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Tuberculosis Control in Prisons: A Manual for Programme Managers

(World Health Organization / Red Cross, 2002, with PAHO collaboration)

E-book
(176 pp, PDF, 2197 KB)
Table of Contents (PDF, 61 KB)

Objective: To provide a practical tool for health workers considering embarking on TB control programs in prisons, covering structural and administrative, as well as medical issues.

Purpose: Applicable tool for TB specialists who may have little knowledge of the prison context as well as for for prison health professionals who may have less specialized knowledge of TB. It is primarily designed for use in settings where there is a high incidence of TB and limited resources.

Key Messages

Overview

The need to effectively address tuberculosis (TB) control in prisons in all countries is becoming increasingly understood by governments, National Tuberculosis Programs (NTPs), international organizations and donors.

This involves recognition of the following:

• TB does not respect man-made boundaries, be they prison walls or international frontier.
• High levels of TB in prisons have a significant impact on the levels of TB in the community at large.
• Conditions within prison encourage the transmission of TB, often turning prisons into reservoirs of the disease.
• Governments have a duty to protect prisoners from harm and to provide access to a standard of health care at least equivalent to that in the community.

The 1998 WHO/ICRC book Guidelines for the Control of Tuberculosis in Prisons provides useful information concerning the technical implementation of the WHO recommended DOTS strategy (see Section 2.3) for TB control in prisons.

However, since its publication it has become clear that an expanded management policy is required to address the many structural and administrative aspects of prison systems that affect TB control. These include the following:

• The effects of high incarceration rates and poor living conditions on the epidemiology of TB.
• Access to diagnosis and effective treatment for all prisoners with TB.
• Continuity and equity of care between civilian and prison sectors.

TB control in prisons must not be undertaken as an isolated technical program. It should form part of an integrated and comprehensive effort to improve health inside and outside prisons.

The manual uses lessons learnt in the field of the practical difficulties of managing TB in prisons and offers recommendations to be used by all authorities and institutions implementing such programs. However, there are still many issues that need to be resolved; and in some instances, a lack of data with which to draw conclusions or derive policies at the current time. These issues include the efficacy, feasibility and cost-effectiveness of strategies for the active management of MDR-TB, active case-finding, and occupational protection. Where possible, suggestions are made for field evaluation; and, as more information comes to light, it is likely that more concrete recommendations can be provided in the future.