ICMR School of Public Health, ICMR-National Institute of Epidemiology, Chennai, India.
Mizoram State AIDS Control Society, Ministry of Health and Family Welfare, Aizawl, India.
PLoS One. 2019 Jul 29;14(7):e0219988. doi: 10.1371/journal.pone.0219988. eCollection 2019.
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.
监狱的结构和个体层面的因素给艾滋病毒/结核病的检测和管理带来了挑战。世界卫生组织和印度的艾滋病毒/结核病控制项目建议在监狱中加强病例发现。在米佐拉姆邦首府艾藻尔的监狱医疗体系中，艾滋病毒和结核病的低检出率表明现有监测策略的实施效果不佳。我们探讨了在艾藻尔中央监狱实施强化病例发现策略的操作可行性。我们通过新囚犯入监筛查、在监囚犯大规模筛查和出狱前筛查来实施强化筛查。我们在监狱内设立了数字 X 光摄影、痰涂片显微镜检查和艾滋病毒检测设施，并将其转介到外部机构进行基于试剂盒的核酸扩增检测（CBNAAT）。我们筛查了 738 名囚犯（男性：626 名；女性：112 名）。53%有疑似结核病症状的囚犯中，有 37%接受了痰显微镜检查。我们发现了 14 例新的结核病病例；总结核病阳性率为 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；总艾滋病毒阳性率为 16.5%。3 名男性囚犯同时感染了艾滋病毒和结核病。尽管存在一定挑战，但通过部门间协调，在监狱中实施结核病/艾滋病毒强化病例发现是可行的。
