Prisons are enclosed facilities built to confine law offenders and separate them from the rest of the community. While these structures have been successful in increasing public safety, sub-standard living conditions and high-risk behavior tend to compromise prisoner health by putting them at an increased risk of disease infection, particularly blood-borne virus infection. 

Hepatitis C virus (HCV) is the most common blood-borne virus circulating in prisons due to a high population of incarcerated people who inject drugs (PWID) and the prevalence of unsafe injecting practices. Currently, the implementation of HCV prevention programs in Australia remain inadequate. While the use of highly effective and short-term direct acting antivirals to cure HCV has emerged, treatment implementation and delivery in prisons remain neglected. Regardless of how high treatment uptake is in the community, it is unlikely to achieve HCV elimination if key populations, such as prisoners, are left behind.

My research explores the dynamics of HCV transmission and evaluates strategies on mitigating ongoing transmission in the Australian prison setting, particularly in New South Wales (NSW). I use an integrated approach of epidemiology, bioinformatics, and computational modelling. Using a well-defined longitudinal cohort of prisoners with 6-monthly blood samples and self-reported injecting behaviour, surveillance was performed by calculating the HCV incidence in this population. Associated risk factors were also identified using statistical analysis. Transmission events were then reconstructed and transmission clusters were identified from this cohort. This was achieved by applying phylogenetic analysis on the E1-hypervariable region of the collected sequences and mapping closely-related sequences with injecting risk behaviour, and geographic and temporal information. Finally, a computational agent-based model was developed to simulate the future of the HCV epidemic in NSW prisons. Ultimately, this model will be used to assess the impact of treatment and prevention strategies (e.g. NSP) in eliminating HCV in this setting.

The researcher has won the following for this research:

1. Westmead Millenium Institute for Medical Research - Young Achiever Award in Hepatitis 2013
2. UNSW International Research Candidate Scholarship 2013-2016

Portions of this research have also been published in:

1. A prospective study of hepatitis C incidence in Australian prisoners Addiction, 2014; Oct;109(10):1695-706.
2. Transmission of hepatitis C virus among prisoners, Australia, 2005-2012 Emerging Infectious Diseases, 2015; May;21(5):765-74.
3. Ongoing incident hepatitis C virus infection among people with a history of injecting drug use in an Australian prison setting, 2005-2014: The HITS-p study Journal of Viral Hepatitis, 2017; April; 10: 10.1111