Intensified tuberculosis and HIV surveillance in a prison in Northeast India: Implementation research
Intensified tuberculosis and HIV surveillance in a prison in Northeast India: Implementation research
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DOI：
10.1371/journal.pone.0219988
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发表时间：
2019-07-29
期刊：
影响因子：
3.7
通讯作者：
Chhakchhuak, Lily
中科院分区：
文献类型：
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作者：
Bhatnagar, Tarun;Ralte, Malsawmtluangi;Chhakchhuak, Lily
监狱中的结构和个人因素对艾滋病毒/结核病的发现和管理构成挑战。世卫组织和印度的艾滋病毒/结核病控制方案建议加强监狱中的病例发现。艾滋病毒和结核病检测率低表明，在米佐拉姆首府艾扎维尔的监狱卫生保健系统内，现有的监测战略执行不力。我们探讨了在艾扎维尔中央监狱实施强化案件发现策略的操作可行性。我们透过对新犯人进行入境检查、对住校犯人进行集体检查，以及在获释时进行出境检查，以加强检查。我们在监狱内建立了数字化胸部X光检查、痰涂片显微镜检查和艾滋病毒检测设施，并转介到外部设施进行基于核酸扩增测试（CBNAAT）。我们筛选了738名囚犯（男性：626人;女性：112人）。在53%有结核病症状的犯人中，37%接受了痰镜检。我们发现了14个新的结核病病例，总的结核病阳性率为1.9%。我们对657名囚犯中的65%进行了艾滋病毒检测，其中发现了41例新病例;总体艾滋病毒阳性率为16.5%。三名男囚犯同时感染艾滋病毒和结核病。尽管存在某些挑战，但在部门间协调下，在监狱中加强结核病/艾滋病毒病例检测是可行的。
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.