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We used incident case detection in prisons to identify clusters of recent HCV transmission.

The Hepatitis C Incidence and Transmission Study in Prisons (HITS-p) is a prospective study of a cohort of 498 prisoners with a history of injection drug use recruited from 37 prisons in NSW during 2005–2012 ( For our study, we considered a HITS-p subset of 79 prisoners infected with HCV genotype 1 or genotype 3 for which HCV E1-HVR1 sequences were available.

The study cohort included 69 (87%) participants who had been previously imprisoned, and most had lifetime risk factors for blood-borne virus acquisition at baseline (Table 1).

No significant differences in demographics and lifetime risk behaviors were found between the 79 study cohort participants and the 317 noninfected HITS-p cohort participants, other than previous imprisonment and having ever injected drugs while in prison (Table 1).

Prisons can be regarded as an enclosed network of facilities within which prisoners are frequently moved.

In NSW, prisoners are often transferred between prisons (e.g., because of changes in prisoner security classifications) and temporarily moved for brief periods (e.g., to go to court or obtain medical treatment).

We detected 3 clusters of recent HCV transmission consisting of 4 likely in-custody transmission events involving source/recipient pairs located in the same prison at the same time.

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