Charalambous Salome, Velen Kavindhran, Rueda Zulma, Croda Julio, Herce Michael E, Shenoi Sheela V, Altice Frederick L, Muyoyeta Monde, Telisinghe Lily, Grandjean Louis, Keshavjee Salmaan, Andrews Jason R
The Aurum Institute, Johannesburg, South Africa; School of Public Health, Wits University, Johannesburg, South Africa; Division of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, CT, USA.
The Aurum Institute, Johannesburg, South Africa.
Lancet Public Health. 2023 Apr;8(4):e305-e310. doi: 10.1016/S2468-2667(23)00002-6. Epub 2023 Feb 10.
People deprived of liberty have among the highest rates of tuberculosis globally. The incidence of tuberculosis is ten times greater than the incidence of tuberculosis in the general population. In 2021, WHO updated its guidance to strongly recommend systematic screening for tuberculosis in prisons and penitentiary systems. Which case-finding strategies should be adopted, and how to effectively implement these strategies in these settings, will be crucial questions facing ministries of health and justice. In this Viewpoint, we review the evidence base for tuberculosis screening and diagnostic strategies in prisons, highlighting promising approaches and knowledge gaps. Drawing upon past experiences of implementing active case-finding and care programmes in settings with a high tuberculosis burden, we discuss challenges and opportunities for improving the tuberculosis diagnosis and treatment cascade in these settings. We argue that improved transparency in reporting of tuberculosis notifications and outcomes in prisons and renewed focus and resourcing from WHO and other stakeholders will be crucial for building the commitment and investments needed from countries to address the continued crisis of tuberculosis in prisons.
在全球范围内，被剥夺自由的人群中结核病发病率极高。其结核病发病率比普通人群高出十倍。2021年，世界卫生组织更新了指南，强烈建议在监狱和感化系统中对结核病进行系统筛查。应采用哪些病例发现策略，以及如何在这些环境中有效实施这些策略，将是卫生和司法部面临的关键问题。在本观点文章中，我们回顾了监狱中结核病筛查和诊断策略的证据基础，突出了有前景的方法和知识空白。借鉴过去在结核病负担较高地区实施主动病例发现和护理项目的经验，我们讨论了在这些环境中改善结核病诊断和治疗流程的挑战与机遇。我们认为，提高监狱中结核病通报和结果报告的透明度，以及世界卫生组织和其他利益相关者重新关注并提供资源，对于促使各国做出承诺并投入所需资源以应对监狱中持续的结核病危机至关重要。
