Comparison of tuberculosis indicators after implementation of the clinical protocol for tuberculosis and HIV management in Iranian prisons: a quasi-experimental study

Seyedahmad Seyedalinaghi,Mostafa Hosseini,Mohammad Shahbazi,Omid Dadras,Sirous Jafari,Minoo Mohraz,Bahar Ataeinia,Ramin Alasvand,Elham Mazaheri-Tehrani,Behnam Farhoudi

doi:10.1108/jhr-04-2019-0074

Abstract

PurposeThe aim of this study was to compare the defined indicators of tuberculosis (TB) control program in the intervention and control prisons, after implementation of the national clinical protocol for TB and HIV management in Iranian prisons, suggesting active health service provision in all steps of service provision.Design/methodology/approachThis was quasi-experimental study conducted among inmates of two prisons in Iran. Great Tehran prison was purposively chosen as the intervention prison and Karaj prison was purposively chosen as control prison as well. Intervention and control prisons were compared in terms of the TB indicators within three periods (before intervention, during implementation and follow-up period) from October 2013 to June 2014.FindingsNumber of inmates with TB symptoms who underwent TB workup was four times more in intervention prison compared to control prison (9.3 vs 2.5 cases out of 1,000 inmates per month in the case prison compared to the control prison). Such difference was also significant in the intervention prison, comparing before and during the intervention period. The patient finding in case prison increased significantly after the intervention (223.6 vs 81.8 cases out of 100,000 inmates per year). The number of TB cases who received HIV testing increased from 50 to 100%.Originality/valueActive health service provision has significantly improved indicators in the intervention prison. The authors recommend implementation of this guideline in all prisons of Iran. Integration of other diseases with high burden among prisoners is also recommended in the active health services provision.

Highlights

In 2017, the number of incarcerated people in Iran was about 230,000
Such a difference was significant in the intervention prison where the numbers of TB case finding were compared before and after the intervention period (9.3 cases with TB symptoms assessed out of 1,000 inmates in the intervention prison after intervention vs 2.0 cases out of 1,000 inmates before the intervention each month)
Due to an inadequate registration system, the healthcare workers in the control prison believed that 100% of possible TB cases had to undergo the sputum acid-fast bacillus (AFB) examination and all of them received the results of the AFB test

Summary

Introduction

In 2017, the number of incarcerated people in Iran was about 230,000. the prisoner turnover rate is around 2.5–3 times more than the prison population each year [1]. There are different risk factors for TB infection in prisons They include overcrowding, poor ventilation, malnutrition, late case detection, inadequate treatment of infectious cases, high turnover rate of prisoners, poor implementation of TB infection control measures and close contact with individuals who are already at a higher risk of TB infection (former prisoners, drug users, homeless people and illegal immigrants from endemic areas) [3]. These risk factors increase the risk of transmission of airborne infections such as TB. The high prevalence of risky behaviors such as unprotected sex, rape and unsafe injecting practices contribute to the higher risk of HIV, which dramatically increases the risk of reactivation of latent TB infection (LTBI) [4]

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