The High Burden of Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) in a Large Zambian Prison: A Public Health Alert
The High Burden of Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) in a Large Zambian Prison: A Public Health Alert
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DOI：
10.1371/journal.pone.0067338
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发表时间：
2013-08-14
期刊：
影响因子：
3.7
通讯作者：
Reid, Stewart E.
中科院分区：
文献类型：
--
作者：
Henostroza, German;Topp, Stephanie M.;Reid, Stewart E.
背景：结核病（TB）和人类免疫缺陷病毒（HIV）是非洲监狱中两个最大的健康威胁。 2010年，赞比亚传染病研究中心、赞比亚监狱管理局和国家结核病规划合作，在赞比亚六所监狱建立了结核病和艾滋病毒筛查项目。我们报告了最大的设施之一：卢萨卡中央监狱的结核病和艾滋病毒流行率数据。方法：2010 年 11 月至 2011 年 4 月期间，我们评估了进入、居住和出监狱的囚犯以及周围社区的结核病和艾滋病毒流行率。筛查方案包括完整的病史和体检、数字放射线照相、选择退出艾滋病毒咨询和检测、痰涂片和培养。结核病病例被定义为细菌学确诊或临床诊断。结果：共有 2323 名参与者完成了筛查。大多数 (88%) 为男性，中位年龄 31 岁，体重指数 21.9。 1430 人（62%）发现了结核病症状。 176 人 (7.6%) 被诊断出结核病，52 人在筛查时已在接受结核病治疗。细菌学确诊88例（3.8%），临床诊断88例（3.8%）。入境和出境干预时确诊的结核病分别为 4.6% 和 5.3%。经细菌学确诊的病例中，只有 25% (n = 22) 的涂片呈阳性。目前居住在监狱的囚犯中艾滋病毒感染率为 27.4%。 结论：无效的结核病和艾滋病毒筛查计划阻碍了监狱设施及其周边社区成功的疾病控制策略。我们发现卢萨卡中央监狱的结核病和艾滋病毒发病率大大高于赞比亚的平均水平，并且这两种疾病有集中和潜在传播的趋势在监狱内和向一般人群传播。迫切需要对机构和刑事司法改革以及监狱特定卫生系统进行投资。
Background: Tuberculosis (TB) and human immunodeficiency virus (HIV) represent two of the greatest health threats in African prisons. In 2010, collaboration between the Centre for Infectious Disease Research in Zambia, the Zambia Prisons Service, and the National TB Program established a TB and HIV screening program in six Zambian prisons. We report data on the prevalence of TB and HIV in one of the largest facilities: Lusaka Central Prison.Methods: Between November 2010 and April 2011, we assessed the prevalence of TB and HIV amongst inmates entering, residing, and exiting the prison, as well as in the surrounding community. The screening protocol included complete history and physical exam, digital radiography, opt-out HIV counseling and testing, sputum smear and culture. A TB case was defined as either bacteriologically confirmed or clinically diagnosed.Results: A total of 2323 participants completed screening. A majority (88%) were male, median age 31 years and body mass index 21.9. TB symptoms were found in 1430 (62%). TB was diagnosed in 176 (7.6%) individuals and 52 people were already on TB treatment at time of screening. TB was bacteriologically confirmed in 88 cases (3.8%) and clinically diagnosed in 88 cases (3.8%). Confirmed TB at entry and exit interventions were 4.6% and 5.3% respectively. Smear was positive in only 25% (n = 22) of bacteriologically confirmed cases. HIV prevalence among inmates currently residing in prison was 27.4%.Conclusion: Ineffective TB and HIV screening programs deter successful disease control strategies in prison facilities and their surrounding communities. We found rates of TB and HIV in Lusaka Central Prison that are substantially higher than the Zambian average, with a trend towards concentration and potential transmission of both diseases within the facility and to the general population. Investment in institutional and criminal justice reform as well as prison-specific health systems is urgently required.