Farhoudi Behnam, SeyedAlinaghi SeyedAhmad, Tabarsi Payam, Mohraz Minoo, Golrokhy Raheleh, Farnia Marzieh, Shahbazi Mohammad, Alasvand Ramin, Ebrahimi Bahman, Esfehani Jafar, Tashakoriyan Mehrzad
Clinical Research Development Center, Amir-Almomenin Hospital, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran.
Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran.
Infect Disord Drug Targets. 2018;18(1):72-80. doi: 10.2174/1871526517666170518093529.
To evaluate the feasibility of the revised "Clinical Guideline for HIV and TB" in the Great Tehran Prison during October 2013 to June 2014.
The guideline includes all aspects of HIV/TB diagnosis based on active case finding (ACF), treatment and care services. Before the implementation, a focus group discussion was conducted, and attended by experts on prison health. The objective was to identify defects and limitations of the guideline. After the discussion, the guideline was revised. The Great Tehran Prison contains three separate units; all prisoners are taken first to "reception and identification unit (quarantine)" and then send to two housing units according to their legal status. An HIV ACF strategy was employed in the quarantine, and two units through a voluntary provider-initiated HIV testing. Three staff of the triangular clinic trained the prisoners about common routes of HIV transmission and the symptoms of TB in the units. In the quarantine, all prisoners were examined for all HIV-risk factors, HIV testing and symptoms of TB. In unit one, healthcare staff continued the ACF process, while in unit two, the peers of prisoners were assigned as the healthcare communicators to proceed with the strategy. At this caring process, when the test result was positive, then the process of care, treatment and follow ups was initiated. Moreover, the use of directly observed therapy (DOT) for antiretroviral therapy (ART) and TB was applied to the sick prisoners. There was also a follow-up caring for released prisoner to refer them to care and treatment services outside the prison.
The guideline was implemented in the prison successfully.
Regarding feasibility of the guideline, the investigators of this study suggest that the guideline should be implemented in other prisons across the country.
评估经修订的《艾滋病毒与结核病临床指南》于2013年10月至2014年6月在德黑兰大监狱实施的可行性。
该指南涵盖基于主动病例发现（ACF）的艾滋病毒/结核病诊断、治疗及护理服务的各个方面。在实施前，开展了一次焦点小组讨论，监狱卫生专家参加了此次讨论。目的是找出该指南的缺陷与局限性。讨论之后，对该指南进行了修订。德黑兰大监狱包含三个独立单元；所有囚犯首先被送至“接待与识别单元（检疫）”，然后根据其法律身份被送往两个居住单元。在检疫单元采用了艾滋病毒主动病例发现策略，在两个居住单元通过自愿的提供者发起的艾滋病毒检测开展相关工作。三角诊所的三名工作人员在各单元对囚犯进行了关于艾滋病毒常见传播途径及结核病症状的培训。在检疫单元，对所有囚犯进行了艾滋病毒风险因素、艾滋病毒检测及结核病症状的检查。在第一单元，医护人员继续进行主动病例发现工作，而在第二单元，囚犯同伴被指定为医护沟通者以推进该策略。在这一护理过程中，检测结果呈阳性时，便启动护理、治疗及随访程序。此外，对患病囚犯采用了直接观察治疗（DOT）以进行抗逆转录病毒治疗（ART）及结核病治疗。还对获释囚犯进行了随访护理，以便将他们转介至监狱外的护理及治疗服务机构。
该指南在监狱成功实施。
关于该指南的可行性，本研究的调查人员建议应在全国其他监狱实施该指南。
