Project lead: Dr. Ruth Zimmermann (FG 34)

Project coordination: Dr. Ida Sperle-Heupel, Dr. Gyde Steffen (FG 34)

Project team members: Dr. Antonia Genath (PAE), Renke Biallas (FG 34) Eva Steinberger, Dr. Iris Hunger (ZIG-GS), Dr. Katja Kajikhina, Dr. Carmen Koschollek, Dr. Claudia Hövener (FG 28)

Cooperation partners: 

• Bremen-Oeslebshausen Prison (and Bremerhaven)

Funding: RKI-internal grant for special research projects

Project duration: 01.01.2025 to 31.12.2025

Aims of the project:

• Estimate prevalence of HBV, HCV and HIV as well as risk and behavioural factors associated with these infections in people in prison who have ever injected drugs
• To Collect data on testing and treatment of these infections in a prison
• Pilot of the study design with focus on feasibility and acceptance

Summary

Worldwide, infections such as hepatitis B, C (HBV, HCV) and HIV are more common among people in prison compared to the general population. Injecting drug use in prison, combined with a lack of access to sterile injecting equipment is one of the main drivers of transmission.

Although prisons are highly controlled facilities, drugs are available in prison. In previous RKI surveys of people who inject drugs, around 80% of all participants stated that they had already been imprisoned, and around 30% of participants with experience of imprisonment stated that they had also injected drugs during their last stay in prison. The frequency and total duration of previous imprisonment was also found to be independently associated with an increased prevalence of HCV. 

Other risk factors in prison for the above-mentioned infections are unprotected (violent) sex, tattoos and piercings carried out under unhygienic conditions and limited access to prevention and care services. Social determinants of health such as migration from countries with a higher prevalence or a lower level of education can influence the burden of disease, as well as knowledge of the infections and the use of medical services. 

The stigma of sexually and blood-borne infections can be an additional barrier to testing and treatment in prison. In Germany, medical care in prison lies within the responsibility of the state ministries of justice, which results in the loss of statutory health insurance when entering prisons. This leads to a discontinuity of care upon release. This is particularly problematic for the continuation of substitution treatment and antiviral therapy and is especially critical for people who inject drugs who are frequently imprisoned for shorter periods of times. 

This pilot study aims to collect data on the prevalence of HBV, HCV and HIV, demographics, prevention and risk behaviour, access to prevention and care as well as knowledge and attitudes in a prison. The prison that will be part of the pilot is located in Bremen, Germany. This is the only prison in Bremen, which allows collection of data from a prison population representative of a federal state. In addition, the feasibility of such data collection is to be evaluated in order to be able to repeat it in other prisons in other federal states in the future. Thereby, obtaining more reliable data on drugs and chronic infectious diseases among people in prison and creating a basis for adapting prevention and care services in prison.

The project is divided into 4 work packages:

AP1	Preparation of data collection tools (Ethics, data protection, study documents, cooperation agreements)
AP2	Quantitative data collection among people in prison
AP3	Qualitative in-depth interviews with prison staff
AP4	Data analysis and write up of reports

Expected results

The data collected enables an assessment of the current coverage of harm reduction and prevention services available for people in prison. This includes access to substitution treatment, sterile injection equipment, HBV vaccinations and testing and treatment for HCV, HBV and HIV. The prevalence of these infections is also collected. In addition, specific risk groups and barriers to accessing services in prison can be identified. The results will provide important information on how prevention, testing and treatment measures in prison can be adapted and optimized at various levels.