Intensified tuberculosis and HIV surveillance in a prison in Northeast India: Implementation research.

Tarun Bhatnagar,Chawnglungmuana Chawnglungmuana,Lalhriatzuali Ralte,Lily Chhakchhuak,Malsawmtluangi Ralte,L Sundaramoorthy,Kwasi Torpey

doi:10.1371/journal.pone.0219988

Tarun Bhatnagar, Chawnglungmuana Chawnglungmuana + Show 5 more

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https://doi.org/10.1371/journal.pone.0219988

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Abstract

Structural and individual level factors in prisons create challenges towards detection and management of HIV/tuberculosis. WHO and India’s HIV/tuberculosis control programs recommend intensified case finding in prisons. Low HIV and tuberculosis detection rates suggest poor implementation of existing surveillance strategies within the prison healthcare system in Mizoram’s capital city of Aizawl. We explored the operational feasibility of implementing the intensified case finding strategy in Aizawl central prison. We implemented the intensified screening through entry screening of new inmates, mass screening of resident inmates and exit screening at release. We set up digital chest radiography, sputum smear microscopy and HIV testing facilities within the prison and referral to external facility for Cartridge Based Nucleic Acid Amplification Test (CBNAAT). We screened 738 inmates (Male: 626; Female: 112). Of 53% inmates having presumptive tuberculosis symptoms, 37% underwent sputum microscopy. We detected 14 new tuberculosis cases; overall tuberculosis positivity 1.9%. We tested 65% of 657 inmates for HIV, of which 41 new cases were detected; overall HIV positivity 16.5%. Three male inmates had HIV-tuberculosis co-infection. It is feasible to implement intensified case detection for tuberculosis/HIV in the prison with inter-departmental coordination, albeit with certain challenges.

Highlights

The Global Plan to End TB 2016–2020 provides strategies to preventing TB, active case finding and contact tracing, including work in varied epidemic and socioeconomic environments with the target of reaching at least 90% of the most vulnerable, underserved, at-risk populations [1]
Two-thirds of the eligible inmates were tested for human immunodeficiency virus (HIV), of which 41 new cases were detected with an overall HIV positivity of 16.5%, including known positives, much higher than 10% prevalence among PWID in Aizawl
Active involvement of key stakeholders including the prison officials, State Tuberculosis and State AIDS Control Societies and SHALOM, a local NGO was critical in effective implementation of the interventions

Summary

Introduction

The Global Plan to End TB 2016–2020 provides strategies to preventing TB, active case finding and contact tracing, including work in varied epidemic and socioeconomic environments with the target of reaching at least 90% of the most vulnerable, underserved, at-risk populations [1]. Overcrowding, inadequate ventilation, and lack of quarantine facilities promote efficient transmission of tuberculosis [6,7,8] This is further exacerbated by individual level factors, including concomitant HIV infection, poor nutrition and hygiene, drug addiction, needle sharing and unsafe sex [9,10,11]. Poor contact detection, inadequate treatment, high turnover of prisoners, and poor implementation of infection control measures hamper tuberculosis control in prisons [5,12] Structural issues such as lack of training in standard tuberculosis treatment and care practices, insufficient laboratory capacity and diagnostic tools, interrupted supply of medicines, weak integration between civilian and prison medical services, and low policy/funding priority for prison healthcare create additional challenges [7,11,13]

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