1
|
Mwatenga SA, Musa AA, Muturi MW, Musyoki AM. Prevalence and associated factors of TB and HIV coinfections among adult inmates with presumptive pulmonary TB in a Kenyan prison. Trop Med Health 2024; 52:54. [PMID: 39148132 PMCID: PMC11328499 DOI: 10.1186/s41182-024-00623-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 08/04/2024] [Indexed: 08/17/2024] Open
Abstract
BACKGROUND Tuberculosis (TB) is more than ten times higher in prisons compared to the general population, and HIV-infected persons are at increased risk of developing active TB and death. In the World Health Organization (WHO) African region, however, where the TB and HIV coinfections are highest, and prisons rarely factored in national disease surveillance, epidemiological data to inform TB control interventions in correctional facilities is limited. In this study, we assessed the prevalence of TB and HIV coinfections, as well as the factors associated with coinfections in our study setting. METHODS This was a prospective cross-sectional study among 157 adult (≥ 18 years) prisoners presenting with symptoms of pulmonary TB at Shimo La Tewa Prison, Kenya, between January and June 2023. The study excluded those with a history of anti-TB drugs use or on treatment follow-up and collected demographic and clinical characteristics data using a questionnaire. Sputum samples were collected and processed immediately using Xpert® MTB/RIF assay or stored at 4 °C for three (3) days in case of delay. RESULTS The overall prevalence of TB among inmates with presumptive pulmonary TB was 10.2%, 95% CI 6.37-16.91% (16/157), HIV 19.1%, 95% CI 13.73-25.97% (30/157). All the TB cases were positive for HIV (16/16, 100%), translating to TB/HIV coinfection of 10.2%, 95% CI 6.37-16.91% (16/157), and there was no rifampicin resistance. TB and HIV coinfection cases were found among underweight (100%, 16/16) prisoners. The independent factors associated with TB and HIV coinfections were education level (adjusted OR = 0.17, p = 0.007), smoking history (adjusted OR = 3.01, p = 0.009) and illegal drug use history (adjusted OR = 4.55, p = 0.044). CONCLUSION We report a high prevalence of pulmonary TB and HIV coinfections among adult inmates with presumptive pulmonary TB in Kenya, with education level, smoking status, and illegal drug use as the independent factors associated with the coinfection. The authority should take measures to protect HIV-positive prisoners from TB, focusing on education, nutrition, smoking, and illegal drug use.
Collapse
Affiliation(s)
- Suleiman Athuman Mwatenga
- Department of Medical Laboratory Sciences, Moi County Referral Hospital, P.O. Box 18-80300, Voi, Kenya
- Department of Medical Laboratory Sciences, Kenyatta University, P.O. Box 43844-00100, Nairobi, Kenya
| | - Ali A Musa
- Clinical Laboratory, Msambweni County Referral Hospital, P.O. Box 8-80404, Msambweni, Kenya
| | - Margaret W Muturi
- Department of Medical Laboratory Sciences, Moi County Referral Hospital, P.O. Box 18-80300, Voi, Kenya
| | - Abednego Moki Musyoki
- Department of Medical Laboratory Sciences, Kenyatta University, P.O. Box 43844-00100, Nairobi, Kenya.
| |
Collapse
|
2
|
Annor F, Nartey YA, Abbew ET, Cudjoe O, Ayisi-Addo S, Ashinyo A, Obiri-Yeboah D. Human immunodeficiency virus care and management in incarcerated populations in Sub-Saharan Africa between 2010 and 2022: A narrative review. Int J STD AIDS 2024; 35:80-95. [PMID: 37793133 DOI: 10.1177/09564624231205335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
BACKGROUND Different countries in sub-Saharan Africa (SSA) have established guidelines to reduce HIV transmission and improve its management in prisons. This narrative review aimed to examine established literature on HIV care and management among incarcerated persons in SSA to identify successful interventions that could inform improved guidelines, policies, and practices related to the clinical care of this population. METHODS We searched PubMed, Scopus, Web of Science, Embase, and TRIP Medical Databases in August 2022 for articles published between 1st January 2010 and 30th June 2022. We identified 27 eligible articles based on the Population/Concept/Context framework. RESULTS HIV screening primarily involved mass campaigns rather than formal prison programmes, with limited implementation of universal testing and treatment. Although a few studies reported on access to antiretrovirals (ARVs), prisoners in urban areas and females had disproportionate access. Barriers identified include poor living conditions, high levels of stigma, and resource constraints. Inter-prison transfers, release from prison, and lack of established programmes hindered follow-up and linkage to care. CONCLUSIONS The implementation of strategies such as universal testing and treatment, human resource strengthening, financing plans for testing, ARV care, and frequent assessment of risk could improve HIV care and management in prisons in SSA.
Collapse
Affiliation(s)
- Francis Annor
- Directorate of Research, Innovation and Consultancy, University of Cape Coast, Cape Coast, Ghana
| | - Yvonne Ayerki Nartey
- Department of Internal Medicine, Cape Coast Teaching Hospital, Cape Coast, Ghana
- Department of Internal Medicine and Therapeutics, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Elizabeth Tabitha Abbew
- Department of Internal Medicine, Cape Coast Teaching Hospital, Cape Coast, Ghana
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerpen, Belgium
| | - Obed Cudjoe
- Department of Medical Laboratory Science, University of Cape Coast, Cape Coast, Ghana
| | - Stephen Ayisi-Addo
- National AIDS/STI Control Program of the Ghana Health Service, Accra, Ghana
| | - Anthony Ashinyo
- National AIDS/STI Control Program of the Ghana Health Service, Accra, Ghana
| | - Dorcas Obiri-Yeboah
- Directorate of Research, Innovation and Consultancy, University of Cape Coast, Cape Coast, Ghana
- Department of Microbiology and Immunology, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| |
Collapse
|
3
|
Sisay Asgedom Y, Ambaw Kassie G, Melaku Kebede T. Prevalence of tuberculosis among prisoners in sub-Saharan Africa: a systematic review and meta-analysis. Front Public Health 2023; 11:1235180. [PMID: 38222088 PMCID: PMC10787954 DOI: 10.3389/fpubh.2023.1235180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 12/04/2023] [Indexed: 01/16/2024] Open
Abstract
Background Tuberculosis (TB) is a key community health problem in numerous settings, predominantly in sub-Saharan Africa (SSA). TB is the second most lethal infectious disease worldwide. Around 1.6 million people died from TB in 2021. TB prevention and control strategies are difficult to implement in prison, especially in sub-Saharan Africa, owing to overcrowding and poor ventilation. Thus, this systematic review and meta-analysis aimed to synthesize the estimated pooled prevalence of tuberculosis among prisoners in sub-Saharan Africa. Materials and methods Electronic biomedical databases such as Google Scholar, Web of Science, PubMed/Medline, EMBASE, and Science Direct were used to systematically explore candidate studies published until December 2022. Data extraction was performed using a Microsoft Excel spreadsheet. The estimated pooled prevalence of tuberculosis was determined using a fixed-effects model. Cochrane Q-test and I2 statistics were used to check heterogeneity statistically across different studies. Begg's rank and Egger's tests were performed to assess evidence of possible publication bias. Results A total of 40 articles involving 59,300 prisoners were included in this systematic review and meta-analysis. The pooled prevalence of tuberculosis was 4.02% (95% CI: 2.68-5.36). We found the highest prevalence using Gene X pert as a diagnostic method, which was 4.97 (95% CI: 2.22-7.73). There is no evidence of publication bias. Conclusion The outcome of this review revealed a high prevalence of tuberculosis among prisoners in sub-Saharan Africa. To reach the "End Tuberculosis strategy" by 2030, early identification of cases through screening on entry and periodical active case finding is important. Moreover, prevention and prompt treatment after diagnosis must be implemented to limit transmission to the general population. Systematic review registration https://www.crd.york.ac.uk/prospero/#searchadvanced, identifier (CRD42023428933).
Collapse
|
4
|
Mera HB, Wagnew F, Akelew Y, Hibstu Z, Berihun S, Tamir W, Alemu S, Lamore Y, Mesganaw B, Adugna A, Tsegaye TB. Prevalence and Predictors of Pulmonary Tuberculosis among Prison Inmates in Sub-Saharan Africa: A Systematic Review and Meta-Analysis. Tuberc Res Treat 2023; 2023:6226200. [PMID: 37260437 PMCID: PMC10228229 DOI: 10.1155/2023/6226200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/29/2022] [Accepted: 04/03/2023] [Indexed: 06/02/2023] Open
Abstract
Introduction Prisoners in Sub-Saharan Africa (SSA) are at a high risk of tuberculosis (TB) infection due to overcrowding and poor ventilation. Consequently, TB is a leading cause of morbidity and mortality in prison, and many inmates face a number of barriers to TB control and had limited information in the region. Thus, the aim of this systematic review and meta-analysis was to estimate the overall pooled prevalence of pulmonary TB and predictors among prison inmates in SSA. Methods From 2006 to 2019, a systematic review and meta-analysis was conducted using various databases, including PubMed, Embase, Web of Science, and Scopus. The data were extracted in Microsoft Excel using a standardized data extraction format, and the analysis was carried out with STATA version 14. To detect heterogeneity across studies, the I2 and the Cochrane Q test statistics were computed. To determine the overall prevalence of TB and predictors among prison populations, a random effect meta-analysis model was used. Results Of the 3,479 retrieved articles, 37studies comprising 72,844 inmates met the inclusion criteria. The pooled prevalence of pulmonary TB among prison inmates in SSA was 7.74% (95% CI: 6.46-8.47). In the subgroup analysis, the highest prevalence was found in the Democratic Republic Congo (DRC) (19.72%) followed by Zambia (11.68%) and then Ethiopia (9.22%). TB/HIV coinfection (OR 4.99 (95% CI: 2.60-9.58)), Body mass index (BMI < 18.5) (OR 3.62 (95% CI: 2.65-6.49)), incarceration (OR 4.52 (95% CI: 2.31-5.68)), and previous TB exposure (OR 2.43 (95% CI: 1.61-3.56)) had higher odds of pulmonary TB among inmates. Conclusion The prevalence of pulmonary TB among SSA prison inmates was found to be high as compared to total population. TB/HIV coinfection, BMI, incarceration duration, and TB exposure were all predictors with pulmonary tuberculosis in prison inmates. As a result, emphasizing early screening for prisoners at risk of pulmonary TB is an important point to achieving global TB commitments in resource-limited settings.
Collapse
Affiliation(s)
- Habtamu Belew Mera
- Department of Medical Laboratory Science, College of Health Sciences, Debre Markos University, Debre Markos 269, Ethiopia
| | - Fasil Wagnew
- Department of Pediatrics Nursing, College of Health Sciences, Debre Markos University, Debre Markos 269, Ethiopia
- National Centre for Epidemiology and Population Health (NCEPH), College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Yibeltal Akelew
- Department of Medical Laboratory Science, College of Health Sciences, Debre Markos University, Debre Markos 269, Ethiopia
| | - Zigale Hibstu
- Department of Medical Laboratory Science, College of Health Sciences, Debre Markos University, Debre Markos 269, Ethiopia
| | - Sileshi Berihun
- Department of Public Health, College of Health Sciences, Injibara University, Injibara 40, Ethiopia
| | - Workineh Tamir
- Department of Medical Laboratory Science, College of Health Sciences, Injibara University, Injibara 40, Ethiopia
| | - Simegn Alemu
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos 269, Ethiopia
| | - Yonas Lamore
- Department of Environmental Health Science, College of Health Sciences, Debre Markos University, Debre, Markos, 269, Ethiopia
| | - Bewket Mesganaw
- Department of Medical Laboratory Science, College of Health Sciences, Debre Markos University, Debre Markos 269, Ethiopia
| | - Adane Adugna
- Department of Medical Laboratory Science, College of Health Sciences, Debre Markos University, Debre Markos 269, Ethiopia
| | - Tefsa Birlew Tsegaye
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos 269, Ethiopia
| |
Collapse
|
5
|
Smith HJ, Herce ME, Mwila C, Chisenga P, Yenga C, Chibwe B, Mai V, Kashela L, Nanyagwe M, Hatwiinda S, Moonga CN, Musheke M, Lungu Y, Sikazwe I, Topp SM. Experiences of Justice-Involved People Transitioning to HIV Care in the Community After Prison Release in Lusaka, Zambia: A Qualitative Study. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:GHSP-D-22-00444. [PMID: 37116925 PMCID: PMC10141426 DOI: 10.9745/ghsp-d-22-00444] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 03/15/2023] [Indexed: 04/30/2023]
Abstract
INTRODUCTION In sub-Saharan Africa (SSA), incarcerated people experience a higher HIV burden than the general population. While access to HIV care and treatment for incarcerated people living with HIV (PLHIV) in SSA has improved in some cases, little is known about their transition to and post-release experience with care in the community. To address this gap, we conducted a qualitative study to describe factors that may influence post-release HIV care continuity in Zambia. METHODS In March-December 2018, we recruited study participants from a larger prospective cohort study following incarcerated and newly released PLHIV at 5 correctional facilities in 2 provinces in Zambia. We interviewed 50 participants immediately before release; 27 (54%) participated in a second interview approximately 6 months post-release. Demographic and psychosocial data were collected through a structured survey. RESULTS The pre-release setting was strongly influenced by the highly structured prison environment and assumptions about life post-release. Participants reported accessible HIV services, a destigmatizing environment, and strong informal social supports built through comradery among people facing the same trying detention conditions. Contrary to their pre-release expectations, during the immediate post-release period, participants struggled to negotiate the health system while dealing with unexpected stressors. Long-term engagement in HIV care was possible for participants with strong family support and a high level of self-efficacy. CONCLUSION Our study highlights that recently released PLHIV in Zambia face acute challenges in meeting their basic subsistence needs, as well as social isolation, which can derail linkage to and retention in community HIV care. Releasees are unprepared to face these challenges due to a lack of community support services. To improve HIV care continuity in this population, new transitional care models are needed that develop client self-efficacy, facilitate health system navigation, and pragmatically address structural and psychosocial barriers like poverty, gender inequality, and substance use.
Collapse
Affiliation(s)
- Helene J Smith
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Michael E Herce
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA
| | - Chilambwe Mwila
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Peter Chisenga
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Chisenga Yenga
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Besa Chibwe
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Vivien Mai
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Lillian Kashela
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Mirriam Nanyagwe
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Sisa Hatwiinda
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Clement N Moonga
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Maurice Musheke
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Yotam Lungu
- Zambia Correctional Service, Government of the Republic of Zambia, Lusaka, Zambia
| | - Izukanji Sikazwe
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| |
Collapse
|
6
|
Placeres AF, de Almeida Soares D, Delpino FM, Moura HSD, Scholze AR, dos Santos MS, Arcêncio RA, Fronteira I. Epidemiology of TB in prisoners: a metanalysis of the prevalence of active and latent TB. BMC Infect Dis 2023; 23:20. [PMID: 36631770 PMCID: PMC9835258 DOI: 10.1186/s12879-022-07961-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 12/20/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) in prisons usually occurs at higher rates than in the general population, especially in developing countries. TB has been reported as the most common cause of death among prisoners. Studies have shown limitations for early detection of TB in prisons that seem to result from mistaken concepts about TB, delayed diagnosis mainly due to the naturalization of lack of healthcare for this population METHODS: A scoping review was performed using the methodology of the Joanna Briggs Institute to assess "What are the scientific evidences on the epidemiology of TB in the prison system?". Then, a meta-analysis was performed to assess the prevalence of TB (active and latent) TB in prisoners. The results are presented as prevalence, in percentage, through random effects models, with a confidence interval of 95%. RESULTS Regarding active TB, the results of the metanalysis showed that countries with a high burden of TB had a prevalence of 3.54% [2.71; 4.63], countries not considered to be high burden TB countries had a prevalence of 1.43% [0.86; 2.37]. Latent TB had a prevalence of 51.61% [39.46; 63.58] in high TB burden countries and a prevalence of 40.24% [23.51; 59.61] in countries with low TB burden. In terms of development, in low- and lower-middle-income countries, the prevalence of active TB was 3.13% [1.84; 5.29] and in high- and upper-middle income countries the prevalence was 2.25% [1.70; 2.99]. The prevalence of latent TB in high- and middle-income countries was 43.77% [28.61; 60.18] and of 49.42% [45.91; 52.94] in low and lower middle-income countries. CONCLUSION Our analysis suggests that TB, and probably other infectious diseases, find fertile ground in prisons where previous acquire social disadvantages seem to thrive-therefore, TB in prisons is a global public health problem and effective strategies are needed to control the disease are needed targeting the prison environment, including rapid health assessments to understand each context and to implement tailored and precision interventions.
Collapse
Affiliation(s)
- Aline Ferreira Placeres
- grid.10772.330000000121511713Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Rua da Junqueira 100, 1349-008 Lisbon, Portugal
| | - Débora de Almeida Soares
- grid.10772.330000000121511713Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Rua da Junqueira 100, 1349-008 Lisbon, Portugal
| | - Felipe Mendes Delpino
- grid.411221.50000 0001 2134 6519Programa de Pós Graduação em Enfermagem, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Heriederson Sávio Dias Moura
- grid.11899.380000 0004 1937 0722Escola de Enfermagem de Ribeirão Preto (EERP/USP), Universidade de São Paulo, São Paulo, Brazil
| | - Alessandro Rolim Scholze
- grid.441795.aUniversidade Estadual do Norte do Paraná, Campus Luiz Meneguel de Bandeirantes, Bandeirantes, Brazil
| | - Márcio Souza dos Santos
- grid.11899.380000 0004 1937 0722Escola de Enfermagem de Ribeirão Preto (EERP/USP), Universidade de São Paulo, São Paulo, Brazil
| | - Ricardo Alexandre Arcêncio
- grid.11899.380000 0004 1937 0722Escola de Enfermagem de Ribeirão Preto (EERP/USP), Universidade de São Paulo, São Paulo, Brazil
| | - Inês Fronteira
- grid.10772.330000000121511713Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa, Lisbon, Portugal
| |
Collapse
|
7
|
Al-Darraji H, Hill P, Sharples K, Altice FL, Kamarulzaman A. Intensified pulmonary tuberculosis case finding among HIV-infected new entrants of a prison in Malaysia: implications for a holistic approach to control tuberculosis in prisons. Int J Prison Health 2023; 19:501-511. [PMID: 36622107 DOI: 10.1108/ijph-01-2022-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE This intensified case finding study aimed to evaluate the prevalence of tuberculosis (TB) disease among people with HIV entering the largest prison in Malaysia. DESIGN/METHODOLOGY/APPROACH The study was conducted in Kajang prison, starting in July 2013 in the men's prison and June 2015 in the women's prison. Individuals tested positive for HIV infection, during the mandatory HIV testing at the prison entry, were consecutively recruited over five months at each prison. Consented participants were interviewed using a structured questionnaire and asked to submit two sputum samples that were assessed using GeneXpert MTB/RIF (Xpert) and culture, irrespective of clinical presentation. Factors associated with active TB (defined as a positive result on either Xpert or culture) were assessed using regression analyses. FINDINGS Overall, 214 incarcerated people with HIV were recruited. Most were men (84.6%), Malaysians (84.1%) and people who inject drugs (67.8%). The mean age was 37.5 (SD 8.2) years, and median CD4 lymphocyte count was 376 cells/mL (IQR 232-526). Overall, 27 (12.6%) TB cases were identified, which was independently associated with scores of five or more on the World Health Organization clinical scoring system for prisons (ARR 2.90 [95% CI 1.48-5.68]). ORIGINALITY/VALUE Limited data exists about the prevalence of TB disease at prison entry, globally and none from Malaysia. The reported high prevalence of TB disease in the study adds an important and highly needed information to design comprehensive TB control programmes in prisons.
Collapse
Affiliation(s)
- Haider Al-Darraji
- The Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia and Centre for International Health, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Philip Hill
- The Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia and Centre for International Health, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Katrina Sharples
- The Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia and Centre for International Health, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Frederick L Altice
- The Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia and Centre for International Health, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Adeeba Kamarulzaman
- Department of Medicine, Division of Infectious Diseases, University of Malaya, Kuala Lumpur, Malaysia and The Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
| |
Collapse
|
8
|
Lindsay B, Nyirongo N, Mwango L, Toeque MG, Masumba C, Litongola JP, Sikanyika J, Kabombo H, Moyo M, Siachibila S, Mudenda J, Tembo K, Olowski P, Olufunso A, Muchinda E, Musonda B, Okuku J, Mwila A, Moonga CN, Herce ME, Claassen CW. Initial implementation of HIV pre-exposure prophylaxis for people who are incarcerated in Zambia: a cross-sectional observational study. Lancet HIV 2023; 10:e24-e32. [PMID: 36243018 DOI: 10.1016/s2352-3018(22)00220-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/22/2022] [Accepted: 07/25/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND There are over 23 000 incarcerated people in Zambia, a population which has higher HIV prevalence than the general population yet has no access to HIV prevention. To evaluate the feasibility of HIV pre-exposure prophylaxis (PrEP) implementation in Zambian criminal justice facilities, we offered PrEP services to incarcerated people and aimed to describe early implementation outcomes. METHODS In this cross-sectional observational study, we implemented a PrEP programme between Oct 1, 2020, and March 31, 2021, supporting 16 criminal justice facilities in four Zambian provinces. Before implementation, we held stakeholder engagement meetings with Zambia Correctional Service officials to discuss PrEP benefits, and trained Zambia Correctional Service health-care workers in PrEP management using the national PrEP training package. People who were incarcerated and screened positive for substantial HIV risk by use of a standardised HIV risk assessment tool were offered voluntary HIV testing and counselling. Those who tested positive were linked to antiretroviral therapy, and those who tested negative and met national HIV prevention eligibility criteria were offered PrEP. We assessed PrEP uptake and used descriptive statistics to characterise programme beneficiaries and the cascade of PrEP services. FINDINGS During the study period, we reached 12 367 people older than 15 years with HIV risk assessment and counselling, including 11 794 (95·4%) men and 573 (4·6%) women. Of these, 2610 people received HIV testing, with 357 (13·7%) testing HIV positive; positivity was significantly higher in women (20·6%) than men (13·2%, p=0·011). 1276 people were identified as HIV negative and PrEP eligible. Of these, 1190 (93·3%) initiated PrEP. The age group with the highest proportion reached and initiated on PrEP was those aged 25-29 years, representing 19·2% (2377 of 12 367) of all people reached and 24·1% (287 of 1190) of those who initiated PrEP. INTERPRETATION Delivery of PrEP to people who are incarcerated is feasible with adequate resourcing and support to the criminal justice health system, and can result in high uptake among eligible individuals. Further assessment is needed of PrEP persistence and adherence, and the perceptions of people who are incarcerated regarding their HIV risk and preferences for combination HIV prevention services. FUNDING US President's Emergency Plan for AIDS Relief through the US Centers for Disease Control and Prevention.
Collapse
Affiliation(s)
- Brianna Lindsay
- Maryland Global Initiatives Corporation Zambia, Lusaka, Zambia; Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Nasho Nyirongo
- Maryland Global Initiatives Corporation Zambia, Lusaka, Zambia
| | | | - Mona Gekanju Toeque
- Maryland Global Initiatives Corporation Zambia, Lusaka, Zambia; Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | | | | | | | | | | | | | - Kalima Tembo
- Maryland Global Initiatives Corporation Zambia, Lusaka, Zambia
| | - Pawel Olowski
- Maryland Global Initiatives Corporation Zambia, Lusaka, Zambia
| | | | | | - Bupe Musonda
- Department of Public Health, Ministry of Health, Lusaka, Zambia
| | - Jackson Okuku
- US Centers for Disease Control and Prevention, Lusaka, Zambia
| | - Annie Mwila
- US Centers for Disease Control and Prevention, Lusaka, Zambia
| | - Clement N Moonga
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Michael E Herce
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia; Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA
| | - Cassidy W Claassen
- Maryland Global Initiatives Corporation Zambia, Lusaka, Zambia; Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA
| |
Collapse
|
9
|
Lindsay BR, Mwango L, Toeque M, Malupande SL, Nkhuwa E, Moonga CN, Chilambe A, Sakala H, Kafunda I, Olowski P, Olufunso A, Okuku J, Kancheya N, Mumba D, Hachaambwa L, Sheneberger R, Blanco N, Lavoie M, Claassen CW. Peer community health workers improve HIV testing and ART linkage among key populations in Zambia: retrospective observational results from the Z-CHECK project, 2019-2020. J Int AIDS Soc 2022; 25:e26030. [PMID: 36317821 PMCID: PMC9624072 DOI: 10.1002/jia2.26030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 10/12/2022] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Zambia has made tremendous progress towards HIV epidemic control; however, gaps remain among key populations (KPs), such as female sex workers (FSWs), men who have sex with men (MSM), people who inject drugs (PWID) and people in prisons and enclosed settings due to cultural, social and legal barriers. The University of Maryland, Baltimore Zambia Community HIV Epidemic Control for Key Populations (Z-CHECK) project aimed to improve HIV case-finding, linkage and treatment adherence at the community level for KPs in Zambia. We describe Z-CHECK strategies and examine HIV positivity yield and antiretroviral therapy (ART) linkage among KPs to inform ongoing programme improvement. METHODS Z-CHECK recruited, trained and deployed peer community health workers (CHWs) for KP groups, with ongoing mentorship in community engagement. CHWs offered HIV testing in safe spaces and escorted newly HIV-diagnosed clients for same-day ART initiation. Z-CHECK also reached out to KP community leaders and gatekeepers for KP mobilization and trained healthcare workers (HCWs) on KP services and sensitivity. We conducted a retrospective observational review of routinely collected aggregate data for KPs aged ≥15 years at high risk for HIV transmission across five districts in Zambia from January 2019 to December 2020. RESULTS Z-CHECK provided HIV testing for 9211 KPs, of whom 2227 were HIV positive (positivity yield, 24%). Among these, 1901 (85%) were linked to ART; linkage for MSM, FSW, PWID and people in prisons and enclosed settings was 95%, 89%, 86% and 65%, respectively. Programme strategies that contributed to high positivity yield and linkage included the use of peer KP CHWs, social network testing strategies and opportunities for same-day ART initiation. Challenges to programme implementation included stigma and discrimination among HCWs, as well as KP CHW attrition, which may be explained by high mobility. CONCLUSIONS Peer CHWs were highly effective at reaching KP communities, identifying persons living with HIV and linking them to care. Engaging KP community gatekeepers resulted in high diffusion of health messages and increased access to health resources. The mobility of CHWs and HCWs is a challenge for programme implementation. Innovative interventions are needed to support PWID and people in prisons and enclosed settings.
Collapse
Affiliation(s)
- Brianna R. Lindsay
- Center for International Health Education and BiosecurityMGIC‐an affiliate of the University of Maryland BaltimoreLusakaZambia,Center for International HealthEducation, and BiosecurityUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | | | - Mona‐Gekanju Toeque
- Center for International HealthEducation, and BiosecurityUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | | | | | | | | | - Henry Sakala
- Center for International Health Education and BiosecurityMGIC‐an affiliate of the University of Maryland BaltimoreLusakaZambia
| | - Ina Kafunda
- Center for International Health Education and BiosecurityMGIC‐an affiliate of the University of Maryland BaltimoreLusakaZambia
| | - Pawel Olowski
- Center for International Health Education and BiosecurityMGIC‐an affiliate of the University of Maryland BaltimoreLusakaZambia
| | - Adebayo Olufunso
- Center for International Health Education and BiosecurityMGIC‐an affiliate of the University of Maryland BaltimoreLusakaZambia
| | - Jackson Okuku
- U.S. Centers for Disease Control and Prevention ZambiaLusakaZambia
| | - Nzali Kancheya
- U.S. Centers for Disease Control and Prevention ZambiaLusakaZambia
| | | | - Lottie Hachaambwa
- Center for International HealthEducation, and BiosecurityUniversity of Maryland School of MedicineBaltimoreMarylandUSA,Ciheb ZambiaLusakaZambia
| | - Robb Sheneberger
- Center for International Health Education and BiosecurityMGIC‐an affiliate of the University of Maryland BaltimoreLusakaZambia,Center for International HealthEducation, and BiosecurityUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Natalia Blanco
- Center for International HealthEducation, and BiosecurityUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Marie‐Claude Lavoie
- Center for International HealthEducation, and BiosecurityUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Cassidy W. Claassen
- Center for International Health Education and BiosecurityMGIC‐an affiliate of the University of Maryland BaltimoreLusakaZambia,Center for International HealthEducation, and BiosecurityUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| |
Collapse
|
10
|
Moreira TR, Passos IBJ, Bueno JVL, Maffacciolli R, Colodette RM, Miguel PS. Prevalence of multidrug-resistant tuberculosis in prisons: Systematic review and meta-analysis. Indian J Med Microbiol 2022; 40:193-199. [PMID: 35120789 DOI: 10.1016/j.ijmmb.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 11/08/2021] [Accepted: 01/15/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND In the context of prisons, multidrug-resistant tuberculosis (MDR-TB) is a major problem. In this article, we estimate the prevalence of MDR-TB among the population deprived of freedom from countries in South America, Europe, Asia and Africa. METHODS The articles were retrieved through systematic search at four databases (EMBASE, CINAHL, LILACS and MEDILINE). The meta-analysis was developed by the random effect model, using the Mantel-Haenszel method, with presentation of the aggregated results through the forest plot. The degree of heterogeneity between the studies was verified using Cochran's Q test and I2. RESULTS Of the 102 articles analyzed, 21 were included in this systematic review. The analysis showed heterogeneity indicated by the Q test (P < 0.001) and I2 statistics (I2 = 50.52%). The funnel graph and Egger test (P < 0.830) showed symmetry between investigations. The grouped prevalence of MDR-TB was 0.48% (95% CI: 0.02 to 1.32), advancing to 1.15 (95% CI: 0.15 to 2.73) when culture and sensitivity test were considered by the authors. No specific characteristics were significantly associated with differences in prevalence rates in the population deprived of freedom. CONCLUSION The study reaffirms the magnitude of MDR-TB in the population deprived of freedom in the world context. Political and technical-scientific efforts should be mobilized to mitigate TB and MDR-TB in prisons and for successful national and international disease control programs.
Collapse
Affiliation(s)
- Tiago Ricardo Moreira
- Doutor e Saúde Pública. Departamento de Medicina e Enfermagem, Universidade Federal de Viçosa, Viçosa-MG, Brazil.
| | | | - João Vitor L Bueno
- Graduado Em Medicina. Departamento de Medicina e Enfermagem, Universidade Federal de Viçosa, Viçosa-MG, Brazil.
| | - Rosana Maffacciolli
- Doutora Em Enfermagem, Escola de Enfermagem, Universidade Federal Do Rio Grande Do Sul, Porto Alegre-RS, Brazil.
| | - Renata Maria Colodette
- Mestre em Ciências da Saúde. Escola Nacional de Saúde Pública Sérgio Arouca. Fundação Oswaldo Cruz, Rio de Janeiro-RJ, Brazil.
| | | |
Collapse
|
11
|
Murray EJ, Dodd PJ, Marais B, Ayles H, Shanaube K, Schaap A, White RG, Bond V. Sociological variety and the transmission efficiency of Mycobacterium tuberculosis: a secondary analysis of qualitative and quantitative data from 15 communities in Zambia. BMJ Open 2021; 11:e047136. [PMID: 34907038 PMCID: PMC8671921 DOI: 10.1136/bmjopen-2020-047136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Selected Zambian communities formed part of a cluster randomised trial: the Zambia and South Africa TB and AIDS Reduction study (ZAMSTAR). There was wide variability in the prevalence of Mycobacterium tuberculosis infection and tuberculosis (TB) disease across these communities. We sought to clarify whether specific communities could have been more/less vulnerable to M. tuberculosis transmission as a result of sociological variety relevant to transmission efficiency. DESIGN We conducted a mixed methods secondary analysis using existing data sets. First, we analysed qualitative data to categorise and synthesise patterns of socio-spatial engagement across communities. Second, we compared emergent sociological variables with a measure of transmission efficiency: the ratio of the annual risk of infection to TB prevalence. SETTING ZAMSTAR communities in urban and peri-urban Zambia, spanning five provinces. PARTICIPANTS Fifteen communities, each served by a health facility offering TB treatment to a population of at least 25 000. TB notification rates were at least 400 per 100 000 per annum and HIV seroprevalence was estimated to be high. RESULTS Crowding, movement, livelihoods and participation in recreational activity differed across communities. Based on 12 socio-spatial indicators, communities were qualitatively classified as more/less spatially crowded and as more/less socially 'open' to contact with others, with implications for the presumptive risk of M. tuberculosis transmission. For example, watching video shows in poorly ventilated structures posed a presumptive risk in more socially open communities, while outdoor farming and/or fishing were particularly widespread in communities with lower transmission measures. CONCLUSIONS A dual dynamic of 'social permeability' and crowding appeared relevant to disparities in M. tuberculosis transmission efficiency. To reduce transmission, certain socio-spatial aspects could be adjusted (eg, increasing ventilation on transport), while more structural aspects are less malleable (eg, reliance on public transport). We recommend integrating community level typologies with genome sequencing techniques to further explore the significance of 'social permeability'. TRIAL REGISTRATION NUMBER ISRCTN36729271.
Collapse
Affiliation(s)
| | - Peter J Dodd
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Ben Marais
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, New South Wales, Australia
| | - Helen Ayles
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Zambart, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Kwame Shanaube
- Zambart, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Albertus Schaap
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Richard G White
- TB Modelling Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Virginia Bond
- Zambart, School of Public Health, University of Zambia, Lusaka, Zambia
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
12
|
Ostermann J, Yelverton V, Smith HJ, Nanyangwe M, Kashela L, Chisenga P, Mai V, Mwila C, Herce ME. Preferences for transitional HIV care among people living with HIV recently released from prison in Zambia: a discrete choice experiment. J Int AIDS Soc 2021; 24:e25805. [PMID: 34648690 PMCID: PMC8516367 DOI: 10.1002/jia2.25805] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 07/30/2021] [Indexed: 02/06/2023] Open
Abstract
Introduction No studies from sub‐Saharan Africa have attempted to assess HIV service delivery preferences among incarcerated people living with HIV as they transition from prisons to the community (“releasees”). We conducted a discrete choice experiment (DCE) to characterize releasee preferences for transitional HIV care services in Zambia to inform the development of a differentiated service delivery model to promote HIV care continuity for releasees. Methods Between January and October 2019, we enrolled a consecutive sample of 101 releasees from a larger cohort prospectively following 296 releasees from five prisons in Zambia. We administered a DCE eliciting preferences for 12 systematically designed choice scenarios, each presenting three hypothetical transitional care options. Options combined six attributes: (1) clinic type for post‐release HIV care; (2) client focus of healthcare workers; (3) transitional care model type; (4) characteristics of transitional care provider; (5) type of transitional care support; and (6) HIV status disclosure support. We analysed DCE choice data using a mixed logit model, with coefficients describing participants’ average (“mean”) preferences for each option compared to the standard of care and their distributions describing preference variation across participants. Results Most DCE participants were male (n = 84, 83.2%) and had completed primary school (n = 54, 53.5%), with 29 (28.7%) unemployed at follow‐up. Participants had spent an average of 8.2 months in the community prior to the DCE, with 18 (17.8%) reporting an intervening episode of re‐incarceration. While we observed significant preference variation across participants (p < 0.001 for most characteristics), releasees were generally averse to clinics run by community‐based organizations versus government antiretroviral therapy clinics providing post‐release HIV care (mean preference = –0.78, p < 0.001). On average, releasees most preferred livelihood support (mean preference = 1.19, p < 0.001) and HIV care support (mean preference = 1.00, p < 0.001) delivered by support groups involving people living with HIV (mean preference = 1.24, p < 0.001). Conclusions We identified preferred characteristics of transitional HIV care that can form the basis for differentiated service delivery models for prison releasees. Such models should offer client‐centred care in trusted clinics, provide individualized HIV care support delivered by support groups and/or peer navigators, and strengthen linkages to programs providing livelihood support.
Collapse
Affiliation(s)
- Jan Ostermann
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.,South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, South Carolina, USA.,Center for Health Policy & Inequalities Research, Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Valerie Yelverton
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Helene J Smith
- Implementation Science Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.,School of Public Health & Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Mirriam Nanyangwe
- Implementation Science Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Lillian Kashela
- Implementation Science Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Peter Chisenga
- Implementation Science Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Vivien Mai
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Chilambwe Mwila
- Implementation Science Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Michael E Herce
- Implementation Science Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.,Institute for Global Health & Infectious Diseases, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| |
Collapse
|
13
|
Saita NM, Andrade RLDP, Bossonario PA, Bonfim RO, Hino P, Monroe AA. Factors associated with unfavorable outcome of tuberculosis treatment in people deprived of liberty: a systematic review. Rev Esc Enferm USP 2021; 55:e20200583. [PMID: 34605533 DOI: 10.1590/1980-220x-reeusp-2020-0583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 07/06/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to analyze factors associated with unfavorable outcome of tuberculosis treatment in people deprived of liberty. METHOD systematic review, carried out in March 2021 in seven databases, with no delimitation of period of publication. The selection process of publications and data extraction was carried out by two independent reviewers. RESULTS a total of 1,448 publications was identified and nine were included in the study. Unfavorable outcome was higher among those who were men; had low level of education; were living in a rural area before detention; had longer prison time; received occasional visits; had been transferred between prisons; with no sputum smear microscopy or with a positive result at the diagnosis; with no follow-up sputum smear microscopy, previous history of tuberculosis; having both clinical forms of the disease, HIV/AIDS; alcoholics; smokers; low body weight; and self-administered treatment. Treatment default was associated with young people and death with older people. CONCLUSION prison health managers and professionals are expected to establish mechanisms of surveillance and health actions innovation aimed at the population deprived of liberty, making efforts to reduce the unfavorable outcomes of tuberculosis treatment.
Collapse
Affiliation(s)
- Nanci Michele Saita
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Departamento Materno Infantil e Saúde Pública, Ribeirão Preto, SP, Brazil
| | - Rubia Laine de Paula Andrade
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Departamento Materno Infantil e Saúde Pública, Ribeirão Preto, SP, Brazil
| | - Pedro Augusto Bossonario
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Departamento Materno Infantil e Saúde Pública, Ribeirão Preto, SP, Brazil
| | - Rafaele Oliveira Bonfim
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Departamento Materno Infantil e Saúde Pública, Ribeirão Preto, SP, Brazil
| | - Paula Hino
- Universidade Federal de São Paulo, Escola Paulista de Enfermagem, Departamento de Saúde Coletiva, São Paulo, SP, Brazil
| | - Aline Aparecida Monroe
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Departamento Materno Infantil e Saúde Pública, Ribeirão Preto, SP, Brazil
| |
Collapse
|
14
|
Kagujje M, Somwe P, Hatwiinda S, Bwalya J, Zgambo T, Thornicroft M, Bozzani FM, Moonga C, Muyoyeta M. Cross-sectional assessment of tuberculosis and HIV prevalence in 13 correctional facilities in Zambia. BMJ Open 2021; 11:e052221. [PMID: 34580101 PMCID: PMC8477336 DOI: 10.1136/bmjopen-2021-052221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To determine the prevalence of tuberculosis (TB) and HIV in 13 Zambian correctional facilities. METHODS Cross-sectional study. SETTING 13 correctional facilities in seven of the 10 provinces in Zambia. PARTICIPANTS All incarcerated individuals were eligible for TB and HIV screening and testing. Of the total study population of 9695 individuals, which represent 46.2% of total correctional population at the beginning of the study, 8267 and 8160 were screened for TB and HIV, respectively. INTERVENTIONS TB and HIV screening and testing was done between July 2018 and February 2019. PRIMARY OUTCOME MEASURES All forms of TB, bacteriologically confirmed TB, drug-resistant TB, HIV. RESULTS Prevalence of all forms of TB and bacteriologically confirmed TB was 1599 (1340-1894) per 100 000 population and 1056 (847-1301) per 100 000 population, respectively. Among those with bacteriologically confirmed TB, 4.6% (1.3%-11.4%) had drug-resistant TB.There was no statistically significant difference in the prevalence of all forms of TB, bacteriologically confirmed TB and drug resistant TB between adults and juveniles: (p=0.82), (p=0.23), (p=0.68) respectively. Of the bacteriologically confirmed TB cases, 28.7% were asymptomatic. The prevalence of HIV was 14.3% (13.6%-15.1%). The prevalence of HIV among females was 1.8 times the prevalence of HIV among males (p=0.01). CONCLUSION Compared with the study in 2011 which screened inmates representing 30% of the country's inmate population, then the prevalence of all forms of TB and HIV in correctional facilities has reduced by about 75% and 37.6%, respectively. However, compared with the general population, the prevalence of all forms of TB and HIV was 3.5 and 1.3 times higher, respectively. TB/HIV programmes in correctional facilities need further strengthening to include aspects of juvenile-specific TB programming and gender responsive HIV programming.
Collapse
Affiliation(s)
- Mary Kagujje
- Tuberculosis Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Paul Somwe
- Strategic Information Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Sisa Hatwiinda
- Tuberculosis Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Joel Bwalya
- Strategic Information Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Tamala Zgambo
- Health directorate, Zambia Correctional Service, Lusaka, Zambia
| | - Moomba Thornicroft
- Tuberculosis Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Fiammetta Maria Bozzani
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Clement Moonga
- Tuberculosis Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Monde Muyoyeta
- Tuberculosis Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| |
Collapse
|
15
|
Claassen CW, Mumba D, Njelesani M, Nyimbili D, Mwango LK, Mwitumwa M, Mubanga E, Mulenga LB, Chisenga T, Nichols BE, Hendrickson C, Chitembo L, Okuku J, O'Bra H. Initial implementation of PrEP in Zambia: health policy development and service delivery scale-up. BMJ Open 2021; 11:e047017. [PMID: 34244265 PMCID: PMC8273462 DOI: 10.1136/bmjopen-2020-047017] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Daily pre-exposure prophylaxis (PrEP) for HIV prevention is highly effective, but not yet widely deployed in sub-Saharan Africa. We describe how Zambia developed PrEP health policy and then successfully implemented national PrEP service delivery. POLICY DEVELOPMENT Zambia introduced PrEP as a key strategy for HIV prevention in 2016, and established a National PrEP Task Force to lead policy advocacy and development. The Task Force was composed of government representatives, regulatory agencies, international donors, implementation partners and civil society organisations. Following an implementation pilot, PrEP was rolled out nationally using risk-based criteria alongside a national HIV prevention campaign. NATIONAL SCALE-UP In the first year of implementation, ending September 2018, 3626 persons initiated PrEP. By September 2019, the number of people starting PrEP increased by over sixfold to 23 327 persons at 728 sites across all ten Zambian provinces. In the first 2 years, 26 953 clients initiated PrEP in Zambia, of whom 31% were from key and priority populations. Continuation remains low at 25% and 11% at 6 and 12 months, respectively. LESSONS LEARNT Risk-based criteria for PrEP ensures access to those most in need of HIV prevention. Healthcare worker training in PrEP service delivery and health needs of key and priority populations is crucial. PrEP expansion into primary healthcare clinics and community education is required to reach full potential. Additional work is needed to understand and address low PrEP continuation. Finally, a task force of key stakeholders can rapidly develop and implement health policy, which may serve as a model for countries seeking to implement PrEP.
Collapse
Affiliation(s)
- Cassidy W Claassen
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Adult Infectious Diseases Center, University Teaching Hospital, Lusaka, Zambia
- Division of Infectious Diseases, Department of Medicine, University of Zambia School of Medicine, Lusaka, Zambia
| | - Daliso Mumba
- National HIV/AIDS/STI/TB Council, Lusaka, Zambia
- Ministry of Health, Lusaka, Zambia
| | | | - Derrick Nyimbili
- Chemonics Global Health Supply Chain Program-Procurement and Supply Management, Lusaka, Zambia
| | | | - Mundia Mwitumwa
- Adult Infectious Diseases Center, University Teaching Hospital, Lusaka, Zambia
- Division of Infectious Diseases, Department of Medicine, University of Zambia School of Medicine, Lusaka, Zambia
| | | | - Lloyd B Mulenga
- Adult Infectious Diseases Center, University Teaching Hospital, Lusaka, Zambia
- Division of Infectious Diseases, Department of Medicine, University of Zambia School of Medicine, Lusaka, Zambia
- Ministry of Health, Lusaka, Zambia
| | | | - Brooke E Nichols
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Health Economics and Epidemiology Research Office, Wits University, Johannesburg-Braamfontein, South Africa
| | - Cheryl Hendrickson
- Health Economics and Epidemiology Research Office, Wits University, Johannesburg-Braamfontein, South Africa
| | | | - Jackson Okuku
- U.S. Centers for Disease Control and Prevention, Lusaka, Zambia
| | - Heidi O'Bra
- U.S. Agency for International Development, Lusaka, Zambia
| |
Collapse
|
16
|
Singh AA, Creswell J, Bhatia V. Framework for planning and monitoring active TB case finding interventions to meet the global targets in the COVID-19 era and beyond: South-East Asia perspective. PLOS GLOBAL PUBLIC HEALTH 2021; 1:e0000073. [PMID: 36962114 PMCID: PMC10021227 DOI: 10.1371/journal.pgph.0000073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There was an estimated 20-40% decline in tuberculosis (TB) case detection in the South-East Asia Region (SEA Region) during 2020 due to COVID-19 outbreak. This is over and above a million people with TB who were missed each year, prior to the pandemic. Active case finding (ACF) for TB has been gaining considerable interest and investment in the SEA Region and will be even more essential for finding people with TB missed due to the COVID-19 pandemic. Many countries in the Region have incorporated ACF activities into national strategic plans and are conducting large scale activities with varying results. ACF can reach people with TB earlier than routine approaches, can lead to increases in the numbers of people diagnosed, and is often needed for certain key populations who face stigma, social, and economic barriers. However, ACF is not a one size fits all approach, and has higher costs than routine care. So, planning interventions in consultation with relevant stakeholders including the affected communities is critical. Furthermore, continuous monitoring during the intervention and after completion is crucial as national TB programmes review progress and decide on the effective utilization of limited resources. Planning and monitoring become more relevant in the COVID-19 era because of constraints posed by resource diversion towards pandemic control. Here, we summarize different aspects of planning and monitoring of ACF approaches to inform national TB programmes and partners based on experiences in the SEA Region, as programmes look to reach those who are missed and catch-up on progress towards ending TB.
Collapse
Affiliation(s)
| | | | - Vineet Bhatia
- South-East Asia Regional Office, World Health Organization, New Delhi, India
| |
Collapse
|
17
|
Kasaro MP, Chilyabanyama ON, Shah NS, Muluka B, Kapata N, Krüüner A, Mwaba I, Kaunda K, Coggin WL, Wen XJ, Henostroza G, Reid S. Performance of Xpert ® MTB/RIF and Determine™ TB-LAM Ag in HIV-infected adults in peri-urban sites in Zambia. Public Health Action 2020; 10:134-140. [PMID: 33437678 DOI: 10.5588/pha.20.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 10/07/2020] [Indexed: 11/10/2022] Open
Abstract
Setting Peri-urban health facilities providing HIV and TB care in Zambia. Objective To evaluate 1) the impact of Xpert® MTB/RIF on time-to-diagnosis, treatment initiation, and outcomes among adult people living with HIV (PLHIV) on antiretroviral therapy (ART); and 2) the diagnostic performance of Xpert and Determine™ TB-LAM Ag assays. Design Quasi-experimental study design with the first cohort evaluated per standard-of-care (SOC; first sputum tested using smear microscopy) and the second cohort per an algorithm using Xpert as initial test (intervention phase; IP). Xpert testing was provided onsite in Chongwe District, while samples were transported 5-10 km in Kafue District. TB was confirmed using mycobacterial culture. Results Among 1350 PLHIV enrolled, 156 (15.4%) had confirmed TB. Time from TB evaluation to diagnosis (P = 0.018), and from evaluation to treatment initiation (P = 0.03) was significantly shorter for IP than for SOC. There was no difference in all-cause mortality (7.0% vs. 8.6%). TB-LAM Ag showed higher sensitivity with lower CD4 cell count: 81.8% at CD4 < 50 cells/mm3 vs. 31.7% overall. Conclusion Xpert improved time to diagnosis and treatment initiation, but there was no difference in all-cause mortality. High sensitivity of Determine TB-LAM Ag at lower CD4 count supports increased use in settings providing care to PLHIV, particularly with advanced HIV disease.
Collapse
Affiliation(s)
- M P Kasaro
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | - N S Shah
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - B Muluka
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - N Kapata
- Ministry of Health Zambia National TB Programme, Lusaka, Zambia
| | - A Krüüner
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - I Mwaba
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - K Kaunda
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - W L Coggin
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - X J Wen
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - G Henostroza
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.,University of Alabama at Birmingham, Birmingham, AL, USA
| | - S Reid
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.,University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
18
|
Kuupiel D, Vezi P, Bawontuo V, Osei E, Mashamba-Thompson TP. Tuberculosis active case-finding interventions and approaches for prisoners in sub-Saharan Africa: a systematic scoping review. BMC Infect Dis 2020; 20:570. [PMID: 32758165 PMCID: PMC7405346 DOI: 10.1186/s12879-020-05283-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 07/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In sub-Saharan Africa (SSA), most prisons are overcrowded with poor ventilation and put prisoners disproportionally at risk of exposure to Mycobacterium tuberculosis (TB) and developing TB infection but are mostly missed due to poor access to healthcare. Active case-finding (ACF) of TB in prisons facilitates early diagnosis and treatment of inmates and prevent the spread. We explored literature and described evidence on TB ACF interventions and approaches for prisoners in SSA prisons. METHODS Guided by the Arksey and O'Malley framework, we searched PubMed, Google Scholar, SCOPUS, Academic search complete, CINAHL and MEDLINE with full text via EBSCOhost for articles on prisoners and ACF from 2000 to May 2019 with no language restriction. Two investigators independently screened the articles at the abstract and full-text stages in parallel guided by the eligibility criteria as well as performed the methodological quality appraisal of the included studies using the latest mixed-method appraisal tool. We extracted all relevant data, organized them into themes and sub-themes, and presented a narrative summary of the results. RESULTS Of the 391 eligible articles found, 31 met the inclusion criteria. All 31 articles were published between 2006 and 2019 with the highest six (19.4%) in 2015. We found evidence in 11 countries. That is, Burkina Faso, Cameroon, Coˆte d'Ivoire, the Democratic Republic of the Congo, Ethiopia, Ghana, Malawi, Nigeria, South Africa, Uganda, and Zambia with most 41.9% (13/31) recorded in Ethiopia. These intervention studies were conducted in 134 prisons between 2001 and 2018 using either a single or combination of mass, facility-led, entry, peer educators for routine screening, and exit ACF approaches. The majority (74%) of the studies utilized only a mass screening approach. The most (68%) reported study outcome was smear-positive TB cases only (68%). We found no evidence in 16 SSA countries although they are classified among the three high-burden country lists for TB TB/HIV and Multidrug resistant-TB group. CONCLUSION Our review highlights a dearth of evidence on TB ACF interventions in most SSA countries prisons. Hence, there is the need to scaling-up ACF interventions in SSA prisons, particularly countries included in the three high-burden country lists for TB, TB/HIV, and MDR-TB.
Collapse
Affiliation(s)
- Desmond Kuupiel
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, 2nd Floor George Campbell Building, Durban, 4001 South Africa
- Research for Sustainable Development Consult, Sunyani, Ghana
| | - Portia Vezi
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, 2nd Floor George Campbell Building, Durban, 4001 South Africa
| | - Vitalis Bawontuo
- Research for Sustainable Development Consult, Sunyani, Ghana
- Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
| | - Ernest Osei
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, 2nd Floor George Campbell Building, Durban, 4001 South Africa
| | | |
Collapse
|
19
|
Herce ME, Hoffmann CJ, Fielding K, Topp SM, Hausler H, Chimoyi L, Smith HJ, Chetty-Makkan CM, Mukora R, Tlali M, Olivier AJ, Muyoyeta M, Reid SE, Charalambous S. Universal test-and-treat in Zambian and South African correctional facilities: a multisite prospective cohort study. Lancet HIV 2020; 7:e807-e816. [PMID: 32763152 DOI: 10.1016/s2352-3018(20)30188-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/29/2020] [Accepted: 05/05/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Despite the global scale-up of antiretroviral therapy (ART), incarcerated people have not benefited equally from test-and-treat recommendations for HIV. To improve access to ART for incarcerated people with HIV, we introduced a universal test-and-treat (UTT) intervention in correctional facilities in South Africa and Zambia, and aimed to assess UTT feasibility and clinical outcomes. METHODS Treatment as Prevention (TasP) was a multisite, mixed methods, implementation research study done at three correctional complexes in South Africa (Johnannesburg and Breede River) and Zambia (Lusaka). Here, we report the clinical outcomes for a prospective cohort of incarcerated individuals who were offered the TasP UTT intervention. Incarcerated individuals were eligible for inclusion if they were aged 18 years or older, with new or previously diagnosed HIV, not yet on ART, and were expected to remain incarcerated for 30 days or longer. To enable the implementation of UTT at the included correctional facilities, we first strengthened on-site HIV service delivery. All participants were offered same-day ART initiation, and had two study-specific follow-up visits scheduled to coincide with routine clinic visits at 6 and 12 months. The main outcomes were ART uptake, time from cohort enrolment to ART initiation, and retention in care and viral suppression at 6 and 12 months. We estimated the association between baseline demographic characteristics and time to ART initiation using Cox proportional hazard models, and, in a post-hoc analysis, we used logistic regression models to assess the association between demographic and clinical variables, including time to ART initiation, and the proportion of participants with a composite poor outcome (defined as viral load >50 copies per mL, or for participants with a missing viral load, lack of retention in care in the on-site ART programme) at 6 months. This study is registered at ClinicalTrials.gov, NCT02946762. FINDINGS Between June 23, 2016, and Dec 31, 2017, we identified 1562 incarcerated people with HIV, of whom 1389 (89%) were screened, 1021 (74%) met eligibility criteria, and 975 (95%) were enrolled and followed up to March 31, 2018. At the end of follow-up, 835 (86%) of 975 participants had started ART. Median time from enrolment to ART initiation was 0 days (IQR 0-8). Of 346 participants who remained incarcerated at 6 months, 327 (95%) were retained in care and 269 (78%) had a documented viral load, of whom 262 (97%) achieved viral suppression (<1000 copies per mL). The mortality rate among the 835 participants who had initiated ART was 1·9 per 100 person-years (95% CI 0·9-3·9). No statistically significant associations were identified between any baseline characteristics and time to ART initiation or composite poor outcome. INTERPRETATION UTT implementation is feasible in correctional settings, and can achieve levels of same-day ART uptake, retention in care, and viral suppression among incarcerated people with HIV that are comparable to those observed in community settings. FUNDING UK Department for International Development, Swedish International Development Cooperation Agency, Norwegian Agency for Development Cooperation.
Collapse
Affiliation(s)
- Michael E Herce
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia; Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC, USA.
| | - Christopher J Hoffmann
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA; The Aurum Institute, Johannesburg, South Africa
| | - Katherine Fielding
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Douglas, QLD, Australia
| | | | | | - Helene J Smith
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Candice M Chetty-Makkan
- The Aurum Institute, Johannesburg, South Africa; School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Mpho Tlali
- The Aurum Institute, Johannesburg, South Africa
| | | | - Monde Muyoyeta
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Stewart E Reid
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia; Department of Medicine, Division of Infectious Diseases, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Salome Charalambous
- The Aurum Institute, Johannesburg, South Africa; School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
20
|
Intensified tuberculosis and HIV surveillance in a prison in Northeast India: Implementation research. PLoS One 2019; 14:e0219988. [PMID: 31356606 PMCID: PMC6662996 DOI: 10.1371/journal.pone.0219988] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 07/04/2019] [Indexed: 02/04/2023] Open
Abstract
Structural and individual level factors in prisons create challenges towards detection and management of HIV/tuberculosis. WHO and India’s HIV/tuberculosis control programs recommend intensified case finding in prisons. Low HIV and tuberculosis detection rates suggest poor implementation of existing surveillance strategies within the prison healthcare system in Mizoram’s capital city of Aizawl. We explored the operational feasibility of implementing the intensified case finding strategy in Aizawl central prison. We implemented the intensified screening through entry screening of new inmates, mass screening of resident inmates and exit screening at release. We set up digital chest radiography, sputum smear microscopy and HIV testing facilities within the prison and referral to external facility for Cartridge Based Nucleic Acid Amplification Test (CBNAAT). We screened 738 inmates (Male: 626; Female: 112). Of 53% inmates having presumptive tuberculosis symptoms, 37% underwent sputum microscopy. We detected 14 new tuberculosis cases; overall tuberculosis positivity 1.9%. We tested 65% of 657 inmates for HIV, of which 41 new cases were detected; overall HIV positivity 16.5%. Three male inmates had HIV-tuberculosis co-infection. It is feasible to implement intensified case detection for tuberculosis/HIV in the prison with inter-departmental coordination, albeit with certain challenges.
Collapse
|
21
|
Moreira TR, Lemos AC, Colodette RM, Gomes AP, Batista RS. [Prevalence of tuberculosis in incarcerated populations: systematic review and meta-analysisPrevalencia de tuberculosis en la población privada de libertad: revisión sistemática y metanálisis]. Rev Panam Salud Publica 2019; 43:e16. [PMID: 31093240 PMCID: PMC6393725 DOI: 10.26633/rpsp.2019.16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 07/28/2018] [Indexed: 11/24/2022] Open
Abstract
Objetivo Estimar a prevalência de tuberculose entre a população privada de liberdade. Métodos Realizou-se uma revisão sistemática com metanálise. Foram selecionados estudos publicados de janeiro de 1997 a dezembro de 2016 nas bases de dados MEDLINE (via PubMed), SciELO e LILACS. O termos de busca foram (“tuberculosis”[MeSH] OR “tuberculosis”[TIAB]) AND (“prisons”[MeSH] OR “prisons”[TIAB]); ou (“tuberculose” [DeCS] OU “tuberculose” [palavras] E “prisões” [DeCS] OU “prisões” [palavras]). O desfecho primário foi a prevalência de tuberculose com intervalo de confiança de 95% (IC95%). Na metanálise, as variáveis associadas com as taxas de prevalência de tuberculose na população privada de liberdade na análise univariada (P ≤ 0,20) foram incluídas no modelo final multivariado. Resultados Com base nos 29 estudos incluídos na metanálise, 2 163 presos foram identificados com tuberculose. A prevalência combinada de tuberculose entre os prisioneiros foi de 2% (IC95%: 0,02 a 0,02). A prevalência de tuberculose entre prisioneiros em países com prevalência de 0 a 24 por 100 mil habitantes na população geral ficou abaixo de 1% (IC95% = 0,00 a 0,00). Nos países com prevalência de tuberculose de 25 a 99/100 mil, a estimativa foi de 3% (IC95% = 0,02 a 0,04); e nos países com prevalência ≥ 300/100 mil, a estimativa foi de 8% (IC95% = 0,05 a 0,11). Conclusão O presente estudo reafirma a alta magnitude da tuberculose entre a população privada de liberdade no contexto mundial. Os resultados mostram ainda uma ligação entre a prevalência de tuberculose na população geral e a prevalência da doença dentro dos presídios.
Collapse
Affiliation(s)
- Tiago Ricardo Moreira
- Universidade Federal de Viçosa (UFV), Programa de Pós-Graduação em Ciências da Saúde, Departamento de Medicina e Enfermagem, Viçosa (MG), Brasil
| | | | - Renata Maria Colodette
- Universidade Federal de Viçosa (UFV), Programa de Pós-Graduação em Ciências da Saúde, Departamento de Medicina e Enfermagem, Viçosa (MG), Brasil
| | - Andréia Patrícia Gomes
- Fundação Oswaldo Cruz (FIOCRUZ), Escola Nacional de Saúde Pública Sérgio Arouca, Programa de Pós-graduação em Bioética, Ética Aplicada e Saúde Coletiva, Rio de Janeiro (RJ), Brasil
| | - Rodrigo Siqueira Batista
- Universidade Federal do Rio de Janeiro (UFRJ), Programa de Pós-graduação em Bioética, Ética Aplicada e Saúde Coletiva, Rio de Janeiro (RJ), Brasil
| |
Collapse
|
22
|
Elduma AH, Mansournia MA, Foroushani AR, Ali HMH, Elegail AMA, Elsony A, Holakouie-Naieni K. Assessment of the risk factors associated with multidrug-resistant tuberculosis in Sudan: a case-control study. Epidemiol Health 2019; 41:e2019014. [PMID: 31010280 PMCID: PMC6545493 DOI: 10.4178/epih.e2019014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 04/20/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES The emergence of multidrug-resistant tuberculosis (MDR-TB) is a major challenge for the global control of tuberculosis (TB). The aim of this study was to determine the risk factors associated with MDR-TB in Sudan. METHODS This case-control study was conducted from May 2017 to February 2019. Patients newly diagnosed with MDR-TB were selected as cases, and controls were selected from TB patients who responded to first-line anti-TB drugs. A questionnaire was designed and used to collect data from study participants. Logistic regression was used to evaluate associations between risk factors and MDR-TB infection. The best multivariate model was selected based on the likelihood ratio test. RESULTS A total of 430 cases and 860 controls were selected for this study. A history of previous TB treatment (adjusted odds ratio [aOR], 54.85; 95% confidence interval [CI], 30.48 to 98.69) was strongly associated with MDR-TB infection. We identified interruption of TB treatment (aOR, 7.62; 95% CI, 3.16 to 18.34), contact with MDR-TB patients (aOR, 5.40; 95% CI, 2.69 to 10.74), lower body weight (aOR, 0.89; 95% CI, 0.87 to 0.91), and water pipe smoking (aOR, 3.23; 95% CI, 1.73 to 6.04) as factors associated with MDR-TB infection. CONCLUSIONS Previous TB treatment and interruption of TB treatment were found to be the main predictors of MDR-TB. Additionally, this study found that contact with MDR-TB patients and water pipe smoking were associated with MDR-TB infection in Sudan. More efforts are required to decrease the rate of treatment interruption, to strengthen patients’ adherence to treatment, and to reduce contact with MDR-TB patients.
Collapse
Affiliation(s)
- Adel Hussein Elduma
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences-International Campus, Tehran, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Rahimi Foroushani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamdan Mustafa Hamdan Ali
- Multidrug-Resistant Tuberculosis Unit, Communicable and Non-Communicable Diseases Control Directorate, Ministry of Health, Khartoum, Sudan
| | - Asrar M A/Salam Elegail
- National Tuberculosis Reference Laboratory, National Public Health Laboratory, Ministry of Health, Khartoum, Sudan
| | - Asma Elsony
- The Epidemiological Laboratory (Epi-Lab), Khartoum, Sudan
| | - Kourosh Holakouie-Naieni
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
23
|
Topp SM, Sharma A, Chileshe C, Magwende G, Henostroza G, Moonga CN. The health system accountability impact of prison health committees in Zambia. Int J Equity Health 2018; 17:74. [PMID: 30244684 PMCID: PMC6151934 DOI: 10.1186/s12939-018-0783-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 05/23/2018] [Indexed: 11/21/2022] Open
Abstract
Background From 2013, the Zambian Corrections Service (ZCS) worked with partners to strengthen prison health systems and services. One component of that work led to the establishment of facility-based Prison Health Committees (PrHCs) comprising of both inmates and officers. We present findings from a nested evaluation of the impact of eight PrHCs 18 months after programme initiation. Methods In-depth-interviews were conducted with 11 government ministry and Zambia Corrections Service officials and 6 facility managers. Sixteen focus group discussions were convened separately with PrHC members (21 females and 51 males) and non-members (23 females and 46 males) in 8 facilities. Memos were generated from participant observation in workshops and meetings preceding and after implementation. We sought evidence of PrHC impact, refined with reference to Joshi’s three domains of impact for social accountability interventions – state (represented by facility-based prison officials), society (represented here by inmates), and state-society relations (represented by inmate-prison official relations). Further analysis considered how project outcomes influenced structural dimensions of power, ability and justice relating to accountability. Results Data pointed to a compelling series of short- and mid-term outcomes, with positive impact on access to, and provision of, health services across most facilities. Inmates (members and non-members) reported being empowered via a combination of improved health literacy and committee members’ newly-given authority to seek official redress for complaints and concerns. Inmates and officers described committees as improving inmate-officer relations by providing a forum for information exchange and shared decision making. Contributing factors included more consistent inmate-officer communications through committee meetings, which in turn enhanced trust and co-production of solutions to health problems. Nonetheless, long-term sustainability of accountability impacts may be undermined by permanently skewed power relations, high rates of inmate (and thus committee member) turnover, variable commitment from some officers in-charge, and the anticipated need for more oversight and resources to maintain members’ skills and morale. Conclusion Our study shows that PrHCs do have potential to facilitate improved social accountability in both state and societal domains and at their intersection, for an extremely vulnerable population. However, sustained and meaningful change will depend on a longer-term strategy that integrates structural reform and is delivered through meaningful cross-sectoral partnership.
Collapse
Affiliation(s)
- Stephanie M Topp
- Centre for Infectious Disease Research in Zambia, PO Box 30346, Lusaka, Zambia. .,James Cook University, College of Public Health, Medical and Veterinary Sciences, Townsville, QLD, 4810, Australia.
| | - Anjali Sharma
- Centre for Infectious Disease Research in Zambia, PO Box 30346, Lusaka, Zambia.,Department of Global Health, University of Washington, Harris Hydraulics Laboratory, Box 357965, Seattle, WA, USA
| | | | | | - German Henostroza
- Centre for Infectious Disease Research in Zambia, PO Box 30346, Lusaka, Zambia.,University of Alabama at Birmingham, School of Medicine, Birmingham, AL, 35233, USA
| | - Clement N Moonga
- Centre for Infectious Disease Research in Zambia, PO Box 30346, Lusaka, Zambia
| |
Collapse
|
24
|
Ilievska-Poposka B, Zakoska M, Pilovska-Spasovska K, Simonovska L, Mitreski V. Tuberculosis in the Prisons in the Republic of Macedonia, 2008-2017. Open Access Maced J Med Sci 2018; 6:1300-1304. [PMID: 30087741 PMCID: PMC6062277 DOI: 10.3889/oamjms.2018.281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 06/18/2018] [Accepted: 06/20/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND: Tuberculosis (TB) is a major health problem in penitentiary institutions (prisons), and its prevalence was reported to be multiple times higher compared to that of the general population. Conditions such as overcrowding, malnutrition and limited access to medical care which often exist in prisons increase the risk of reactivation, transmission and poor prognosis of tuberculosis disease among inmates. AIM: The main objective of this study was to present the epidemiological situation of TB in the prisons from 2008 till 2017 in the Republic of Macedonia (RM). PATIENTS AND METHODS: There are 13 different penitentiary institutions in the RM with a total capacity to house 2600 prisons inmates. Management of TB in the prisons is part of the National TB program in RM, and the Institute for Lung Diseases and Tuberculosis in Skopje is in charge of it. All prisoners with TB in the RM are registered in the Central Register for TB within this Institute. We use the data from the Central Register, and with the method of description, we present the epidemiological data and clinical characteristics of the prisoners about TB in prisons in RM for 10 years’ period. RESULTS: From 2008 till 2017 there were 58 TB cases registered in prisons in total. The absolute number of TB cases in the prisons is not big, but the incidence rate is higher than 100/100,000 population, or several times bigger than in the general population (except in 2012 and 2016). In 2017 there were 10 TB cases registered in the prisons with an incidence rate of 323.9/100,000 population which is many times higher than in the general population in RM. The majority of inmates with TB were young men with risk factors for TB infection or TB disease before incarceration such as drug abuse, alcohol, smoking, but there was no association with HIV infection. The most of the patients diagnosed in prison were new cases (54), secondary TB due to reactivation from the latent TB infection or secondary TB due to the environment. From 2008-2017 there were 82.75% successfully treated TB cases in the prisons, and there were no cases of multi-drug resistant tuberculosis (MDR-TB). CONCLUSION: The results from our study showed that the TB control in the prisons in RM is good with satisfactory treatment outcome. On the other hand, the high incidence rate showed that the prisons in RM provide conditions for TB transmission and with other additional risk factors present place for high TB prevalence. The study findings can be used for planning more effective TB control interventions for the prison population in RM.
Collapse
Affiliation(s)
| | - Maja Zakoska
- Institute for Lung Diseases and Tuberculosis, Skopje, Republic of Macedonia
| | | | | | - Vladimir Mitreski
- Institute for Lung Diseases and Tuberculosis, Skopje, Republic of Macedonia
| |
Collapse
|
25
|
Ndlovu DT, Hoffmann CJ. Including the criminal justice-involved at the HIV policy, research and service delivery table. J Int AIDS Soc 2018; 21:e25145. [PMID: 29878719 PMCID: PMC5991587 DOI: 10.1002/jia2.25145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/23/2018] [Indexed: 11/09/2022] Open
|
26
|
Comparing Tuberculosis Incidence in a Prison with the Society, Tehran, Iran. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2018. [DOI: 10.5812/archcid.60247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
27
|
Topp SM, Sharma A, Moonga CN, Chileshe C, Magwende G, Henostroza G. Evaluation of a health system strengthening initiative in the Zambian prison system. BMJ Glob Health 2018; 3:e000614. [PMID: 29564162 PMCID: PMC5859816 DOI: 10.1136/bmjgh-2017-000614] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 12/14/2017] [Accepted: 01/03/2018] [Indexed: 12/25/2022] Open
Abstract
Introduction In 2013, the Zambian Correctional Service (ZCS) partnered with the Centre for Infectious Disease Research in Zambia on the Zambian Prisons Health System Strengthening project, seeking to tackle structural, organisational and cultural weaknesses within the prison health system. We present findings from a nested evaluation of the project impact on high, mid-level and facility-level health governance and health service arrangements in the Zambian Correctional Service. Methods Mixed methods were used, including document review, indepth interviews with ministry (11) and prison facility (6) officials, focus group discussions (12) with male and female inmates in six of the eleven intervention prisons, and participant observation during project workshops and meetings. Ethical clearance and verbal informed consent were obtained for all activities. Analysis incorporated deductive and iterative inductive coding. Results Outcomes: Improved knowledge of the prison health system strengthened political and bureaucratic will to materially address prison health needs. This found expression in a tripartite Memorandum of Understanding between the Ministry of Home Affairs, Ministry of Health (MOH) and Ministry of Community Development, and in the appointment of a permanent liaison between MOH and ZCS. Capacity-building workshops for ZCS Command resulted in strengthened health planning and management outcomes, including doubling ZCS health professional workforce (from 37 to78 between 2014 and 2016), new preservice basic health training for incoming ZCS officers and formation of facility-based prison health committees with a mandate for health promotion and protection. Mechanisms: continuous and facilitated communication among major stakeholders and the emergence of interorganisational trust were critical. Enabling contextual factors included a permissive political environment, a shift within ZCS from a ‘punitive’ to ‘correctional’ organisational culture, and prevailing political and public health concerns about the spread of HIV and tuberculosis. Conclusion While not a panacea, findings demonstrate that a ‘systems’ approach to seemingly intractable prison health system problems yielded a number of short-term tactical and long-term strategic improvements in the Zambian setting. Context-sensitive application of such an approach to other settings may yield positive outcomes.
Collapse
Affiliation(s)
- Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.,Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.,Nossal Institute for Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Anjali Sharma
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Clement N Moonga
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | | | - German Henostroza
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.,School of Medicine, University of Alabama, Tuscaloosa, Alabama, USA
| |
Collapse
|
28
|
Hatwiinda S, Topp SM, Siyambango M, Harris JB, Maggard KR, Chileshe C, Kapata N, Reid SE, Henostroza G. Poor continuity of care for TB diagnosis and treatment in Zambian Prisons: a situation analysis. Trop Med Int Health 2018; 23:243-250. [PMID: 29230918 DOI: 10.1111/tmi.13024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Prisons act as infectious disease reservoirs. We aimed to explore the challenges of TB control and continuity of care in prisons in Zambia. METHODS We evaluated treatment outcomes for a cohort of inmates diagnosed with TB during a TB REACH funded screening programme initiated by the Zambia Prisons Service and the Centre for Infectious Disease Research in Zambia. RESULTS Between October 2010 and September 2011, 6282 inmates from six prisons were screened for TB, of whom 374 (6.0%) were diagnosed. TB treatment was initiated in 345 of 374 (92%) inmates. Of those, 66% were cured or completed treatment, 5% died and 29% were lost to follow-up. Among those lost to follow-up, 11% were released into the community and 13% were transferred to other prisons. CONCLUSIONS Weak health systems within the Zambian prison service currently undermines continuity of care, despite intensive TB screening and case-finding interventions. To prevent TB transmission and the development of drug resistance, we need sufficient numbers of competent staff for health care, reliable health information systems including electronic record keeping for prison facilities, and standard operating procedures to guide surveillance, case-finding and timely treatment initiation and completion.
Collapse
Affiliation(s)
- S Hatwiinda
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - S M Topp
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.,College of Public Health, Medical & Veterinary Sciences, James Cook University, Townsville, Australia
| | - M Siyambango
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - J B Harris
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - K R Maggard
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - C Chileshe
- Zambia Ministry of Home Affairs, Lusaka, Zambia
| | - N Kapata
- Zambia Ministry of Health, National Tuberculosis Program, Lusaka, Zambia
| | - S E Reid
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.,University of Alabama at Birmingham, Birmingham, AL, USA
| | - G Henostroza
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.,University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
29
|
Prevalence and Associated Factors of Tuberculosis in Prisons Settings of East Gojjam Zone, Northwest Ethiopia. INTERNATIONAL JOURNAL OF BACTERIOLOGY 2017; 2017:3826980. [PMID: 29226216 PMCID: PMC5684609 DOI: 10.1155/2017/3826980] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 08/04/2017] [Accepted: 09/13/2017] [Indexed: 12/18/2022]
Abstract
Background Tuberculosis, mainly in prisoners, is a major public health problem in Ethiopia where there is no medical screening during prison admission. This creates scarcity of TB data in such settings. Objective To determine prevalence and associated factors of TB in prisons in East Gojjam Zone, Northwest Ethiopia. Methods A cross-sectional study was conducted from February to May 2016 among 265 prisoners in three prison sites. Sputum was processed using GeneXpert MTB/RIF. Data were analyzed using SPSS version 20.0. Multivariable logistic regression was used; p values = 0.05 were considered statistically significant. Results Of 265 prisoners, 9 (3.4%) were TB positive (males); 77.8%, 55.6%, and 55.6% of cases were rural dwellers, married, and farmers, respectively. Seven (2.6%) prisoners were HIV positive, and 3 (1.13%) had TB/HIV coinfection. One (0.4%) TB case was rifampicin resistant. Marriage (AOR = 1.5; 95% CI: 1.7, 13.03), HIV (AOR = 0.14; 95% CI: 0.001, 0.17), and sharing of rooms (AOR = 1.62; 95% CI: 2.6, 10.20) were predictors for TB. Conclusion Nine prisoners were TB positive. One case showed rifampicin resistance and three had TB/HIV coinfection. Marriage, HIV, and sharing of rooms were predictors for TB. Prevention/control and monitoring are mandatory in such settings.
Collapse
|
30
|
Prevalence of pulmonary tuberculosis among prison inmates: A cross-sectional survey at the Correctional and Detention Facility of Abidjan, Côte d'Ivoire. PLoS One 2017; 12:e0181995. [PMID: 28759620 PMCID: PMC5536365 DOI: 10.1371/journal.pone.0181995] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 07/10/2017] [Indexed: 01/20/2023] Open
Abstract
Background In Côte d’Ivoire, a TB prison program has been developed since 1999. This program includes offering TB screening to prisoners who show up with TB symptoms at the infirmary. Our objective was to estimate the prevalence of pulmonary TB among inmates at the Correctional and Detention Facility of Abidjan, the largest prison of Côte d’Ivoire, 16 years after this TB program was implemented. Methods Between March and September 2015, inmates, were screened for pulmonary TB using systematic direct smear microscopy, culture and chest X-ray. All participants were also proposed HIV testing. TB was defined as either confirmed (positive culture), probable (positive microscopy and/or chest X-ray findings suggestive of TB) or possible (signs or symptoms suggestive of TB, no X-Ray or microbiological evidence). Factors associated with confirmed tuberculosis were analysed using multivariable logistic regression. Results Among the 943 inmates screened, 88 (9.3%) met the TB case definition, including 19 (2.0%) with confirmed TB, 40 (4.2%) with probable TB and 29 (3.1%) with possible TB. Of the 19 isolated TB strains, 10 (53%) were TB drug resistant, including 7 (37%) with multi-resistance. Of the 10 patients with TB resistant strain, only one had a past history of TB treatment. HIV prevalence was 3.1% overall, and 9.6%among TB cases. Factors associated with confirmed TB were age ≥30 years (Odds Ratio 3.8; 95% CI 1.1–13.3), prolonged cough (Odds Ratio 3.6; 95% CI 1.3–9.5) and fever (Odds Ratio 2.7; 95% CI 1.0–7.5). Conclusion In the country largest prison, pulmonary TB is still 10 (confirmed) to 44 times (confirmed, probable or possible) as frequent as in the Côte d’Ivoire general population, despite a long-time running symptom-based program of TB detection. Decreasing TB prevalence and limiting the risk of MDR may require the implementation of annual in-cell TB screening campaigns that systematically target all prison inmates.
Collapse
|
31
|
Augusto Â, Augusto O, Taquimo A, Nhachigule C, Siyawadya N, Tembe N, Bhatt N, Mbofana F, Gudo ES. First description of HTLV-1/2 seroprevalence in HIV-infected inmates in Mozambique. J Med Virol 2017; 89:1498-1502. [PMID: 28240367 DOI: 10.1002/jmv.24801] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 01/24/2017] [Indexed: 11/10/2022]
Abstract
No study has yet been conducted to estimate the burden of co-infection of HIV and HTLV-1/2 in inmates in sub-Saharan Africa. To investigate prevalence of co-infection in inmates in Mozambique, a total of 2140 inmates were screened for HIV, of which 515 were HIV seropositive. All HIV seropositive inmates were further screened for HTLV infection, and eight (1.55%) were co-infected. Co-infection was higher in females (3.45% [2/58; CI: 0.42-11.91]) as compared to males (1.35% [6/445; CI: 0.55-3.06]). Early screening of HTLV in prisons is urgently needed in Mozambique in order to improve the care provided to incarcerated individuals, including initiation of ART.
Collapse
Affiliation(s)
- Ângelo Augusto
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Orvalho Augusto
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Atija Taquimo
- Departamento de Ciências Biológicas, Faculdade de Ciências, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Carina Nhachigule
- Departamento de Ciências Biológicas, Faculdade de Ciências, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Narcisa Siyawadya
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Nelson Tembe
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Nilesh Bhatt
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Francisco Mbofana
- Direcção Nacional de Saúde Pública, Ministério da Saúde, Maputo, Mozambique
| | - Eduardo Samo Gudo
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| |
Collapse
|
32
|
Mulder C, Mgode G, Reid SE. Tuberculosis diagnostic technology: an African solution … think rats. Afr J Lab Med 2017; 6:420. [PMID: 28879158 PMCID: PMC5516919 DOI: 10.4102/ajlm.v6i2.420] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 09/20/2016] [Indexed: 11/17/2022] Open
Affiliation(s)
- Christiaan Mulder
- Tuberculosis Department, Anti-Persoonsmijnen Ontmijnende Product Ontwikkeling (APOPO), Sokoine University of Agriculture, Morogoro, Tanzania.,Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands
| | - Georgies Mgode
- Tuberculosis Department, Anti-Persoonsmijnen Ontmijnende Product Ontwikkeling (APOPO), Sokoine University of Agriculture, Morogoro, Tanzania
| | - Stewart E Reid
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.,Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, United States
| |
Collapse
|
33
|
Multidrug resistant tuberculosis in prisons located in former Soviet countries: A systematic review. PLoS One 2017; 12:e0174373. [PMID: 28334036 PMCID: PMC5363920 DOI: 10.1371/journal.pone.0174373] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 03/08/2017] [Indexed: 12/16/2022] Open
Abstract
Background A systematic literature review was performed to investigate the occurrence of multidrug-resistant tuberculosis (MDR TB) in prisons located in countries formerly part of the Soviet Union. Methods A systematic search of published studies reporting MDR TB occurrence in prisons located in former Soviet countries was conducted by probing PubMed and Cumulative Index Nursing and Allied Health Literature for articles that met predetermined inclusion criteria. Results Seventeen studies were identified for systematic review. Studies were conducted in six different countries. Overall, prevalence of MDR TB among prisoners varied greatly between studies. Our findings suggest a high prevalence of MDR TB in prisons of Post-Soviet states with percentages as high as 16 times more than the worldwide prevalence estimated by the WHO in 2014. Conclusion All studies suggested a high prevalence of MDR TB in prison populations in Post-Soviet states.
Collapse
|
34
|
Prasad BM, Thapa B, Chadha SS, Das A, Babu ER, Mohanty S, Pandurangan S, Tonsing J. Status of Tuberculosis services in Indian Prisons. Int J Infect Dis 2017; 56:117-121. [PMID: 28179148 DOI: 10.1016/j.ijid.2017.01.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 01/25/2017] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Prisons are known to be a high risk environment for tuberculosis (TB) due to overcrowding, low levels of nutrition, poor infection control and lack of accessible healthcare services. India has nearly 1400 prisons housing 0.37 million inmates. However, information on, availability of diagnostic and treatment services for TB in the prison settings is limited. This study examined the availability of TB services in prisons of India. Simultaneously, prison inmates were screened for tuberculosis. METHOD The study was conducted in 157 prisons across 300 districts between July-December 2013. Information on services available and practices followed for screening, diagnosis and treatment of TB was collected. Additionally, the inmates and prison staff were sensitised on TB using interpersonal communication materials. The inmates were screened for cough ≥2 weeks as a symptom of TB. Those identified as presumptive TB patients (PTBP) were linked with free diagnostic and treatment services. RESULTS Diagnostic and treatment services for TB were available in 18% and 54% of the prisons respectively. Only half of the prisons screened inmates for TB on entry, while nearly 60% practised periodic screening of inmates. District level prisons (OR, 6.0; 95% CI, 1.6-22.1), prisons with more than 500 inmates (OR, 52; 95% CI, 1.4-19.2), and prisons practising periodic screening of inmates (OR, 2.7; 95% CI, 1.0-7.2) were more likely to diagnose TB cases. 19% of the inmates screened had symptoms of TB (cough ≥2 weeks) and 8% of the PTBP were diagnosed with TB on smear microscopy. CONCLUSION The TB screening, diagnostic and treatment services are sub-optimal in prisons in India and need to be strengthened urgently.
Collapse
Affiliation(s)
- Banuru Muralidhara Prasad
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India.
| | - Badri Thapa
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India
| | - Sarabjit Singh Chadha
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India
| | - Anand Das
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India
| | - Entoor Ramachandra Babu
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India
| | - Subrat Mohanty
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India
| | - Sripriya Pandurangan
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India
| | - Jamhoih Tonsing
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India
| |
Collapse
|
35
|
Maggard KR, Hatwiinda S, Harris JB, Phiri W, Krüüner A, Kaunda K, Topp SM, Kapata N, Ayles H, Chileshe C, Henostroza G, Reid SE. Screening for tuberculosis and testing for human immunodeficiency virus in Zambian prisons. Bull World Health Organ 2016; 93:93-101. [PMID: 25883402 PMCID: PMC4339958 DOI: 10.2471/blt.14.135285] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Revised: 11/11/2014] [Accepted: 11/13/2014] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To improve the Zambia Prisons Service's implementation of tuberculosis screening and human immunodeficiency virus (HIV) testing. METHODS For both tuberculosis and HIV, we implemented mass screening of inmates and community-based screening of those residing in encampments adjacent to prisons. We also established routine systems – with inmates as peer educators – for the screening of newly entered or symptomatic inmates. We improved infection control measures, increased diagnostic capacity and promoted awareness of tuberculosis in Zambia's prisons. FINDINGS In a period of 9 months, we screened 7638 individuals and diagnosed 409 new patients with tuberculosis. We tested 4879 individuals for HIV and diagnosed 564 cases of infection. An additional 625 individuals had previously been found to be HIV-positive. Including those already on tuberculosis treatment at the time of screening, the prevalence of tuberculosis recorded in the prisons and adjacent encampments – 6.4% (6428/100,000) – is 18 times the national prevalence estimate of 0.35%. Overall, 22.9% of the inmates and 13.8% of the encampment residents were HIV-positive. CONCLUSION Both tuberculosis and HIV infection are common within Zambian prisons. We enhanced tuberculosis screening and improved the detection of tuberculosis and HIV in this setting. Our observations should be useful in the development of prison-based programmes for tuberculosis and HIV elsewhere.
Collapse
Affiliation(s)
- Katie R Maggard
- Centre for Infectious Disease Research in Zambia, 5032 Great North Road, PO Box 34681, Lusaka, 10101, Zambia
| | - Sisa Hatwiinda
- Centre for Infectious Disease Research in Zambia, 5032 Great North Road, PO Box 34681, Lusaka, 10101, Zambia
| | - Jennifer B Harris
- University of Alabama at Birmingham, Birmingham, United States of America
| | - Winifreda Phiri
- Centre for Infectious Disease Research in Zambia, 5032 Great North Road, PO Box 34681, Lusaka, 10101, Zambia
| | - Annika Krüüner
- Centre for Infectious Disease Research in Zambia, 5032 Great North Road, PO Box 34681, Lusaka, 10101, Zambia
| | - Kaunda Kaunda
- Centre for Infectious Disease Research in Zambia, 5032 Great North Road, PO Box 34681, Lusaka, 10101, Zambia
| | - Stephanie M Topp
- University of Alabama at Birmingham, Birmingham, United States of America
| | - Nathan Kapata
- National Tuberculosis and Leprosy Control Programme, Ministry of Health, Lusaka, Zambia
| | - Helen Ayles
- Zambia AIDS Related Tuberculosis Project, Lusaka, Zambia
| | | | - German Henostroza
- University of Alabama at Birmingham, Birmingham, United States of America
| | - Stewart E Reid
- Centre for Infectious Disease Research in Zambia, 5032 Great North Road, PO Box 34681, Lusaka, 10101, Zambia
| |
Collapse
|
36
|
Edge CL, King EJ, Dolan K, McKee M. Prisoners co-infected with tuberculosis and HIV: a systematic review. J Int AIDS Soc 2016; 19:20960. [PMID: 27852420 PMCID: PMC5112354 DOI: 10.7448/ias.19.1.20960] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 10/01/2016] [Accepted: 10/24/2016] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Almost from the beginning of the HIV epidemic in 1981, an association with tuberculosis (TB) was recognized. This association between HIV and TB co-infection has been particularly evident amongst prisoners. However, despite this, few studies of TB in prisons have stratified results by HIV status. Given the high prevalence of HIV-positive persons and TB-infected persons in prisons and the documented risk of TB in those infected with HIV, it is of interest to determine how co-infection varies amongst prison populations worldwide. For this reason we have undertaken a systematic review of studies of co-infected prisoners to determine the incidence and/or prevalence of HIV/TB co-infection in prisons, as well as outcomes in this group, measured as treatment success or death. METHODS A literature search was undertaken using the online databases PubMed, Embase, IBSS, Scopus, Web of Science, Global Health and CINAHL Plus. No restrictions were set on language or publication date for article retrieval, with articles included if indexed up to 18 October 2015. A total of 1975 non-duplicate papers were identified. For treatment and outcome data all eligible papers were appraised for inclusion; for incidence/prevalence estimates papers published prior to 2000 were excluded from full text review. After full text appraisal, 46 papers were selected for inclusion in the review, 41 for incidence/prevalence estimates and nine for outcomes data, with four papers providing evidence for both outcomes and prevalence/incidence. RESULTS Very few studies estimated the incidence of TB in HIV positive prisoners, with most simply reporting prevalence of co-infection. Co-infection is rarely explicitly measured, with studies simply reporting HIV status in prisoners with TB, or a cross-sectional survey of TB prevalence amongst prisoners with HIV. Estimates of co-infection prevalence ranged from 2.4 to 73.1% and relative risks for one, given the other, ranged from 2.0 to 10.75, although some studies reported no significant association between HIV and TB. Few studies provided a comparison with the risk of co-infection in the general population. CONCLUSIONS Prisoners infected with HIV are at high risk of developing TB. However, the magnitude of risk varies between different prisons and countries. There is little evidence on treatment outcomes in co-infected prisoners, and the existing evidence is conflicting in regards to HIV status influence on prisoner treatment outcomes.PROSPERO Number: CRD42016034068.
Collapse
Affiliation(s)
- Chantal L Edge
- London School of Hygiene and Tropical Medicine, London, England;
| | - Emma J King
- Brighton and Hove City Council, Brighton and Hove, England
| | - Kate Dolan
- Program of International Research and Training, National Drug and Alcohol Research Centre, UNSW Medicine, University of New South Wales, Sydney, Australia
| | - Martin McKee
- ECOHOST, London School of Hygiene and Tropical Medicine, London, England
| |
Collapse
|
37
|
Topp SM, Moonga CN, Luo N, Kaingu M, Chileshe C, Magwende G, Heymann SJ, Henostroza G. Exploring the drivers of health and healthcare access in Zambian prisons: a health systems approach. Health Policy Plan 2016; 31:1250-61. [PMID: 27220354 PMCID: PMC5035781 DOI: 10.1093/heapol/czw059] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2016] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Prison populations in sub-Saharan Africa (SSA) experience a high burden of disease and poor access to health care. Although it is generally understood that environmental conditions are dire and contribute to disease spread, evidence of how environmental conditions interact with facility-level social and institutional factors is lacking. This study aimed to unpack the nature of interactions and their influence on health and healthcare access in the Zambian prison setting. METHODS We conducted in-depth interviews of a clustered random sample of 79 male prisoners across four prisons, as well as 32 prison officers, policy makers and health care workers. Largely inductive thematic analysis was guided by the concepts of dynamic interaction and emergent behaviour, drawn from the theory of complex adaptive systems. RESULTS A majority of inmates, as well as facility-based officers reported anxiety linked to overcrowding, sanitation, infectious disease transmission, nutrition and coercion. Due in part to differential wealth of inmates and their support networks on entering prison, and in part to the accumulation of authority and material wealth within prison, we found enormous inequity in the standard of living among prisoners at each site. In the context of such inequities, failure of the Zambian prison system to provide basic necessities (including adequate and appropriate forms of nutrition, or access to quality health care) contributed to high rates of inmate-led and officer-led coercion with direct implications for health and access to healthcare. CONCLUSIONS This systems-oriented analysis provides a more comprehensive picture of the way resource shortages and human interactions within Zambian prisons interact and affect inmate and officer health. While not a panacea, our findings highlight some strategic entry-points for important upstream and downstream reforms including urgent improvement in the availability of human resources for health; strengthening of facility-based health services systems and more comprehensive pre-service health education for prison officers.
Collapse
Affiliation(s)
- Stephanie M Topp
- Centre for Infectious Disease Research in Zambia, PO Box 30346, Lusaka, Zambia; James Cook University, School of Public Health Medical and Veterinary Sciences, Douglas, QLD, 4810, Australia,
| | - Clement N Moonga
- Centre for Infectious Disease Research in Zambia, PO Box 30346, Lusaka, Zambia
| | - Nkandu Luo
- C/-CAPAH, National Assembly Parliament Buildings, PO Box 31299
| | - Michael Kaingu
- C/-CAPAH, National Assembly Parliament Buildings, PO Box 31299
| | | | | | - S Jody Heymann
- Fielding of Public Health, University of Los Angeles, CA, 90095-1772, USA
| | - German Henostroza
- Centre for Infectious Disease Research in Zambia, University of Alabama at Birmingham, PO Box 30346, Lusaka, Zambia
| |
Collapse
|
38
|
Gebrecherkos T, Gelaw B, Tessema B. Smear positive pulmonary tuberculosis and HIV co-infection in prison settings of North Gondar Zone, Northwest Ethiopia. BMC Public Health 2016; 16:1091. [PMID: 27756279 PMCID: PMC5070002 DOI: 10.1186/s12889-016-3761-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 10/11/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In correctional settings tuberculosis is a public health concern. The incarcerated population is at greater risk for tuberculosis (TB) than the general population. The aim of this study was to determine the prevalence of smear positive pulmonary tuberculosis (PTB) and associated risk factors in prison settings. METHODS A cross-sectional study was conducted among prisoners of North Gondar zone where all inmates with a history of cough for ≥ 2 weeks were included. Socio-demographic characteristics and potential risk factors were assessed using a structured questionnaire. Spot-morning-spot sputum samples were collected, smears were prepared and stained with Auramine O stain and examined through light emitting diode- fluorescence microscope. All samples positive for acid-fast bacilli were further examined by GeneXpert MTB/RIF assay. Data was analyzed using SPSS version 20 and a P-value < 0.05 was taken as statistically significant. The multivariable logistic regression analysis was used to determine the association between risk factors and prison tuberculosis. RESULTS A total of 282 prison inmates suspected of PTB were enrolled in the study. The overall prevalence of smear positive PTB infection was 5.3 % (15/282), but none of the smear positive TB cases were resistant to rifampicin. The prevalence of HIV infection among TB suspected prisoners and smear positive PTB cases was 6 and 27 %, respectively. Moreover, smear positive PTB disease was significantly associated with smoking status, malnutrition, number of prison inmates per cell, poor cell ventilation, and a history of contact with TB patients. CONCLUSION The prevalence of smear positive pulmonary tuberculosis among north Gondar prison inmates was still high although lower than previous reports. There was a high prevalence of HIV among smear positive PTB cases. Reducing the burden of prison inmates in a particular cell, preventing malnutrition, establishing ventilation system can possibly minimize the transmission of tuberculosis among prisoners.
Collapse
Affiliation(s)
- Teklay Gebrecherkos
- Department of Medical Microbiology, School of Biomedical and Laboratory sciences, College of Medicine and Health Sciences (CMHS), University of Gondar (UOG), P.O. box 196, Gondar, Ethiopia
| | - Baye Gelaw
- Department of Medical Microbiology, School of Biomedical and Laboratory sciences, College of Medicine and Health Sciences (CMHS), University of Gondar (UOG), P.O. box 196, Gondar, Ethiopia.
| | - Belay Tessema
- Department of Medical Microbiology, School of Biomedical and Laboratory sciences, College of Medicine and Health Sciences (CMHS), University of Gondar (UOG), P.O. box 196, Gondar, Ethiopia
| |
Collapse
|
39
|
Topp SM, Moonga CN, Mudenda C, Luo N, Kaingu M, Chileshe C, Magwende G, Heymann JS, Henostroza G. Health and healthcare access among Zambia's female prisoners: a health systems analysis. Int J Equity Health 2016; 15:157. [PMID: 27671534 PMCID: PMC5037633 DOI: 10.1186/s12939-016-0449-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 09/16/2016] [Indexed: 01/14/2023] Open
Abstract
Background Research exploring the drivers of health outcomes of women who are in prison in low- and middle-income settings is largely absent. This study aimed to identify and examine the interaction between structural, organisational and relational factors influencing Zambian women prisoners’ health and healthcare access. Methods We conducted in-depth interviews of 23 female prisoners across four prisons, as well as 21 prison officers and health care workers. The prisoners were selected in a multi-stage sampling design with a purposive selection of prisons followed by a random sampling of cells and of female inmates within cells. Largely inductive thematic analysis was guided by the concepts of dynamic interaction and emergent behaviour, drawn from the theory of complex adaptive systems. Results We identified compounding and generally negative effects on health and access to healthcare from three factors: i) systemic health resource shortfalls, ii) an implicit prioritization of male prisoners’ health needs, and iii) chronic and unchecked patterns of both officer- and inmate-led victimisation. Specifically, women’s access to health services was shaped by the interactions between lack of in-house clinics, privileged male prisoner access to limited transport options, and weak responsiveness by female officers to prisoner requests for healthcare. Further intensifying these interactions were prisoners’ differential wealth and access to family support, and appointments of senior ‘special stage’ prisoners which enabled chronic victimisation of less wealthy or less powerful individuals. Conclusions This systems-oriented analysis revealed how Zambian women’s prisoners’ health and access to healthcare is influenced by weak resourcing for prisoner health, administrative biases, and a prevailing organisational and inmate culture. Findings highlight the urgent need for investment in structural improvements in health service availability but also interventions to reform the organisational culture which shapes officers’ understanding and responsiveness to women prisoners’ health needs.
Collapse
Affiliation(s)
- Stephanie M Topp
- College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, 4812, Australia. .,Centre for Infectious Disease Research in Zambia, PO Box 30346, Lusaka, Zambia.
| | - Clement N Moonga
- College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, 4812, Australia
| | - Constance Mudenda
- College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, 4812, Australia
| | - Nkandu Luo
- c/- CAPAH, National Assembly Parliament Buildings, PO Box 31299, Lusaka, Zambia
| | - Michael Kaingu
- c/- CAPAH, National Assembly Parliament Buildings, PO Box 31299, Lusaka, Zambia
| | | | | | - Jody S Heymann
- School of Public Health, University of California, LA, Los Angeles, CA, USA
| | - German Henostroza
- College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, 4812, Australia.,University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
40
|
Telisinghe L, Charalambous S, Topp SM, Herce ME, Hoffmann CJ, Barron P, Schouten EJ, Jahn A, Zachariah R, Harries AD, Beyrer C, Amon JJ. HIV and tuberculosis in prisons in sub-Saharan Africa. Lancet 2016; 388:1215-27. [PMID: 27427448 PMCID: PMC6182190 DOI: 10.1016/s0140-6736(16)30578-5] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Given the dual epidemics of HIV and tuberculosis in sub-Saharan Africa and evidence suggesting a disproportionate burden of these diseases among detainees in the region, we aimed to investigate the epidemiology of HIV and tuberculosis in prison populations, describe services available and challenges to service delivery, and identify priority areas for programmatically relevant research in sub-Saharan African prisons. To this end, we reviewed literature on HIV and tuberculosis in sub-Saharan African prisons published between 2011 and 2015, and identified data from only 24 of the 49 countries in the region. Where data were available, they were frequently of poor quality and rarely nationally representative. Prevalence of HIV infection ranged from 2·3% to 34·9%, and of tuberculosis from 0·4 to 16·3%; detainees nearly always had a higher prevalence of both diseases than did the non-incarcerated population in the same country. We identified barriers to prevention, treatment, and care services in published work and through five case studies of prison health policies and services in Zambia, South Africa, Malawi, Nigeria, and Benin. These barriers included severe financial and human-resource limitations and fragmented referral systems that prevent continuity of care when detainees cycle into and out of prison, or move between prisons. These challenges are set against the backdrop of weak health and criminal-justice systems, high rates of pre-trial detention, and overcrowding. A few examples of promising practices exist, including routine voluntary testing for HIV and screening for tuberculosis upon entry to South African and the largest Zambian prisons, reforms to pre-trial detention in South Africa, integration of mental health services into a health package in selected Malawian prisons, and task sharing to include detainees in care provision through peer-educator programmes in Rwanda, Zimbabwe, Zambia, and South Africa. However, substantial additional investments are required throughout sub-Saharan Africa to develop country-level policy guidance, build human-resource capacity, and strengthen prison health systems to ensure universal access to HIV and tuberculsosis prevention, treatment, and care of a standard that meets international goals and human rights obligations.
Collapse
Affiliation(s)
- Lilanganee Telisinghe
- Field Epidemiology Services, Public Health England, Bristol, UK; University of Bristol, Bristol, UK.
| | - Salome Charalambous
- The Aurum Institute, Johannesburg, South Africa; School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia; Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Michael E Herce
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia; University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | | | - Peter Barron
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Andreas Jahn
- Department of HIV and AIDS, Ministry of Health, Lilongwe, Malawi; International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA, USA
| | - Rony Zachariah
- Médecins Sans Frontières, Brussels Operational Centre, Operational Research Unit, Luxembourg City, Luxembourg
| | - Anthony D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France; London School of Hygiene & Tropical Medicine, London, UK
| | - Chris Beyrer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joseph J Amon
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Health and Human Rights Division, Human Rights Watch, New York, NY, USA
| |
Collapse
|
41
|
Kamarulzaman A, Reid SE, Schwitters A, Wiessing L, El-Bassel N, Dolan K, Moazen B, Wirtz AL, Verster A, Altice FL. Prevention of transmission of HIV, hepatitis B virus, hepatitis C virus, and tuberculosis in prisoners. Lancet 2016; 388:1115-1126. [PMID: 27427456 DOI: 10.1016/s0140-6736(16)30769-3] [Citation(s) in RCA: 132] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The prevalence of HIV, hepatitis B virus, hepatitis C virus, and tuberculosis are higher in prisons than in the general population in most countries worldwide. Prisons have emerged as a risk environment for these infections to be further concentrated, amplified, and then transmitted to the community after prisoners are released. In the absence of alternatives to incarceration, prisons and detention facilities could be leveraged to promote primary and secondary prevention strategies for these infections to improve prisoners health and reduce risk throughout incarceration and on release. Effective treatment of opioid use disorders with opioid agonist therapies (eg, methadone and buprenorphine) prevents blood-borne infections via reductions in injection in prison and after release. However, large gaps exist in the implementation of these strategies across all regions. Collaboration between the criminal justice and public health systems will be required for successful implementation of these strategies.
Collapse
Affiliation(s)
- Adeeba Kamarulzaman
- Centre of Excellence for Research in AIDS, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia; Yale School of Medicine, New Haven, CT, USA.
| | - Stewart E Reid
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Lucas Wiessing
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
| | | | - Kate Dolan
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Babak Moazen
- Non-Communicable Diseases Research Centre, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Institute of Public Health, University of Heidelberg, Heidelberg, Germany
| | - Andrea L Wirtz
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Frederick L Altice
- Centre of Excellence for Research in AIDS, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia; Yale School of Medicine, New Haven, CT, USA
| |
Collapse
|
42
|
Topp SM, Moonga CN, Luo N, Kaingu M, Chileshe C, Magwende G, Henostroza G. Mapping the Zambian prison health system: An analysis of key structural determinants. Glob Public Health 2016; 12:858-875. [PMID: 27388512 DOI: 10.1080/17441692.2016.1202298] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Health and health service access in Zambian prisons are in a state of 'chronic emergency'. This study aimed to identify major structural barriers to strengthening the prison health systems. A case-based analysis drew on key informant interviews (n = 7), memos generated during workshops (n = 4) document review and investigator experience. Structural determinants were defined as national or macro-level contextual and material factors directly or indirectly influencing prison health services. The analysis revealed that despite an favourable legal framework, four major and intersecting structural factors undermined the Zambian prison health system. Lack of health financing was a central and underlying challenge. Weak health governance due to an undermanned prisons health directorate impeded planning, inter-sectoral coordination, and recruitment and retention of human resources for health. Outdated prison infrastructure simultaneously contributed to high rates of preventable disease related to overcrowding and lack of basic hygiene. These findings flag the need for policy and administrative reform to establish strong mechanisms for domestic prison health financing and enable proactive prison health governance, planning and coordination.
Collapse
Affiliation(s)
- Stephanie M Topp
- a College of Public Health, Medical and Veterinary Sciences, James Cook University , Townsville , QLD , Australia.,b Centre for Infectious Disease Research in Zambia , Lusaka , Zambia
| | - Clement N Moonga
- b Centre for Infectious Disease Research in Zambia , Lusaka , Zambia
| | - Nkandu Luo
- c Coalition of African Parliamentarians Against HIV/AIDS (CAPAH) , National Assembly Parliament Buildings , Lusaka , Zambia
| | - Michael Kaingu
- c Coalition of African Parliamentarians Against HIV/AIDS (CAPAH) , National Assembly Parliament Buildings , Lusaka , Zambia
| | | | | | - German Henostroza
- b Centre for Infectious Disease Research in Zambia , Lusaka , Zambia.,e School of Medicine, University of Alabama at Birmingham , Birmingham , AL , USA
| |
Collapse
|
43
|
Henostroza G, Harris JB, Kancheya N, Nhandu V, Besa S, Musopole R, Krüüner A, Chileshe C, Dunn IJ, Reid SE. Chest radiograph reading and recording system: evaluation in frontline clinicians in Zambia. BMC Infect Dis 2016; 16:136. [PMID: 27005684 PMCID: PMC4804604 DOI: 10.1186/s12879-016-1460-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 03/10/2016] [Indexed: 02/04/2023] Open
Abstract
Background In Zambia the vast majority of chest radiographs (CXR) are read by clinical officers who have limited training and varied interpretation experience, meaning lower inter-rater reliability and limiting the usefulness of CXR as a diagnostic tool. In 2010–11, the Zambian Prison Service and Ministry of Health established TB and HIV screening programs in six prisons; screening included digital radiography for all participants. Using front-line clinicians we evaluated sensitivity, specificity and inter-rater agreement for digital CXR interpretation using the Chest Radiograph Reading and Recording System (CRRS). Methods Digital radiographs were selected from HIV-infected and uninfected inmates who participated in a TB and HIV screening program at two Zambian prisons. Two medical officers (MOs) and two clinical officers (COs) independently interpreted all CXRs. We calculated sensitivity and specificity of CXR interpretations compared to culture as the gold standard and evaluated inter-rater reliability using percent agreement and kappa coefficients. Results 571 CXRs were included in analyses. Sensitivity of the interpretation “any abnormality” ranged from 50–70 % depending on the reader and the patients’ HIV status. In general, MO’s had higher specificities than COs. Kappa coefficients for the ratings of “abnormalities consistent with TB” and “any abnormality” showed good agreement between MOs on HIV-uninfected CXRs and moderate agreement on HIV-infected CXRs whereas the COs demonstrated fair agreement in both categories, regardless of HIV status. Conclusions Sensitivity, specificity and inter-rater agreement varied substantially between readers with different experience and training, however the medical officers who underwent formal CRRS training had more consistent interpretations. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1460-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- German Henostroza
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, USA. .,Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
| | - Jennifer B Harris
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, USA.,Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.,Department of Epidemiology, University of Alabama at Birmingham, Birmingham, USA
| | - Nzali Kancheya
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | - Stable Besa
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Robert Musopole
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Annika Krüüner
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, USA.,Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Chisela Chileshe
- Prisons Health Services, Ministry of Home Affairs, Lusaka, Zambia
| | - Ian J Dunn
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Stewart E Reid
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.,Department of Medicine, Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, USA
| |
Collapse
|
44
|
Half of Pulmonary Tuberculosis Cases Were Left Undiagnosed in Prisons of the Tigray Region of Ethiopia: Implications for Tuberculosis Control. PLoS One 2016; 11:e0149453. [PMID: 26914770 PMCID: PMC4767818 DOI: 10.1371/journal.pone.0149453] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 01/31/2016] [Indexed: 12/03/2022] Open
Abstract
Introduction Prison settings have been often identified as important but neglected reservoirs for TB. This study was designed to determine the prevalence of undiagnosed pulmonary TB and assess the potential risk factors for such TB cases in prisons of the Tigray region. Method A cross-sectional study was conducted between August 2013 and February 2014 in nine prisons. A standardized symptom-based questionnaire was initially used to identify presumptive TB cases. From each, three consecutive sputum samples were collected for acid-fast bacilli (AFB) microscopy and culture. Blood samples were collected from consented participants for HIV testing. Result Out of 809 presumptive TB cases with culture result, 4.0% (95% CI: 2.65–5.35) were confirmed to have undiagnosed TB. The overall estimated point prevalence of undiagnosed TB was found to be 505/100,000 prisoners (95% CI: 360–640). Together with the 27 patients who were already on treatment, the overall estimated point prevalence of TB would be 793/100,000 prisoners (95% CI: 610–970), about four times higher than in the general population. The ratio of active to passive case detection was 1.18:1. The prevalence of HIV was 4.4% (36/809) among presumptive TB cases and 6.3% (2/32) among undiagnosed TB cases. In a multivariate logistic regression analysis, chewing Khat (adjusted OR = 2.81; 95% CI: 1.02–7.75) and having had a close contact with a TB patient (adjusted OR = 2.18; 95% CI: 1.05–4.51) were found to be predictors of undiagnosed TB among presumptive TB cases. Conclusions This study revealed that at least half of symptomatic pulmonary TB cases in Northern Ethiopian prisons remain undiagnosed and hence untreated. The prevalence of undiagnosed TB in the study prisons was more than two folds higher than in the general population of Tigray. This may indicate the need for more investment and commitment to improving TB case detection in the study prisons.
Collapse
|
45
|
Farhoudi B, SeyedAlinaghi S, Mohraz M, Hosseini M, Farnia M. Tuberculosis, hepatitis C and hepatitis B co-infections in patients with HIV in the Great Tehran Prison, Iran. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2016. [DOI: 10.1016/s2222-1808(15)60989-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
46
|
Prevalence of Pulmonary Tuberculosis among Prison Inmates in Ethiopia, a Cross-Sectional Study. PLoS One 2015; 10:e0144040. [PMID: 26641654 PMCID: PMC4671540 DOI: 10.1371/journal.pone.0144040] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 11/12/2015] [Indexed: 11/19/2022] Open
Abstract
SETTING Tuberculosis (TB) is one of the major health problems in prisons. OBJECTIVE This study was done to assess the prevalence and determinants of active tuberculosis in Ethiopian prisons. DESIGN A cross-sectional study was conducted from January 2013 to December 2013 in 13 zonal prisons. All incarcerated inmates underwent TB symptom screening according to WHO criteria. From identified TB-suspects two sputum samples were analyzed using smear microscopy and solid culture. A standardized questionnaire assessing TB risk factors was completed for each TB suspect. RESULTS 765 (4.9%) TB suspects were identified among 15,495 inmates. 51 suspects were already on anti-TB treatment (6.67%) and 20 (2.8%) new culture-confirmed TB cases were identified in the study, resulting in an overall TB prevalence of 458.1/100,000 (95%CI: 350-560/100,000). Risk factors for active TB were alcohol consumption, contact with a TB case before incarceration and no window in prison cell. HIV prevalence was not different between TB suspects and active TB cases. Further, the TB burden in prisons increased with advancing distance from the capital Addis Ababa. CONCLUSIONS The overall TB prevalence in Ethiopian prisons was high and extremely variable among different prisons. TB risk factors related to conditions of prison facilities and the impact of implemented TB control measures need to be further studied in order to improve TB control among inmates.
Collapse
|
47
|
Determinants of Pulmonary Tuberculosis among Inmates at Mangaung Maximum Correctional Facility in Bloemfontein, South Africa. Tuberc Res Treat 2015; 2015:752709. [PMID: 25866677 PMCID: PMC4381858 DOI: 10.1155/2015/752709] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 02/09/2015] [Accepted: 02/10/2015] [Indexed: 12/28/2022] Open
Abstract
Introduction. Correctional facilities house large number of inmates who are at high risk of developing tuberculosis (TB); however factors associated with TB among inmates at Mangaung Correctional Centre have not been studied. Study Population and Methods. We undertook a case control study and reviewed a total of 1140 medical records of inmates treated for TB between 2009 and 2010. Cases were selected randomly from the medical records of inmates who were treated. Data collected were analysed using STATA version 12.0 and determinants of TB were evaluated using multiple logistic regression analyses. Factors with P < 0.05 were considered significant. Results. Prevalence of TB was 8.8% and 52% of inmates with TB were aged 31–40 years; 58% of the TB cases were HIV positive and 34% of them had CD4 cell count 350 cells/mm3. Factors associated with TB among inmates were HIV coinfection (OR: 4.2; 95% CI: 2.64–7.00); previous history of TB disease (OR: 3.58; 95% CI: 2.25–5.70); and smoking (OR: 2.1; 95% CI: 1.16–3.81). Conclusion. Interventions to improve TB detection such as regular screening of inmates with such factors need to be reinforced to control transmission of TB among inmates and the community.
Collapse
|
48
|
Bates M, Mudenda V, Shibemba A, Kaluwaji J, Tembo J, Kabwe M, Chimoga C, Chilukutu L, Chilufya M, Kapata N, Hoelscher M, Maeurer M, Mwaba P, Zumla A. Burden of tuberculosis at post mortem in inpatients at a tertiary referral centre in sub-Saharan Africa: a prospective descriptive autopsy study. THE LANCET. INFECTIOUS DISEASES 2015; 15:544-51. [PMID: 25765217 DOI: 10.1016/s1473-3099(15)70058-7] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients with subclinical tuberculosis, smear-negative tuberculosis, extrapulmonary tuberculosis, multidrug-resistant tuberculosis, and asymptomatic tuberculosis are difficult to diagnose and may be missed at all points of health care. We did an autopsy study to ascertain the burden of tuberculosis at post mortem in medical inpatients at a tertiary care hospital in Lusaka, Zambia. METHODS Between April 5, 2012, and May 22, 2013, we did whole-body autopsies on inpatients aged at least 16 years who died in the adult inpatient wards at University Teaching Hospital, Lusaka, Zambia. We did gross pathological and histopathological analysis and processed lung tissues from patients with tuberculosis through the GeneXpert MTB/RIF assay to identify patients with multidrug-resistant tuberculosis. The primary outcome measure was specific disease or diseases stratified by HIV status. Secondary outcomes were missed tuberculosis, multidrug-resistant tuberculosis, and comorbidities with tuberculosis. Data were analysed using Pearson χ(2), the Mann-Whitney U test, and binary logistic regression. FINDINGS The median age of the 125 included patients was 35 years (IQR 29-43), 80 (64%) were men, and 101 (81%) were HIV positive. 78 (62%) patients had tuberculosis, of whom 66 (85%) were infected with HIV. 35 (45%) of these 78 patients had extrapulmonary tuberculosis. The risk of extrapulmonary tuberculosis was higher among HIV-infected patients than among uninfected patients (adjusted odds ratio 5·14, 95% CI 1·04-24·5; p=0·045). 20 (26%) of 78 patients with tuberculosis were not diagnosed during their life and 13 (17%) had undiagnosed multidrug-resistant tuberculosis. Common comorbidities with tuberculosis were pyogenic pneumonia in 26 patients (33%) and anaemia in 15 (19%). INTERPRETATION Increased clinical awareness and more proactive screening for tuberculosis and multidrug-resistant tuberculosis in inpatient settings is needed. Further autopsy studies are needed to ascertain the generalisability of the findings. FUNDING UBS Optimus Foundation, EuropeAID, and European Developing Countries Clinical Trials Partnership (EDCTP).
Collapse
Affiliation(s)
- Matthew Bates
- Department of Infection, Division of Infection and Immunity, University College London, London, UK; University of Zambia and University College London Medical School Research and Training Project, University Teaching Hospital, Lusaka, Zambia
| | - Victor Mudenda
- Department of Pathology and Microbiology, University Teaching Hospital, Lusaka, Zambia
| | - Aaron Shibemba
- Department of Pathology and Microbiology, University Teaching Hospital, Lusaka, Zambia
| | - Jonas Kaluwaji
- University of Zambia and University College London Medical School Research and Training Project, University Teaching Hospital, Lusaka, Zambia
| | - John Tembo
- University of Zambia and University College London Medical School Research and Training Project, University Teaching Hospital, Lusaka, Zambia
| | - Mwila Kabwe
- University of Zambia and University College London Medical School Research and Training Project, University Teaching Hospital, Lusaka, Zambia
| | - Charles Chimoga
- University of Zambia and University College London Medical School Research and Training Project, University Teaching Hospital, Lusaka, Zambia
| | - Lophina Chilukutu
- University of Zambia and University College London Medical School Research and Training Project, University Teaching Hospital, Lusaka, Zambia
| | - Moses Chilufya
- University of Zambia and University College London Medical School Research and Training Project, University Teaching Hospital, Lusaka, Zambia
| | - Nathan Kapata
- National Tuberculosis Control Programme, Ministry of Community Development, Maternal and Child Health, Lusaka, Zambia
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich, Munich, Germany
| | - Markus Maeurer
- Therapeutic Immunology, Department of Laboratory Medicine, Department of Microbiology, and Department of Tumour and Cell Biology, Karolinska Institute, Stockholm, Sweden
| | - Peter Mwaba
- University of Zambia and University College London Medical School Research and Training Project, University Teaching Hospital, Lusaka, Zambia
| | - Alimuddin Zumla
- Department of Infection, Division of Infection and Immunity, University College London, London, UK; University of Zambia and University College London Medical School Research and Training Project, University Teaching Hospital, Lusaka, Zambia; National Institute for Health Research Biomedical Research Centre, University College London Hospitals, London, UK.
| |
Collapse
|
49
|
Milloy MJ, Montaner JSG, Wood E. Incarceration of people living with HIV/AIDS: implications for treatment-as-prevention. Curr HIV/AIDS Rep 2015; 11:308-16. [PMID: 24962285 DOI: 10.1007/s11904-014-0214-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Contact with the criminal justice system, including incarceration, is a common experience for many people living with HIV/AIDS. Optimism has recently been expressed that correctional facilities could be important locations for treatment-as-prevention (TasP)-based initiatives. We review recent findings regarding the effect of incarceration on patterns of HIV transmission, testing, treatment initiation and retention. We found that the prevalence of HIV infection among incarcerated individuals remains higher than analogous non-incarcerated populations. Recent studies have shown that voluntary HIV/AIDS testing is feasible in many correctional facilities, although the number of previously undiagnosed individuals identified has been modest. Studies have implied enhanced linkage to HIV/AIDS treatment and care in jails in the United States was associated with improvements in the HIV cascade of care. However, for many individuals living with HIV/AIDS, exposure to the correctional system remains an important barrier to retention in HIV/AIDS treatment and care. Future research should evaluate structural interventions to address these barriers and facilitate the scale-up of TasP-based efforts among individuals living in correctional settings.
Collapse
Affiliation(s)
- M-J Milloy
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada,
| | | | | |
Collapse
|
50
|
Zishiri V, Charalambous S, Shah MR, Chihota V, Page-Shipp L, Churchyard GJ, Hoffmann CJ. Implementing a large-scale systematic tuberculosis screening program in correctional facilities in South Africa. Open Forum Infect Dis 2015; 2:ofu121. [PMID: 25884008 PMCID: PMC4396427 DOI: 10.1093/ofid/ofu121] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 12/16/2014] [Indexed: 11/15/2022] Open
Abstract
Background. Tuberculosis (TB) prevalence is high in correctional facilities in southern Africa. With support from local South African nongovernmental organizations, the South African Department of Correctional Services initiated a program of systematically screening newly admitted and current inmates for symptoms followed by GeneXpert Mycobacterium tuberculosis (MTB)/rifampicin (Rif) for microbiologic testing of symptomatic inmates. Methods. We conducted a program evaluation during a 5-month window describing program reach, effectiveness, adoption within the facilities, cost, and opportunities for sustainability. This evaluation included 4 facilities (2 large and 2 smaller) with a total daily census of 20 700 inmates. Results. During the 5-month evaluation window from May to September 2013, 7426 inmates were screened at the 4 facilities. This represents screening 87% of all new admits (the remaining new admits were screened by correctional staff only and are not included in these statistics) and 23% of the daily inmate census, reaching 55% of the overall screening target as calculated per annum. The reach ranged from 57% screened during these 5 months at one of the smaller facilities to 13% at the largest facility. Two hundred one cases of pulmonary TB were diagnosed, representing 2.1% of the screened population; 93% had documented initiation of TB treatment. The cost per TB case identified was $1513, excluding treatment costs (with treatment costs it was $1880). Conclusions. We reached a large number of inmates with high-volume screening and effectively used GeneXpert MTB/Rif to diagnose pulmonary TB and rapidly initiate treatment. The cost was comparable to other screening programs.
Collapse
Affiliation(s)
| | - Salome Charalambous
- The Aurum Institute, Johannesburg, South Africa
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Maunank R. Shah
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | | | | | - Gavin J. Churchyard
- The Aurum Institute, Johannesburg, South Africa
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Christopher J. Hoffmann
- The Aurum Institute, Johannesburg, South Africa
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|