As global health systems work toward eliminating sexually transmitted and blood-borne infections, two new studies led by聽, scientist in the聽, draw renewed attention to a population central to these goals: people in prison.
The first study, published in聽Lancet Public Health, presents the first rigorous systematic review and meta-analysis of bacterial sexually transmitted infections (STIs) in incarcerated populations. Drawing on data from more than 1.4 million individuals, it identifies a high prevalence of chlamydia, gonorrhea, and syphilis, with the greatest burden among women and adolescents aged 鈮�19 years. These findings strengthen the rationale for implementing opt-out STI testing for all people in prison upon admission to support earlier detection and reduce preventable complications, and minimally, to all women and adolescents where resources are limited.
鈥淧rison health is public health. To reach global elimination goals, no community should be left behind,鈥� says Dr. Kronfli. 鈥淢y research focuses on improving infectious disease care for people in prison, recognizing they are central 鈥� not peripheral 鈥� to meaningful progress.鈥�
Addressing a long-standing evidence gap
The last global review of bacterial STIs in prisons was published in 2012 and did not examine age-specific trends, despite age emerging as a key predictor of infection. By comparing results across sex and age groups, this review offers a clearer picture of STI prevalence in carceral settings 鈥� evidence that can help guide systematic screening approaches on prison admission. 鈥淧risons are not isolated settings鈥攖hey are part of our communities鈥�, explains first author Gabrielle Beaudry, PhD,聽Research Fellow and MDCM Candidate (Class of 2026). 鈥淕aps in carceral STI care lead to preventable harm. Timely testing and treatment benefits both people in prison and the broader public.鈥�
The study also highlights persistent gaps in global surveillance, including limited data from low- and middle-income countries and inconsistent reporting of syphilis testing methods, offering opportunities for improved testing reporting, and research globally.
Further work: strengthening global hepatitis care
A second study, appearing in聽Lancet Infectious Diseases, summarizes the first global best practice guidelines for viral hepatitis service delivery in prisons, led by Dr. Kronfli, through a systematic review and a GRADE process with 17 experts from around the world. Drawing on 703 studies, the guidelines outline 30 recommendations across eight domains 鈥� including testing, treatment, continuity of care, and harm reduction 鈥� with the goal of standardizing viral hepatitis care across carceral settings. Most importantly, the guidelines were informed by people with lived and living experience of incarceration and viral hepatitis, an integral component of Dr. Kronfli鈥檚 research. 鈥淭his work brought together global experts and centered the voices of people in prison living with hepatitis,鈥� expresses co-first author Akhil Garg, MD, Infectious Disease Fellow 2025. 鈥淭he resulting guidance will help advance the elimination of viral hepatitis in a long-neglected population.鈥� Similarly, this work highlights evidence gaps in under-resourced countries and the need for further research to support context-specific adaptation. 鈥淭hat said, it is the first of its kind and puts people in prison at the forefront of viral hepatitis elimination efforts鈥� says Dr. Kronfli.
Looking ahead
Together, these two publications highlight ongoing challenges and opportunities in prison health care and the importance of strengthening STI and hepatitis services in settings closely connected to community health. Dr. Kronfli鈥檚 work reflects a broader research program focused on developing scalable models of care that support health equity and inform global elimination efforts for people in prison. Next steps include sharing all findings with international partners including the World Health Organization and developing key performance indicators to ensure united efforts in the global approach to prison-based health care delivery.
About the studies
鈥淏acterial sexually transmitted infections in incarcerated populations: a systematic review and meta-analysis鈥� by Gabrielle Beaudry, Brendan L. Harney, Sarah Larney, Emma Plugge, Anne C. Spaulding and Nadine Kronfli was published in The Lancet Public Health.
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鈥淏est practice guidelines for viral hepatitis service delivery in prisons鈥� by Yumi Sheehan, Akhil Garg, Julia Sheehan, Nonso Maduka, Frederick L. Altice, Filipa Alves da Costa, Sean Cox, Ahmed M. Elsharkawy, Ehab Salah, Mark Stoov茅, Lara Tavoschi, Alexander J. Thompson, Karla Thornton, Andrew R. Lloyd, Joaqu铆n Cabezas, Matthew J. Akiyama and Nadine Kronfli was published in The Lancet Infectious Diseases.
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