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Modelling the Impact of Condom Distribution on the Incidence and Prevalence of Sexually Transmitted Infections in an Adult Male Prison System.
PLoS One. 2015; 10(12):e0144869.Plos

Abstract

AIMS

To determine the effects of 1) a condom distribution program and 2) a condom distribution program combined with opt-out sexually transmitted infection (STI) screening on the transmission and prevalence of STIs in a prison system.

METHODS

Using data from an implementation evaluation of a state-wide prison condom program and parameter estimates from available literature, a deterministic model was developed to quantify the incidence and prevalence of sexually transmitted HIV, hepatitis B, chlamydia, syphilis and gonorrhoea across 14 Victorian prisons. The model included individual prison populations (by longer (>2 years) or shorter sentence lengths) and monthly prisoner transfers. For each STI, simulations were compared: without any intervention; with a condom distribution program; and with a combined condom and opt-out STI screening at prison reception intervention program.

RESULTS

Condoms reduced the annual incidence of syphilis by 99% (N = 66 averted cases); gonorrhoea by 98% (N = 113 cases); hepatitis B by 71% (N = 5 cases); chlamydia by 27% (N = 196 cases); and HIV by 50% (N = 2 cases every 10 years). Condom availability changed the in-prison epidemiology of gonorrhoea and syphilis from self-sustaining to levels unlikely to result in infection outbreaks; however, condoms did not reduce chlamydia prevalence below a self-sustaining level due to its high infectiousness, high prevalence and low detection rate. When combined with a screening intervention program, condoms reduced chlamydia prevalence further, but not below a self-sustaining level. The low prevalence of HIV and hepatitis B in Australian prisons meant the effects of condoms were predicted to be small.

CONCLUSION

Condoms are predicted to effectively reduce the incidence of STIs in prison and are predicted to control syphilis and gonorrhoea transmission, however even combined with a screening on arrival program may be insufficient to reduce chlamydia prevalence below self-sustaining levels. To control chlamydia transmission additional screening of the existing prison population would be required.

Authors+Show Affiliations

Centre for Population Health, Burnet Institute, Melbourne, VIC 3004, Australia. Department of Epidemiology and Preventive Medicine, Monash University, Clayton, VIC 3008, Australia.Centre for Population Health, Burnet Institute, Melbourne, VIC 3004, Australia. Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD 4811, Australia. Department of Medicine, The University of Melbourne, Parkville, VIC 3050, Australia.Centre for Population Health, Burnet Institute, Melbourne, VIC 3004, Australia.Centre for Population Health, Burnet Institute, Melbourne, VIC 3004, Australia. Department of Epidemiology and Preventive Medicine, Monash University, Clayton, VIC 3008, Australia.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26658518

Citation

Scott, Nick, et al. "Modelling the Impact of Condom Distribution On the Incidence and Prevalence of Sexually Transmitted Infections in an Adult Male Prison System." PloS One, vol. 10, no. 12, 2015, pp. e0144869.
Scott N, McBryde E, Kirwan A, et al. Modelling the Impact of Condom Distribution on the Incidence and Prevalence of Sexually Transmitted Infections in an Adult Male Prison System. PLoS ONE. 2015;10(12):e0144869.
Scott, N., McBryde, E., Kirwan, A., & Stoové, M. (2015). Modelling the Impact of Condom Distribution on the Incidence and Prevalence of Sexually Transmitted Infections in an Adult Male Prison System. PloS One, 10(12), e0144869. https://doi.org/10.1371/journal.pone.0144869
Scott N, et al. Modelling the Impact of Condom Distribution On the Incidence and Prevalence of Sexually Transmitted Infections in an Adult Male Prison System. PLoS ONE. 2015;10(12):e0144869. PubMed PMID: 26658518.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Modelling the Impact of Condom Distribution on the Incidence and Prevalence of Sexually Transmitted Infections in an Adult Male Prison System. AU - Scott,Nick, AU - McBryde,Emma, AU - Kirwan,Amy, AU - Stoové,Mark, Y1 - 2015/12/14/ PY - 2015/04/21/received PY - 2015/11/24/accepted PY - 2015/12/15/entrez PY - 2015/12/15/pubmed PY - 2016/6/29/medline SP - e0144869 EP - e0144869 JF - PloS one JO - PLoS ONE VL - 10 IS - 12 N2 - AIMS: To determine the effects of 1) a condom distribution program and 2) a condom distribution program combined with opt-out sexually transmitted infection (STI) screening on the transmission and prevalence of STIs in a prison system. METHODS: Using data from an implementation evaluation of a state-wide prison condom program and parameter estimates from available literature, a deterministic model was developed to quantify the incidence and prevalence of sexually transmitted HIV, hepatitis B, chlamydia, syphilis and gonorrhoea across 14 Victorian prisons. The model included individual prison populations (by longer (>2 years) or shorter sentence lengths) and monthly prisoner transfers. For each STI, simulations were compared: without any intervention; with a condom distribution program; and with a combined condom and opt-out STI screening at prison reception intervention program. RESULTS: Condoms reduced the annual incidence of syphilis by 99% (N = 66 averted cases); gonorrhoea by 98% (N = 113 cases); hepatitis B by 71% (N = 5 cases); chlamydia by 27% (N = 196 cases); and HIV by 50% (N = 2 cases every 10 years). Condom availability changed the in-prison epidemiology of gonorrhoea and syphilis from self-sustaining to levels unlikely to result in infection outbreaks; however, condoms did not reduce chlamydia prevalence below a self-sustaining level due to its high infectiousness, high prevalence and low detection rate. When combined with a screening intervention program, condoms reduced chlamydia prevalence further, but not below a self-sustaining level. The low prevalence of HIV and hepatitis B in Australian prisons meant the effects of condoms were predicted to be small. CONCLUSION: Condoms are predicted to effectively reduce the incidence of STIs in prison and are predicted to control syphilis and gonorrhoea transmission, however even combined with a screening on arrival program may be insufficient to reduce chlamydia prevalence below self-sustaining levels. To control chlamydia transmission additional screening of the existing prison population would be required. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/26658518/Modelling_the_Impact_of_Condom_Distribution_on_the_Incidence_and_Prevalence_of_Sexually_Transmitted_Infections_in_an_Adult_Male_Prison_System_ L2 - http://dx.plos.org/10.1371/journal.pone.0144869 DB - PRIME DP - Unbound Medicine ER -