Large scale TB screening in prisons, jails can be done, should be done, researchers say

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OFIDA program that screened more than 7000 inmates for tuberculosis at four South Africa correctional facilities showed that a large number of inmates could be diagnosed with TB and quickly begin treatment in a setting where confronting the disease is widely considered critical to broader public health objectives, an article released today in Open Forum Infectious Diseases says. The authors say the results counter arguments that large scale screening, diagnosis and treatment of TB in correctional settings is cost prohibitive and impractical. An evaluation of the program found that screening and using GeneXpert technology in the prisons and jails led to 201 diagnoses of the disease, and the start of treatment for at least 187 of those inmates.

The cost per patient identified with tuberculosis added up to $1513, and with the cost of treatment came to $1880, comparable to screening programs elsewhere, according to the authors of Implementing a Large-Scale Systematic Tuberculosis Screening Program in Correctional Facilities in South Africa. The benefit, they indicate, is priceless in settings with high prevalence of tuberculosis as well as high transmission risks, from which inmates return to their own communities. The authors point to studies in Zambia as well as South Africa showing TB prevalence of nearly 3-to-4 percent among inmate populations and modeling studies indicating that as much as 17.2 percent of tuberculosis among communities in low and middle income countries can be attributed to transmission from people who were infected with the disease while incarcerated.

The authors believe their findings can be applied broadly, supplying information on costs and approaches to other correctional settings. At the same time they note indications that the number of cases detected fell short of the actual number of cases in the settings. They also suggest additional measures to control TB in prisons and jails, including treatment of tuberculosis infection in those who are not yet sick, and addressing environmental factors in those settings that increase risks of transmission.

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