Limiting the Spread

Tracking Resistance

Improving Stewardship

Developing New Solutions

Communicable diseases, such as Tuberculosis (TB), Hepatitis C (HCV), Hepatitis B (HBV), human immunodeficiency virus (HIV), and Sexually Transmitted Infections (STI) like gonorrhea and chlamydia, are over-represented in prisoners.

A new guidance highlights that incarceration represents a unique opportunity to target groups that are usually hard to reach when in the community. The European Centre for Disease Prevention and Control (ECDC) and the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) recommend as a key measure the implementation of provider-initiated active case finding at prison intake.1 Early diagnosis, including testing for resistance, followed by an appropriate treatment initiation can prevent transmission of disease, both within prison and to the wider community. This contributes to public health prevention strategies.

Figure 1. Schematic representation of the public health guidance modules.1

For TB, a variety of different diagnostic tests are available for fast active case finding at prison entry. Their usage depends on various factors such as available resources, including laboratory facilities (at national & local levels) and national/international guidelines. Usually, risk-based or questionnaire-based, screening tools are not sufficiently sensitive and should therefore not be the only method. In contrast, sputum-based tests can be easily implemented because individuals can self-collect the specimens under supervision and deliver them to the healthcare staff. Rapid WHO-endorsed tests offer clear advantages, as they do not require an advanced laboratory, they provide rapid results and information on drug-resistance, and can speed up isolation and treatment initiation. Systems that enable co-testing for TB, HIV, HBV, HCV, and STIs from non-invasive samples provide an opportunity to meet the challenges of implementing an effective active case finding strategy in prison settings.

References:
1. European Centre for Disease Prevention and Control, European Monitoring Centre for Drugs and Drug Addiction. Public health guidance on active case finding of communicable diseases in prison settings. Stockholm and Lisbon: ECDC and EMCDDA; 2018. https://ecdc.europa.eu/sites/portal/files/documents/Active-case-finding-communicable-diseases-in-prisons.pdf

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