Trends in hepatitis B prevalence and associated risk factors among Indigenous and non-Indigenous prison entrants in Australia, 2004 to 2013

Objective: This study describes and compares prevalence trends of markers for hepatitis B (HBV) from 2004 to 2013 and HBV risk factors between Indigenous and non-Indigenous prison entrants. Methods: A cross-sectional survey carried out over two weeks in 2004, 2007, 2010 and 2013 in reception prisons in New South Wales, Queensland, Western Australia and Tasmania. Results: The study included 2,223 prison entrants; 544 were Indigenous. Indigenous prison entrants had significantly higher hepatitis B core antibody (anti-HBc) prevalence than non-Indigenous prisoners in 2004 (29% vs. 18%, P=0.026), 2007 (40% vs. 15%, P<0.001) and 2010 (21% vs. 16% 2010, P=0.002), and similar anti-HBc prevalence to non-Indigenous entrants in 2013 (14% vs. 14%, P=0.888), with a significant decline from 2007 for Indigenous entrants (P=0.717)^ᶺ. Being more than 30 years old and coming from an area classified as ‘non-highly accessible’ were associated with anti-HBc positivity in both populations. For Indigenous prison entrants, first time in prison and survey year was associated with anti-HBc positivity. For non-Indigenous participants, a history of injecting drug use and body piercings was associated with anti-HBc positivity. Conclusion: There are unique risk factors associated with HBV prevalence for both Indigenous and non-Indigenous prison entrants. Implications for public health: In developing public health programs and policies for HBV, consideration of similarities and differences of associated HBV risk factors between Indigenous and non-Indigenous offenders is required.