The global epidemiology of injecting drug use, HIV, viral hepatitis and tuberculosis among people who are incarcerated: a multistage systematic review

BACKGROUND: This global systematic review assesses the prevalence of injecting drug use (IDU) and key infectious diseases (HIV, hepatitis C virus [HCV], tuberculosis and hepatitis B virus [HBV]) among people who are incarcerated. METHODS: We conducted a systematic search of peer-reviewed (Medline, Embase, PsycINFO), internet, and grey literature databases, from January 2000 through 2nd June 2025 and engaged international experts and relevant agencies liaising with key agencies focused on incarcerated populations (WHO, UNODC, UNAIDS and EUDA). Data on study methods, size of incarcerated populations and demographic characteristics, and prevalence of IDU, HIV, HCV, HBV and tuberculosis among incarcerated populations were extracted. Meta-analyses pooled data where multiple estimates were available for a country; regional and global estimates were calculated, weighted by incarcerated population size. We present overall country, regional and global prevalence estimates for each variable examined, stratified by sex. We then estimated the ratio of IDU, HIV, HCV, HBV and tuberculosis prevalence among incarcerated populations compared to the general population. RESULTS: Of 75,755 screened documents, 2,968 were eligible for data extraction. There are approximately 11,322,000 people aged 15-64 years incarcerated globally with their incarceration rate being 221 per 100,000 (29 per 100,000 among females and 404 per 100,000 among males). Substantial variation in rates across countries and regions were observed with the highest regional rate being in North America. Globally, we estimate that 11Aú9% of people who are incarcerated have ever injected drugs (1,348,000; 95%CI 1,061,500-1,687,000), 51Aú4 times higher than the general population. We estimate that 3Aú7% (95%CI 2Aú5-5Aú4) of people who are incarcerated globally are living with HIV (25.1Aú times higher than the general population); 11Aú7% (95%CI 7Aú7-17Aú1) have current HCV infection (15Aú6 times higher); 4Aú4% (95%CI 2Aú4-7Aú7) have current HBV infection (2Aú2 times higher) and 2Aú5% (95%CI 1Aú5-3Aú8) have active tuberculosis (45Aú3 times higher than the general population). There is substantial variation geographically and among females and males. CONCLUSION: The substantial concentration of people with multiple risks and comorbidities requires improved strategies to screen, evaluate, treat and prevent these adverse consequences, which is crucial for global control efforts. FUNDING: Australian National Health and Medical Research Council

• Epidemiology and Determinants of Health
  • Epidemiology
• Population(s)
  • Prisoners
  • General HIV+ population
  • General HIV- population
• Prevention, Engagement and Care Cascade
  • Prevention
• Prevention
  • Drug use behaviours/harm reduction
• Testing
  • Testing
• Substance Use
  • Nonmedicinal drugs
• Co-infections
  • Hepatitis B, C
  • Tuberculosis
• Health Systems
  • Governance arrangements