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III^rd Regional Workshop on TB Control in Prisons

(San Salvador, El Salvador, 27–28 April 2006)

Workshop aimed at Prison Directors & Heads of National Tuberculosis Programs from Latin American & Caribbean countries, sponsored by the PAHO Regional Program on Tuberculosis & the Spanish Agency for International Cooperation (Agencia Española de Cooperación Internacional / AECI).

Agenda (PDF, 49 Kb)
Final Report (in Spanish, 28 pp, PDF, 917 Kb; chapter heading translated below for user orientation)
- Abbreviations
- Executive Summary (text to right)
- Background
- Opening of the III^rd Regional Workshop on TB Control in Prisons (San Salvador, El Salvador, 27–28 April 2006)
- Objectives (text to right)
- Methodology (text to right)
- Session of Thursday, 27 April
- Country Presentations

- Session of Friday, 28 April
- Working Groups
- Group Presentations (SWOT Analysis: Strength, Weaknesses, Opportunities, Threats)
- Conclusions (text to right)
- Recommendations (text to right)
Annex I: List of Participants

Contact: PAHO Regional Program on Tuberculosis, Communicable Disease Unit, PAHO Headquarters, Washington, DC, USA

WHO Links
- WHO Tuberculosis Page
- WHO HIV Page

Stop TB Partnership

PAHO Links
- Workshops on TB in Prisons prior to this one: 2004 | 2003
- Workshops on TB/HIV: 2006 | 2004 | 2003
- PAHO Tuberculosis Page
- PAHO AIDS Page

• Objectives
• Methodology
• Executive Summary
• Conclusions
• Recommendations

Objectives

• Analyze and discuss aspects related to tuberculosis control in prisons; become acquainted with the experiences of selected countries.
• Discuss social-communication strategies for TB control in penal institutions.
• Establish collaboration plans between Tuberculosis Programs and the prison sector.
• Get to know the Salvadoran experience with implementing TB control activities in correctional facilities.

Methodology

Participants from the different countries and international agencies introduced themselves, while providing a brief look at the scope of their work. They participated actively in the following activities:

1. Roundtable discussion, with a situation analysis and country experiences.
2. Country presentations: "Progress in the implementation of TB control plans in penitentiaries."
3. Working gr
oup session: Identifying needs vis-à-vis communication, SWOT analysis (Strengths/Weaknesses/Opportunities/Threats).
4. Preparation of 2006–2007workplans.
5. Visit to a penal institution.

Executive Summary

Tuberculosis is an important public health problem throughout the world that can affect anybody, although some population groups are especially vulnerable to this disease. Among these people are persons deprived of liberty (PDLs) who present incidence rates from 15 to 30 times greater as inmates than do people on the outside.

In prisons, there are many factors favorable to TB transmission, such as HIV/AIDS, malnutrition, deprivation, mental illness, violence, and overcrowding. The results of this are more infected people, more patients, and more deaths from TB.

Sustained support from governments, NTPs, NGOs, and international and donor organizations has facilitated the startup of positive dialogs between authorities with the goal of extending high-quality DOTS services to the PDLs.

Efforts made to promote the collaboration of the aforementioned entities have been fruitful and they are currently being expanded through such activities as those presented in the III^rd Regional Workshop on TB Control in Prisons, held in San Salvador, El Salvador, from 27 to 28 April 2006. During the event, the participants discussed the challenges and opportunities for controlling TB and of TB/HIV, sharing experiences and becoming familiar with the new WHO Stop TB strategy. Participants prepared their workplans jointly (i.e. the Ministry of Health and the penal system) and guaranteed the implementation of activities aimed at TB control, in accordance with the progress shown at this meeting.

Conclusions

1. During the event, the participants discussed the challenges and opportunities for TB and of TB/HIV control, sharing experiences and becoming acquainted with the WHO Stop TB strategy.
2. Operational epidemiological data from the countries, as well as indicators on the situation of TB in prisons, were presented, in accordance with research carried out in 2004.
3. The presentations made on the situation of TB control in prisons exposures of the situation of TB control by countries that attended the second workshop in Lima in 2004, showed great advances in the application of the DOTS strategy. Countries incorporated into this 3rd meeting presented initial implementation plans for TB control activities.
4. All the participating countries recognize strengthening political support for TB control in prisons as a cornerstone, with an increase in interinstitutional coordination (Ministries of Health, NTPs, and the penal sector).
5. During the country presentations, it was demonstrated the problems throughout the penal system in acquiring information on TB
.
6. TB/HIV coinfection is recognized as an important public health problem in prisons that needs to be addressed jointly between the two programs.
7. It is recognized additional factors (alcoholism, drug use, and smoking), as well as to risky sexual practices, occur frequently in prisons, thus becoming aggravating factors for both the TB epidemic and the HIV epidemic.
8. Strategic communication (i.e. a strategy for mass communication) has been identified as a tool designed to help control TB in prisons, and the countries need to incorporate it into their plans.
9. The experiences presented showed that the progress made in several countries is due to the increase in economic resources from Fund Global projects, the Red Cross, NGOs, etc. However, this situation has generated concern over the sustainability of long-term actions.
10. The participants (from the Ministry of Health and penal system) prepared their workplans jointly and guaranteed the implementation of activities aimed at TB control, in accordance with progress demonstrated at this meeting.

Recommendations

1. Maintain the political commitment of all entities involved to improving TB control in prisons.
2. Sustain quality should be sustained and the application of DOTS strategy, expanding it to cover all prisons in each country attending this third meeting.
3. Improve monitoring of TB control in prisons, analysis of case-finding and follow-up trends as well as of treatment results and contact control, thus strengthening information systems and the analytical capacity of the prison health teams.
4. Strengthen ongoing intramural and extramural coordination in order to offer equivalent services in both sectors involved in TB control (follow-up on national standards, access to quality diagnoses, uninterrupted and supervised TB treatment, and contact control, in accordance with established standards).
5. Having recognized the serious problem that TB/HIV coinfection represents in the prisons of the Region, guarantee to every TB patient counseling and voluntary free HIV testing, and offer the access to antiretrovirals in HIV-positive cases. Similarly, test all PDLs for TB and providing treatment or chemoprophylaxis as laid out in the regulations of DOTS strategy.
6. At the countries' behest, that PAHO/WHO propose to the coordinating committees of TB and HIV/AIDS programs in the different countries of the Region that they assign high priority to prison health as part of their national strategic plans.
7. For the National Program for TB Control in Prisons to introduce this debate, in order to incorporate strategies aimed at the orientation, prevention, and rehabilitation of people with a drug addiction and who engage in risky sexual practices.
8. For the countries to prepare communication plans that follow the scientific methodology presented during this meeting.
9. Consider such opportunities as international support, health system reform, legal reform, and social movements, in order to incorporate them into the countries' political agenda for TB control in prisons.
10. Monitor, evaluate, and update the collaboration plan between the TB Control program and the penal sector, in accordance with the status of the progress made in its implementation.
11. Apply the others components of the Stop TB strategy (TB/HIV; MDR-TB; strategic mass communication; incorporating PDLs into TB control activities, and operational research).
12. At the best of the PAHO Regional Program on Tuberculosis, for both the health sector and the prison health sector evaluate and recognize the work of prison health workers and incorporate them into all technical, scientific and training activities provided by the health sector.