The goal of the French Directorate-General for Health’s 2010 recommendations was to define the methods for coordination, re-emphasize that MUs are responsible for establishing a protocol among the various professionals, and set up a referral CSAPA in order to ensure complete prevention and healthcare, not only during imprisonment but also after release, in order to facilitate the necessary detainee follow-up outside.5

Therefore, after reflection and training conducted by the regional committee for the fight against HIV, our study sought to promote HIV and hepatitis virus screening on entry and release from the two prisons located in the Puy-de-Dôme department (Clermont-Ferrand and Riom), an administrative department of the Auvergne region in France. This was to be coupled with identification of addictive behaviour, diagnosis of fibrosis using Fibrometer and transient elastography (Fibroscan) in chronic virus carriers and drug users (use of illegal substances, either alcohol-associated or not), and promotion of hepatitis B vaccination. The detainees were assessed to improve links to care and prevention. That is why we added to the study the collection of these data.



This prospective study was carried out between June 2012 and December 2013 in the Clermont-Ferrand and Riom prisons, offering holding capacities of 86 and 122 detainees, respectively. Both had MUs affiliated with the university hospital of Clermont-Ferrand, providing psychiatric consultation conducted by Sainte-Marie Psychiatric Hospital physicians and the Clermont-Ferrand referral CSAPA.

Inclusion and non-inclusion criteria

Posters were mounted in the prisons encouraging HIV and hepatitis screening on entry and on release. The testing proposition met the recommendations of taking health care of persons placed on judicial control.6 Personalized information letters were presented to the detainees, including the possibility of signing their consent to the study protocol and computerization of their data, once agreement had been granted by the respective committee for the protection of persons (CPP: comité pour la protection des personnes) and the national commission for data protection and liberties (CNIL, France).

Subjects included were adult detainees who could understand French and were not under legal guardianship prior to inclusion. Individuals who refused to take part were not included. Written consent was obtained from all who agreed to participate.

Collected data

The study ensured the collection of data resulting from entry consultation. Along with clinical examinations, the detainees’ deprivation state associated with inequalities in health care and higher morbidity and mortality was assessed by means of questionnaire to establish the EPICES score on entry.7 HIV, HCV and HBV were screened using the ELISA method (Architect ABBOTT). Detainees were tested for consumption of toxic substances and assessed in terms of related addictive behaviour, using the FAGERSTROM test for nicotine dependence, the French version of the CAGE (Cut down, Annoyed, Guilty, Eye opener) test for those meeting the DSM-IV (Diagnostic and statistical manual of mental disorders, 4th. edition) alcohol abuse or dependency criteria, and the Cannabis Abuse Screening Test for cannabis users.8–10 In cases of chronic virus infection or addiction, the procedures enabled management of these patients. Hepatic fibrosis was evaluated by means of Fibrometer and transient elastography (Fibroscan) for those presenting with chronic viral hepatitis or alcohol intoxication. Detainees who were HBV-free and exhibited no hepatitis B surface (HBs) antibodies were offered HBV vaccination in accordance with national French recommendations.11 On release, HIV was screened for using the rapid point-of-care (POC) HIV test (INSTI HIV1 HIV2 Nephroteck).

Statistical analysis

All the data collected and recorded in the MU medical files were also entered anonymized into the EpiInfo system, then subject to descriptive analysis.

Statistical analysis was performed using Stata software (Version 13, StataCorp, College Station, TX). All tests were two-sided, with a Type I error set at an alpha level of 0.05. Continuous data was expressed as means and standard deviations or as medians with interquartile range (IQR), with categorical parameters expressed as frequencies and associated percentages. Comparisons between independent groups were analysed using the Chi-squared test or Fisher’s exact test for categorical variables, with Student’s t-test or the Mann–Whitney test applied for quantitative parameters, as appropriate, with the Gaussian distribution verified by the Shapiro–Wilk test and homoscedasticity by the Fisher–Snedecor test. Multivariate logistic regressions, conducted with dichotomous parameter as dependent variable, were performed by means of stepwise selection approach according to univariate results and clinical relevance.12, 13


During the entire study period, a total of 702 individuals were incarcerated, of whom 396 (56.4%) accepted to be assessed and 357 (50.9%) accepted to take part in the PRODEPIST study: 206 detainees in the Clermont-Ferrand prison and 151 in the Riom prison. When one compares the percentage of inmates evaluated during this study with that of inmates screened in 2010 (56.4% vs. 30.9%, respectively), there is a significant difference (P < 0.001).

The reasons for neither taking part in the protocol nor benefiting from any screening were surveyed for three consecutive months from October to December 2013 among the 107 newly incarcerated individuals. There were 62 who did not take part in the protocol: 59 (95.2%) were male with a median age of 25 years [17–69]. A total of 11 (17.7%) did not fulfil the criteria for inclusion and 20 (32.3%) refused to take part or be screened, whereas 31 (50%) were not invited to participate in the study (17 transferred from another establishment, 8 rapidly re-incarcerated and 6 interviews were not properly arranged because of consultations overload, emergencies in the MU decreasing the time of the consultation or violence of certain situations). All in all, 20 of the 107 (18.7%) newly-incarcerated detainees refused the PRODEPIST study and all associated screenings. The main reasons of refusal were fear of needles, problems of understanding, tiredness of medical concerns sounding like police harassment they have experienced in the context of judicial proceedings, and refusal to take part to a clinical research protocol.

The socio-demographic characteristics of the 357 people included in the study have been presented in Table 1. The patients were predominantly male, with a median age of 30 years (IQR: 25-39). Over 60% were repeat offenders. The median term of this imprisonment was 183 days (IQR: 92–396).

View this table:
Table 1

Social and demographic data concerning the 357 included detainees

N/Number testedPercentage
AgeMedian [IQR]30.0 [25.0–39.0]
NationalityFrance (metropolitan and overseas territories)312/34690.2
Western Europe5/3461.4
Eastern Europe/Turkey/Russia14/3464.0
Africa/South America/West Indies15/3464.4
Family situationUnmarried236/35067.4
Number of children, mean (SD)2.3 (1.5)
With parents77/31224.7
No fixed abode38/31212.2
Vocational trainingNone114/33933.6
Lower secondary school qualification212/33962.5
Higher education4/331.2
Work contract, independent91/32827.8
In training4/3281.2
Social security coverNone56/33116.9
French national health insurance120/33136.3
Universal health insurance150/33145.3
Parental insurance5/3311.5
Top-up insuranceYes183/30759.6
EPICES scoreMedian [IQR]50.3 [36.7–66.3]
Mean ± SD50.8 ± 20.1
Deprivation state evaluated by EPICESNo deprivation49/30516.1
Extreme deprivation142/30546.5
Imprisonment number1128/32938.9
5 or more44/32913.4
Transfer from another establishment113.1
Judicial rulingCondemned222/33266.9
Under investigation110/33233.1
Duration of imprisonment (condemned subjects) in daysMedian [IQR]183.0 [92.0–396.0]
  • SD, standard deviation; IQR, interquartile range.

Medical characteristics have been presented in Table 2. The main results are: 58.9% of the detainees had a history of surgery, 35.8% had a medical history and 22.5% had a psychiatric history. Finally, 24.2% suffered from pathologies related to alcohol consumption and 24.2% from opiate-related pathologies. Half had already undergone HIV screening, in most cases in connection with a previous prison term. One individual declared being HIV-positive and nine declared history of HCV-positivity.

View this table:
Table 2

Medical data for the 357 included detainees

N/Number testedPercentage
Registered with a general practitionerYes223/35562.8
Did not know7/3352.0
Body mass indexMedian [IQR]22.4 [20.2–26.0]
Between 15 and 25232/33269.9
Above 25100/33230.1
Physically activeYes132/33339.6
Did not know8/3332.4
Medical histories:All126/35235.8
Asthma/chronic obstructive pulmonary disease32/3529.1
Gastritis/gastroesophageal reflux15/3524.3
High blood pressure12/3523.4
Skin condition9/3522.6
Myocardial infarction4/3521.1
Sexually-transmitted disease4/3521.1
Surgical histories:All208/35358.9
History of allergy49/30716.0
Psychiatric disordersAll78/34622.5
Depressive syndrome31/3469.0
Behavioural problems22/3466.4
Pathology related to addictionAll160/32748.9
Alcohol ± cannabis79/32724.2
Cannabis alone2/3270.6
Opiates ± Alcohol79/32724.2
Follow-up for addiction prior to incarceration(CSAPA, hospital or general practitioner)90/35525.2
Prior HIV serologyNot tested141/35240.0
Did not know32/3529.1
Prior HCV serologyNot tested139/34440.4
Did not know32/3449.3
  • IQR, interquartile range; CSAPA, drug and alcohol addiction treatment centres and prevention services.

  • a: Already known, viral load undetectable.

  • b: Two were spontaneously resolved and five efficaciously treated. Two non-responders.

HIV, HCV and HBV screenings and HBV vaccination

HIV and hepatitis virus screenings concerned 92.2% of the included detainees (Table 3). Nine (2.5%) did not provide samples, primarily due to sudden release from prison, and 22 (6.3%) finally refused the blood test. Of the 326 detainees who were tested, one (0.3%) was known to already be HIV-positive and undergoing effective antiretroviral therapy, which was continued. HCV serological test was positive for 16 (4.7%) detainees, five of whom had been unaware of their infection and two who had not reported it. A multivariate analysis applying the dependent variable ‘HCV’ indicated that age (P < 0.05) and illegal substance consumption (P = 0.02) are the two associated factors. All underwent testing for HCV ribonucleic acid (RNA), found present in five.

View this table:
Table 3

Results of promotion of screening for the 357 included detainees

N/Number testedPercentage
HIV serologyPositivea1/3480.3
HCV serologyPositiveb16/3424.7
HCV PCR +5/3421.5
HBs antigenPositive2/3470.6
HBc antibodiesPositive26/3477.5
HBs antibodiesPositive171/34749.3
Cigarettes/dayMedian [IQR]20.0 [10.0–20.0]
Nicotine dependence (Fagerström)Not dependent34/23414.5
Slightly dependent48/23420.5
Averagely dependent89/23438.1
Highly dependent48/23420.5
Very highly dependent15/2346.4
Alcohol consumption179/33753.1
Excessive consumption (DETA CAGE)65/9171.4
Cannabis useNo153/34045.0
Yes, in the past42/34012.4
Yes, in the past and/or just prior to incarceration145/34042.6
Addiction consultation to be offered (CAST)85/11573.9
Substitution treatments prescribed by a doctorNo273/34379.6
Yes, in the past22/3436.4
Yes, in the past and/or just prior to incarceration48/34314.0
Substitution treatments without prescriptionNo282/33983.2
Yes, in the past28/3398.3
Yes, in the past and/or just prior to incarceration29/3398.5
Cocaine/crack cocaineNo254/33974.9
Yes, in the past56/33916.5
Yes, in the past and just prior to incarceration29/3398.6
Heroin or other opiatesNo262/33977.3
Yes, in the past49/33914.4
Yes, in the past and/or just prior to incarceration28/3398.3
Injectable drugs26/3387.7
  • PCR, polymerase chain reaction; IQR: interquartile range; HBc, hepatitis B core.

  • a: Already known.

  • b: Seven new detections, four of which spontaneously resolved.

Two detainees (0.6%) exhibited positive HBs antigens, with one having suddenly been released and the other unaware, checked for fibrosis but without fulfilling the criteria to warrant therapy, 26 (7.5%) had previous contact with HBV disease, and 145 (41.8%) previous HBV vaccination. Of the 149 individuals who had negative serum markers, 54.4% accepted vaccination, whereas 12.1% refused. It was not possible to offer vaccination to the others, primarily due to the long delay before receiving serological test results and early release of detainees without final medical consultation.

Addiction assessment

It was possible to assess the consumption of all substances for 94.9% (339/357) of the included prisoners, revealing 83.8% to be smokers, 42.6% cannabis users and 53.1% alcohol consumers, with 14.0% receiving opiate substitution therapy (OST), categorized as long-term users, 8.6% as cocaine consumers and 8.3% opiate users, whereas 7.7% were opiate, buprenorphine or mixed illegal substance injectors (Table 3).

Addiction screening was carried out for 234 of the 294 (79.6%) tobacco smokers, as well as for 115 of the 145 (79.3%) cannabis users, but only 91/179 (50.8%) drinkers were assessed. Of the detainees receiving OST, 7/47 (14.9%), had HCV four of whom presented with active hepatitis, vs. 9/283 (3.2%) of those not receiving this therapy, one with active chronic hepatitis (P = 0.01).

Fibrosis evaluation

We deemed 80 detainees an appropriate population for fibrosis evaluation. Out of the 80, 10 were active or past carriers of chronic hepatitis C among the 16 with HCV serological positive test, 2 were active hepatitis B cases and 68 excessive drinkers. But finally 75 (93.7%) were tested (Table 4). Moderate to severe fibrosis was found in 12/75 (16.0%) of these detainees, and hence in 4/9 (44.4%) HCV carriers and 8/65 (12.3%) excessive alcohol drinkers with a mean age of 38 years. Of all the detainees with confirmed fibrosis, 30% were HCV-positive and 70% were heavy drinkers.

View this table:
Table 4

Promotion of hepatic fibrosis screening of nine patients with chronic HCV hepatitis, one patient with chronic HBV hepatitis and 65 excessive alcohol abusers

FibrosisAssessment method
Fibrometer N = 26Fibroscan N = 33Fibroscan and fibrometer N = 16Total N = 75Percentage
F1 or F1/F2Total9177c3344.0
  • HCV: hepatitis C virus HBV: hepatitis B virus.

  • a:Three assessed as F1 by fibrometer

  • b: One PCR positive and two PCR negative

  • c: Two assessed as F0 and one as F3 by fibrometer

  • d: Two PCR positive

  • e: Assessed as F1 by fibrometer

  • f: One PCR negative

  • g: One assessed as F3 by fibrometer

  • h: One PCR positive and two PCR negative.

Care to patients with HIV, HCV and HBV

Of the 11 detainees already known to have HCV infection, four exhibited spontaneous cure and seven were treated, resulting in five responders. Of those who had not previously been screened, two out of five were spontaneously cured. Thus, the prevalence of HCV chronic infection in the study population was 5/326 (1.5%). Of these five detainees four were treated during detention, with one exhibiting sustained viral response, two others exhibiting viral response under treatment on completion in France then being extradited to Georgia and the last patient discontinuing treatment after release from prison due to poor tolerance with relapse.

Care to patients with addiction

All in all, 52 detainees expressed a desire to quit smoking, all of whom were prescribed a nicotine substitute by the physician. The CSAPA was able to care for 23/83 (27.7%) detainees who wished to stop using cannabis, providing them with repeated psychiatric visits and, in some cases, anxiolytic prescription. They were also able to help 23/60 (38.3%) detainees who desired or required help to stop excessive drinking, 24/53 (45.3%) opiate users wishing to stop and 19/37 (51.4%) receiving OST.

Screening on release

A total of 216 detainees left prison during the study period, with 88 transferred, 65 freed, 32 placed under electronic supervision, 13 released, four placed on external work duty and 2 hospitalized. Of these, we were able to conduct 57 (26.4%) discharge consultations, for 34 of the freed detainees and 19 of those placed under electronic supervision. During these consultations, nine POC HIV testing were carried out, with the others not receiving testing primarily due to the fact that two refused and the lasts were not offered. All the results were negative.


This field study underlined the effectiveness of training caregivers and displaying posters and other means of informing prospective participants of screening for HIV, HCV and HBV infections. This was assessed comparing 2010 data with PRODEPIST data, demonstrating a significant increase of 30.9% to 56.4% in terms of participation (P < 0.001). Moreover, whilst only two prisoners were detected as HCV-positive in 2010, there were 19 found to be positive in the 2012–13 screening, including 16 HCV cases, one HIV and two HBV. All but one—due to fast release—of these positive-result detainees received appropriate monitoring and treatment. Complementary assessment for addictions, and if needed liver monitoring, revealed the importance of alcohol in addition to that of HCV for the presence of liver fibrosis.

Nevertheless, some people even declined screening, although this was not the only cause of non-participation. Half of the time no offer was made due to transfers, rapidly re-incarceration, or setback, despite the observation that detainees represented a group at high risk of contamination, requiring repeated screening offers. Even if facing repeated or difficult situations, the initial evaluation still remains a determining issue that should be dealt with now. We believe that all professionals involved with this population must be reminded of this fact14. In the preceding decade, refusal by the detainee could be related to the fear of being stigmatized. However, by ensuring good ethics, such as in providing fully informed consent, and safeguarding human rights issues, such as confidentiality, detainee refusal is today not related to stigmatization. We now tackle the issues of learning one’s seropositivity or status as carrier of a hepatitis virus with appropriate information on the current context of HIV infection management, consisting only of one pill a day, and how it has proven highly effective, as well as the extremely efficient new anti-HCV treatments now available that cause no side-effects.14,15 However, refusals occurred in ∼20% of cases on entry, partly due the resentment of medical concerns in the context of judicial proceedings, encouraging caregivers to repeat the offer. We must also be all the more convincing when dealing with older prisoners and those who use illegal substances, two associated factors of HCV infection. This is the first and most significant challenge to address.

The social characteristics of the detainees included in the study above highlight how great their deprivation state is. For comparison, Epices score has been assessed at 26.8 (± 22.9) for men and 28.7 (± 22.9) for women in France.16 Their medical and surgical histories are the first and most extensive reported in Europe, corresponding to the data available in Australian literature and exceeding those of detainees in the USA.17–20 Our results, relative to the rates of history of psychiatric disease, alcohol dependences and opiate uses, are consistent with previous French data, showing how representative to the French detainee population this study is.21–23 Furthermore, the 4.7% prevalence of HCV-positive serology was comparable to that found in recent studies.3 Bearing in mind the small sample size, our study is the first to report that HCV infection was first discovered during detention in nearly one case out of three, and that the prevalence of chronic infection, all found to have positive HCV serology following additional work-up with screening for HCV RNA, was assessed at 1.5%. It is important to note the high prevalence of HCV infection in people undergoing OST, as most were illegal-substance injectors. We also wish to underline the fact that once the diagnosis was established, there was no difficulty in prescribing expensive treatments against chronic viral infections, nor in their monitoring.

While the use of tobacco has remained at the previously assessed high level, that of cannabis can be seen to be growing, assessed by our study at 45% in comparison with its 2000 prevalence at 25.6% of people entering prison.4 Addictions to these substances were well-assessed, with our study revealing high levels of dependence, yet this is not true for alcohol use, with alcohol consumption assessed but excessive alcohol abuse only screened for in half of cases. Alcohol does, in fact, appear to be a major problem in this young population, and their denial, as well as that of care staff, of the issue is extremely widespread. This may be related to the high frequency of alcohol consumption, rendering it banal, which has been increasing in France since 2003 and is approaching figures reported for Australia in 2011.16,24 The second challenge in the prison environment is therefore that of screening and treating heavy drinkers, whereas alcohol abuse is likely directly related to incarceration. Moreover, only 38.3% of detainees received care for their alcoholism, partially due to the temporary nature of certain visits and a lack of motivation for such care among both detainees and staff, yet also as a result of poor coordination between the MUs and prison administration. One notion remains clear: by improving the management of heavy drinkers, prison terms could be reduced.

Most of the detainees infected by chronic viral hepatitis or exhibiting addiction to alcohol were able to undergo a non-invasive test for fibrosis. Our results revealed that 16% of detainees suffered from severe fibrosis, including 44% of those presenting with chronic active HCV hepatitis and 12.3% of those presenting with a high level of alcohol intoxication. These results, combined with high prevalence of alcoholism and HCV infections are in favour of making elastometry assessment available in prisons, as half of the prisoners did not want a blood test yet would probably have accepted this non-invasive test for fibrosis. This new assessment method could also help motivate alcoholics and the care staff to initiate treatment. With this in mind, within the scope of the 2008–11 French government plan to combat drugs and drug addiction, a Fibroscan was made available to five MUs with the results demonstrating that 96% of detainees accepted this diagnosis tool.25 The third essential challenge is therefore to argue for the implementation of Fibroscan equipment in all MUs.

Given the failure to offer HBV vaccination in 33.5% of cases, primarily due to logistic problems yet also combined with the lack of specific medical consultation on discharge, questions could be raised concerning the inadequacies of medical staff in these structures. For this reason, greater advantage should be taken of the support provided by partners already working in this field, like the AIDES coalition against AIDS for example, in order to offer HIV rapid testing, as well as HCV diagnosis methods soon to come, and ensure complete prevention and care on release.26,27 The fourth challenge is therefore to implement and ensure timely medical discharge consultations from prisons, whatever the means, with other offers of screening and extended continuity of care.

To resume, our study revealed that the systematic proposition of screening in this population with high levels of deprivation does not lead to the final objective of assessing all detainees. As such, the offer from care givers has to be improved with the participation of detainees, particularly the more at risk illegal substance consumers, and probably to be repeated further. Second, the hepatitis fibrosis, issue of public health, was linked to hepatitis viral infection but also high levels of alcohol consumption which is of high frequency in the detainee population and rarely evaluated to date. Therefore, the goal of screening, in the aim to perform care and prevention in prison, is to tackle the issue at a global level. It seemed impossible to detach HIV, hepatitis, addiction, hepatitis fibrosis, from one another. This argues also to extend the reach of fibrosis assessment by offering elastometry, and implement an effective and timely medical evaluation before discharge in order to propose adequate healthcare outside the prison, potentially with the involvement of partner associations.


Janssen, MSD and Roche Laboratories provided funding for the rapid diagnosis testing and fibroscan equipment rental. They were not involved in study design; data collection, analysis or interpretation; medical writing or submission; decision to publish; or preparation of the manuscript. This paper presents independent research conducted by the Clermont-Ferrand University Hospital Group (CHU), the promoter of the study.

Conflicts of interest: None declared.

Key points

  • In prisons where the prevalence of HIV, HCV and HBV is already known to be higher than that reported outside, the promotion for chronic virus infection screening is still highly relevant as it needs to overcome environment constraints and initial refusals from detainees.

  • Addiction screening and therefore alcohol abuse screening must be improved, if only in order to diagnose and manage hepatic fibrosis.

  • Investigating for hepatic fibrosis by means of non-invasive test methods, such as elastometry, is well accepted and enables assessment not only of viral fibrosis but also of previously unrecognized alcohol fibrosis.

  • Screening is very difficult to achieve on release and requires special assistance.


The authors would like to thank the participating detainees and MU practitioners and nurses who ensured prevention, screening and management, with particular thanks to investigators Christophe Perrier, Corinne Pourrat, Anne Laure Pontonnier and Christian Perrier.


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View Abstract