HIV and tuberculosis in prisons in sub-Saharan Africa

Telisinghe, Lilanganee, Charalambous, Salome, Topp, Stephanie M., Herce, Michael E., Hoffmann, Christopher J., Barron, Peter, Schouten, Erik J., Jahn, Andreas, Zachariah, Rony, Harries, Anthony D., Beyrer, Chris, and Amon, Joseph J. (2016) HIV and tuberculosis in prisons in sub-Saharan Africa. Lancet, 388 (10050). pp. 1215-1227.

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Abstract

Given the dual epidemics of HIV and tuberculosis in sub-Saharan Africa and evidence suggesting a disproportionate burden of these diseases among detainees in the region, we aimed to investigate the epidemiology of HIV and tuberculosis in prison populations, describe services available and challenges to service delivery, and identify priority areas for programmatically relevant research in sub-Saharan African prisons. To this end, we reviewed literature on HIV and tuberculosis in sub-Saharan African prisons published between 2011 and 2015, and identified data from only 24 of the 49 countries in the region. Where data were available, they were frequently of poor quality and rarely nationally representative. Prevalence of HIV infection ranged from 2·3% to 34·9%, and of tuberculosis from 0·4 to 16·3%; detainees nearly always had a higher prevalence of both diseases than did the non-incarcerated population in the same country. We identified barriers to prevention, treatment, and care services in published work and through five case studies of prison health policies and services in Zambia, South Africa, Malawi, Nigeria, and Benin. These barriers included severe financial and human-resource limitations and fragmented referral systems that prevent continuity of care when detainees cycle into and out of prison, or move between prisons. These challenges are set against the backdrop of weak health and criminal-justice systems, high rates of pre-trial detention, and overcrowding. A few examples of promising practices exist, including routine voluntary testing for HIV and screening for tuberculosis upon entry to South African and the largest Zambian prisons, reforms to pre-trial detention in South Africa, integration of mental health services into a health package in selected Malawian prisons, and task sharing to include detainees in care provision through peer-educator programmes in Rwanda, Zimbabwe, Zambia, and South Africa. However, substantial additional investments are required throughout sub-Saharan Africa to develop country-level policy guidance, build human-resource capacity, and strengthen prison health systems to ensure universal access to HIV and tuberculsosis prevention, treatment, and care of a standard that meets international goals and human rights obligations.

Item ID: 44765
Item Type: Article (Research - C1)
ISSN: 1474-547X
Additional Information:

This is the fifth in a Series of six papers about HIV and related infections in prisoners.

Funders: National Institute on Drug Abuse (NIDA), Open Society Foundations (OSF), United Nations Population Fund (UNPF), Johns Hopkins University Center for AIDS Research (JHUCAR), National Institutes of Health (NIH)
Projects and Grants: JHUCAR a National-Institutes-of-Health-funded programme; 1P30AI094189
Date Deposited: 12 Sep 2016 04:01
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111799 Public Health and Health Services not elsewhere classified @ 40%
11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111706 Epidemiology @ 40%
16 STUDIES IN HUMAN SOCIETY > 1605 Policy and Administration > 160508 Health Policy @ 20%
SEO Codes: 92 HEALTH > 9204 Public Health (excl. Specific Population Health) > 920404 Disease Distribution and Transmission (incl. Surveillance and Response) @ 30%
92 HEALTH > 9205 Specific Population Health (excl. Indigenous Health) > 920599 Specific Population Health (excl. Indigenous Health) not elsewhere classified @ 40%
94 LAW, POLITICS AND COMMUNITY SERVICES > 9404 Justice and the Law > 940408 Rehabilitation and Correctional Services @ 30%
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