8. TB prevention and control care in prisons

Key points • TB in prisons is a major public health problem in many settings, particularly in countries with a high incidence of TB. • The TB notification rate in prisons ranges from 11 to 81 times higher than in the general population. The situation is worsened by the emergence and spread of drug-resistant TB, particularly multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB. • Prompt detection of TB among prisoners should be ensured through a combination of screening methods (screening on entry, mass screening at regular intervals, passive screening, contact screening) based on clinical questionnaires, chest X-rays, smear microscopy and self-referrals. • The implementation of new, rapid diagnostic methods such as Xpert MTB/RIF is an important breakthrough in the fight against TB and (X)MDR. • Drug susceptibility testing (DST) should be performed on all patients with treatment adapted to the resistance pattern to help further amplification of resistance. • Effectiveness is improved when treatment is administered under the direct observation of health care staff and in line with national TB programme (NTP) guidelines. • Adequate procurement, supply and management of quality medication and effective administration should be in place. Airborne infection control, including protective measures for staff, should be ensured, and provider-initiated HIV counselling and testing to detect HIV and TB/HIV co-infected individuals should be promoted to provide the necessary support and care. • Continuity of care is imperative for released prisoners who are on treatment and for individuals who are on treatment before entering the prison services. • TB control is strengthened in prison-based programmes by raising awareness of TB among prisoners and prison medical and non-medical staff through continuous educational activities. • Operational research should be promoted to contribute to evidence-building for effectiveness.