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The Health Crisis of Tuberculosis in Prisons Extends beyond the Prison Walls


article has not abstract


Published in the journal: . PLoS Med 7(12): e32767. doi:10.1371/journal.pmed.1000383
Category: Editorial
doi: https://doi.org/10.1371/journal.pmed.1000383

Summary

article has not abstract

The scourge of tuberculosis (TB) in prisons remains a persistent problem; rates among inmates remain much higher—from 5 to up to 50 times—than those of national averages across both the developed and the developing world [1][5], and the situation may be worsening in some regions. In Europe and Central Asian countries, recent research has shown a clear relationship between the rate of growth of prison populations and the increased incidence of TB and multidrug-resistant TB [6]. And at a recent meeting on TB/HIV in the WHO European Region that focused on integrating treatment of these diseases [7], Diane Havlir, chair of the Stop TB Partnership's TB/HIV Working Group, opened proceedings by asking “What about prisons? Mandatory hospitalization for drug-susceptible TB? We need a debate about these things and to make improvements.”

Some important gaps in our understanding of TB in prisons exist: it's still unclear how much TB there is within prisons and what fraction of TB in the general population is contributed by disease in incarcerated groups. An article in this week's PLoS Medicine helps bridge that gap. Iacapo Baussano and colleagues systematically reviewed all the available published evidence on incident latent tuberculosis infection (LTBI) and TB in prisons worldwide, and by doing so were able to estimate the proportion of TB in national populations that is due to TB in prisons. The most striking finding is that, although it is clear that the rate of TB is higher in prisons than in the community, even after a thorough search and rigorous analysis of the evidence, it is not possible to give accurate estimates of the increased incidence of TB in prisons over community rates [8].

The paucity of reliable research evidence on TB in prisons found in this review should spur a renewed research effort. Such research is desperately needed to better inform policies to protect not only the health of people that are incarcerated, but also the health of the community outside.

Prisons provide ideal conditions for TB transmission. The bacterium causing TB is distributed in tiny liquid droplets that are produced when someone with active TB coughs, sneezes, spits, or speaks, enabling one person to infect many others. Therefore, the risk of TB being transmitted in settings in which people are in close contact—as in prisons and hospitals—is particularly high. Numerous other factors, such as poor health services frequently encountered in prisons, poor nutrition, drug addiction, and the presence of other diseases, such as HIV infection, are risk factors that predispose imprisoned people to a high risk of TB incidence.

Obstacles to tackling TB in prisons include inadequate infection control measures, conflicts between infection control measures and prisoner segregation (according to crime and length of sentence), lack of adequate medical facilities, lack of resources (including prison staff), and the low priority that policymakers give to health care within the prison system. Roberts and colleagues outlined how 20 jails in the US implemented measures to control TB and prevent new infections [9]. Even in this high-income setting, only four of the 20 prisons had conducted risk assessments for TB transmission, 11 had monitored tuberculin skin test conversions of inmates and staff, and only nine of the 20 prisons had policies to offer HIV counseling and testing to those with TB—an alarming situation given that HIV infection is the single largest cofactor for development of TB infection.

The new systematic review published in PLoS Medicine provides much-needed evidence for policymakers, including WHO, to renew their efforts to tackle TB in prisons. There is ample guidance available on how best to control and prevent TB in prisons [10],[11] and many academics, health workers, and campaigners have called for the intensive screening of high-risk populations, including prisoners, to be introduced [12] as part of an integrated strategy to reduce global incidence of TB. Future research areas uncovered by this systematic review include measuring the impact of conditions in prisons on TB transmission and assessing the population attributable risk of prison-to-community spread.

On 13 October 2010, the Global Plan to Stop TB 2011–2015 was launched by the Stop Tuberculosis Partnership (a coalition of more than 400 organizations worldwide) with the aim of halving TB mortality and prevalence rates by 2015 compared with a 1990 baseline [13]. One objective to achieving this aim is to “Ensure early diagnosis of all TB cases,” including vulnerable populations such as prisoners. The publication of this systematic review marks a shift from considering the incidence of TB in each prison population to considering the massive global impact of tuberculosis in prisons.


Zdroje

1. BoneA

AertsA

GrzemskaM

KimerlingM

KlugeH

2000 Tuberculosis control in prisons: A Manual for Programme Managers. Geneva World Health Organization

2. DaraM

GrzemskaM

KimerlingME

ReyesH

ZagorskiyA

2009 Guidelines for control of tuberculosis in prisons. The Global Health Bureau, Office of Health, Infectious Disease and Nutrition (HIDN), US Agency for International Development

3. MacNeilJR

LobatoMN

MooreM

2005 An unanswered health disparity: tuberculosis among correctional inmates, 1993 through 2003. Am J Public Health 1 1800 1805

4. BanuS

HossainA

UddineMKM

UddinMR

AhmedT

2010 Pulmonary tuberculosis and drug resistance in Dhaka central jail, the largest prison in Bangladesh. PLoS One 5 e10759 doi:10.1371/journal.pone.0010759

5. ConinxR

Eshaya-ChauvinB

ReyesH

1995 Tuberculosis in prisons. Lancet 346 1238 1239

6. StucklerD

BasuS

McKeeM

KingL

2008 Mass incarceration can explain population increases in TB and multidrug-resistant TB in European and central Asian countries. Proc Natl Acad Sci U S A 105 13280 13285

7. [No author listed] 2010 Accelerating the implementation of collaborative TB/HIV activities in the WHO European Region 16-17 July 2010, Vienna Available at: http://www.stoptb.org/wg/tb_hiv/assets/documents/agenda2.pdf. Accessed 4 November 2010

8. BaussanoI

WilliamsBG

NunnP

BeggiatoM

FedeliU

2010 Tuberculosis incidence in prisons: A systematic review. PLoS Med 7 e381 doi:10.1371/journal.pmed.1000381

9. RobertsCA

LobatoMN

BazermanLB

KlingR

ReichardAA

2006 Tuberculosis prevention and control in large jails: A challenge to tuberculosis elimination. Am J Prev Med 30 125 130

10. WHO 2000 Tuberculosis control in prisons. WHO/CDS/TB/2001/.281. Geneva: WHO. Available at: http://www.who.int/tb/publications/prisons_tb_control_manual/en/index.html. Accessed 4 November 2010

11. Centers for Disease Control and Prevention (CDC), National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention 2006 Prevention and control of tuberculosis in correctional and detention facilities: Recommendations from CDC. MMWR Recomm Rep 55 1 44 Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5509a1.htm. Accessed 4 November 2010

12. LönnrothK

CastroKG

ChakayaJM

ChauhanLS

FloydK

2010 Tuberculosis control and elimination 2010-50: Cure, care, and social development. Lancet 375 1814 29

13. Stop TB partnership 2010 Global plan to stop TB 2011-2015: Transforming the Fight - Towards Elimination of Tuberculosis. Available at: http://www.stoptb.org/assets/documents/global/plan/TB_GlobalPlanToStopTB2011-2015.pdf. Accessed 4 November 2010

Štítky
Interní lékařství

Článek vyšel v časopise

PLOS Medicine


2010 Číslo 12
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