Disease Prevention and Control / Communicable Diseases / Tuberculosis
Guidelines for the Control of Tuberculosis in Prisons(World Health Organization/WHO, International Committee of the Red Cross, 1998) | ||
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Full Text (90 pp, PDF) - PAHO Workshops on TB in Prisons: 
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The World Health Organization (WHO) and the International Committee of the Red Cross (ICRC) have joined forces to produce these guidelines. The goal is to improve the control of tuberculosis in prisons and other institutions where people are incarcerated. The guidelines apply wherever people are in custody: prisons, police stations, remand centres, detention centres for asylum-seekers, secure hospitals, penal colonies and prisoner-of-war camps. Several international conventions guarantee the welfare of prisoners. Prisoners lose liberty but retain certain rights in prison. These include protection from harm and access to a standard of health care equivalent to that provided in the community. In practice, few prison authorities comply fully with these conventions. Low standards of general custodial care and of health care are common. Despite the often limited information available on the health of prisoners, there is increasing recognition of the health needs of prisoners, including the need to control tuberculosis. Contracting tuberculosis should not be part of a prisoner's sentence. Tuberculosis is common in many prisons worldwide and treatment is often ill-informed and inadequate. Prisons form a reservoir of tuberculosis, including drug-resistant tuberculosis. Tuberculosis is a problem both inside prisons and outside in the wider community, since people enter, leave and re-enter prisons. There is therefore an urgent need to institute effective control of tuberculosis in prisons. Successful tuberculosis control in a country requires effective tuberculosis control in prisons. The WHO recommended strategy for tuberculosis control (known by the "brand name" of DOTS) relies on the detection and cure of tuberculosis patients, with a priority for the infectious cases. The specific features of prisons and of prisoners necessitate specific approaches to implementation of the DOTS strategy. The prison health services must implement the DOTS strategy in close collaboration with national tuberculosis control programmes. Practical guidelines are necessary for prison authorities to be able to implement the DOTS strategy. Policy-makers and decision-makers may be unaware of the extent of the problem of tuberculosis in prisons, the potential for spread to the wider community, and the emergence of drug-resistance. The guidelines therefore also highlight to policy-makers and decision-makers the need to control tuberculosis in prisons. Several countries, usually with low tuberculosis prevalence, have developed their own guidelines. However, there is a need for global guidelines for use in any country with high tuberculosis prevalence populations. WHO's Global Tuberculosis Programme (GTB) and ICRC contribute to these guidelines expertise in tuberculosis control and in the welfare of prisoners. The objectives of the guidelines are the following:
The guidelines are primarily for prison authorities (administration, health staff), policy-makers and decision-makers in relevant ministries (e.g. justice, interior, health), NGOs and donor agencies, and National Tuberculosis Programme (NTP) staff. Part I provides background information on tuberculosis and prisons, of particular relevance to prison authorities and decision-makers in relevant ministries. Part II provides guidelines for the control of tuberculosis in prisons, of particular relevance to prison health staff. Part III gives guidance to national prison authorities and NGOs on how to establish a prison tuberculosis control programme. These guidelines require field testing in different situations. Comments on the guidelines are welcome and will help to improve future editions. Please send any comments to theWHO Global Tuberculosis Programme. To order copies of these guidelines, please contact:
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