Title

Tuberculosis in prisons

Code

TUBS02

Session Type

Bridging Session

Venue

Auditorium

Date Time

Tuesday 24 July, 14:30 - 16:00

Co-Chairs:

Sabine Hermans, Amsterdam Institute for Global Health and Development, Netherlands
Robin Wood, The Desmond Tutu HIV Centre, South Africa

Globally, tuberculosis (TB ) rates in prisons are 30 times greater than in the general population due to crowding, poor ventilation, substance use, undernutrition and poor access to health services. Despite this, most prison inmates in low- and middle-income countries do not receive systematic screening and prevention services. There remain major knowledge gaps about how to effectively control TB in these high-transmission environments. Moreover, growing evidence suggests that prisons represent a major reservoir or “institutional amplifier” of community TB, such that failing to address TB in prisons may undermine control efforts in the general population. This session will highlight recent advances in the study of TB in incarcerated populations, including transmission, diagnosis and prevention. Themes to be addressed include:

How do concentrated epidemics of TB in prisons affect population-level control efforts?
What are the major evidence gaps in TB diagnosis and prevention for incarcerated populations?
What are obstacles to effective implementation of TB control interventions in prisons?
What are innovative models of care and prevention that can be scaled up in high-transmission prisons?
How can TB, HIV and HCV be managed effectively at the transitions of care between prisons and communities?

14:30 TUBS0201	Introduction

14:35 TUBS0202	TB transmission in prisons and spillover into communities: Why addressing tuberculosis epidemics in prisons should be a public health priority Jason Andrews, Stanford, United States	Slides

14:50 TUBS0203	Knowledge gaps for formulating TB control policies for prisons Masoud Dara, World Health Organization, Denmark	Slides

15:05 TUBS0204	Mass screening for tuberculosis in Brazil’s prisons: Generating a scalable model for early diagnosis and prevention Julio Croda, Oswaldo Cruz Foundation, Brazil	Slides

15:20 TUBS0205	State of HIV and TB in prisons in Sub-Saharan Africa

15:35 TUBS0206	Community perspective on TB care in prisons Karabo Rafube, Community representative, South Africa	Slides

15:50 TUBS0207	Panel discussion

AUTHOR

Peter Wiessner

SUMMARY

TB rates are 30 times higher in prisons than in the general population. However, few countries perceive prison health as a public health priority. The session addressed setting-based TB risks factors for prisoners, such as overcrowding, poor air-ventilation, lack of sunlight, poor access to health services, identified knowledge-gaps and best-practices.

HIGHLIGHTS

Prisons are an amplifier of tuberculosis. The growth of incarceration rates by 275% globally between 2000-2016 adds to the problem. Studies in Brazil demonstrate a 42% likelihood to get infected within a single year in prison. Prison health authorities often do not follow WHO guidelines. Establishing TB programs in prison reduces the TB burden in the general population. In many regions, prisons are the key driver of TB and MDR-TB that spill over to general population. Reason are poor adherence, discontinuation of treatment upon release and lack of access for NGOs delivering services in prison. To tackle the situation good screening practices were identified. However, prisons remain disconnected from the general health system, leading to double standards, disregard of guidelines and lacking sufficiently-trained health personnel. Better cooperation between Ministries of Health, Justice and Interior are needed to change the situation.

CRITICAL ASSESSMENT

The TB situation in prisons is a public heath emergency, a crisis and a scandal. The session made it clear that nothing much will change, as long as the prison health is siloed. Ministries responsible for prison health need to cooperate and change the underlying political factors that cause the problems identified above. To break the barrier between realities inside and outside prison, sessions like this should include those working in prison, in prison health administrations and relevant ministries.

AUTHOR

Sean Wasserman

SUMMARY

TB rates in prisons are much higher than in the general population and may represent a reservoir of TB in the community. The session highlighted new research related to the public health burden of TB among prison populations. Themes included transmission, screening and prevention strategies, implementation challenges, and community perspectives.

HIGHLIGHTS

To support the hypothesis that prisons serve as reservoirs of TB epidemics in LMICs, Jason Andrews showed that the risk of incident TB disease in South-Western Brazil remains higher amongst ex-prisoners for up to 7 years after leaving prison and demonstrated that prison and community epidemics are genetically interrelated, suggesting transmission spillover. A mathematical model predicted that exit screening would be more beneficial than entry screening, and that a combined intervention would result in > 60% reduction in TB incidence in prisons, and > 30% reduction in community TB burden. Julio Croda presented data from a cohort study involving 12 prisons in South-Western Brazil showing that biannual screening is predicted to result in substantial reductions in new TB cases. In preliminary data from a prospective mass TB screening study, only 27% of new TB cases were identified using traditional screening approaches plus chest X-ray with automated interpretation.

CRITICAL ASSESSMENT

The presenters showed compelling data to support the hypothesis that TB in prisons is a major public health issue, and a potentially important driver of TB in the community. Current strategies for screening, diagnosis, and prevention appear to be inadequate, and this new evidence should be used to inform updated screening recommendations. This session highlighted the importance of finding ways to address the TB epidemic in prisons, including advocating for this issue at the upcoming UN High Level Meeting on TB.