Regional epidemiological study of hepatitis B, hepatitis C, and human immunodeficiency virus among prisoners

Infections of hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) are leading contributors to Indonesia's disease burden, particularly among prisoners with limited access to care. This study investigates the prevalence and risk factors of these infections in prisoners of Semarang.

A cross-sectional study at Kedungpane prison, Semarang, Central Java, Indonesia included informed consent, questionnaires about awareness and risk factors, and blood tests. HBV and HCV were determined through rapid serological methods, whereas HIV was confirmed with three rapid tests.

Among 1,642 prisoners (mean age 35.1 years), HBV, HCV and HIV prevalence was 3.3%, 1.5% and 0.9%, respectively. Significant risk factors for HCV included commercial sex workers (p = 0.009), people who inject drugs (PWID) (p = 0.000), blood transfusions (p = 0.025), drug use (p = 0.007), and multiple partners (p = 0.005). For HIV, key factors were being a transgender women (p = 0.037) and PWID (p = 0.001). Although 94.3% of prisoners had HIV screening, only 12 out of 15 HIV-positive prisoners understood their diagnosis and received treatment. The awareness levels were higher for HIV (76%) than for HBV (35.3%) and HCV (30.7%), with most information from media (51.2%) and counseling (30.4%). In the multivariate analysis, confirmed using exact logistic regression, only PWID remained independently associated with HCV infection, while both PWID and being a transgender woman were independently associated with HIV infection. These associations were strong but should be interpreted cautiously due to limited event counts.

Prisoners had the highest prevalence of HBV, followed by HCV and HIV, with HCV rates higher than WHO data. Risk behaviors involved drug use and multiple sexual partners, and knowledge of HIV was higher than that of HBV and HCV mainly from social media and television.