Implementing a TB-Control Program in Prisons: The Basics. Dr. Mayra Arias. Elements Needed before a TB-Control Program in Prisons Is Considered. Political will: - Prison authorities. - Public-health authorities. Civilian TB-Control Program (NTP) in place.
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Dr. Mayra Arias
- Public-health authorities.
1- Reduce morbidity and mortality.
2- Prevent the development of drug-resistant TB.
3- Reduce and ultimately stop the transmission of TB infection.
1- Early diagnosis of TB.
2- Effective treatment, cure.
- Responsibility of health services in prisons (whose?).
- Cases management (diagnosis, treatment, follow-up).
- Untrained and unmotivated staff.
- Exclusion of some groups of prisoners.
- Legal and security requirements.
- Patient-doctor relationship.
•Screening at entry (active)
•Mass screening (active)
Health staff must be alert to recognize symptoms, diagnose and treat TB.
TB care must be accessible.
Fear of effects of a TB diagnosis.
Need for trained personnel.
Weak TB services, corruption.Case-Finding through Self-Referral
Education & close supervision
Standardized by NTP guidelines Considered
Should be implemented promptly after diagnosing a case (*smear positive)
What is a close contact?
What protocol should be followed?
Time-consumingCase-Finding through Contact Investigation
Establishment of protocols, Training of health staff
Recommended by UN and Council of Europe. Considered
Inmates usually from a background where the prevalence of TB is already high.
Allows for the containment of infection
Inconvenience to prison authorities.
Lack of medical staff in prisons
In many cases, entry of inmates occurs at all times.
Lack of isolation facilities.Case-Finding during Entry Screening
Close communication between prison administrative and health staff and between civilian and prison health staff
Detects pool of prevalent cases. Considered
All prisoners must be screened.
May be done once and followed-up by other strategies.
Should prioritize prisons with higher risk for TB.Case-Finding through Mass Screening
Symptom Assessment Considered
Simple to implement.
Low positive predictive value.
Must be administered by trained personnel.
Recommended where resources are limited.
Sensitivity and specificity: broad spectrum.
High capital and running cost.
High degree of training required.Screening Methods
3 levels of Infection Control
** Early diagnosis (smear-positive cases)
Areas of higher risk of exposure to M. tuberculosis (isolation wards, procedures that produce aerosols):
Tuberculosis Control in Prisons – A Manual for Programme Managers