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Accepted (AM)Open Access (License Unspecified), Open
Journal article
HIV and tuberculosis in prisons in sub-Saharan Africa
The Lancet (British edition), v 388(10050), pp 1215-1227
17 Sep 2016
PMID: 27427448
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Given the dual epidemics of HIV and tuberculosis in sub-Saharan Africa and evidence suggesting a disproportionate burden of these diseases among detainees in the region, we aimed to investigate the epidemiology of HIV and tuberculosis in prison populations, describe services available and challenges to service delivery, and identify priority areas for programmatically relevant research in sub-Saharan African prisons. To this end, we reviewed literature on HIV and tuberculosis in sub-Saharan African prisons published between 2011 and 2015, and identified data from only 24 of the 49 countries in the region. Where data were available, they were frequently of poor quality and rarely nationally representative. Prevalence of HIV infection ranged from 2.3% to 34.9%, and of tuberculosis from 0.4 to 16.3%; detainees nearly always had a higher prevalence of both diseases than did the non-incarcerated population in the same country. We identified barriers to prevention, treatment, and care services in published work and through five case studies of prison health policies and services in Zambia, South Africa, Malawi, Nigeria, and Benin. These barriers included severe financial and human-resource limitations and fragmented referral systems that prevent continuity of care when detainees cycle into and out of prison, or move between prisons. These challenges are set against the backdrop of weak health and criminal-justice systems, high rates of pre-trial detention, and overcrowding. A few examples of promising practices exist, including routine voluntary testing for HIV and screening for tuberculosis upon entry to South African and the largest Zambian prisons, reforms to pre-trial detention in South Africa, integration of mental health services into a health package in selected Malawian prisons, and task sharing to include detainees in care provision through peer-educator programmes in Rwanda, Zimbabwe, Zambia, and South Africa. However, substantial additional investments are required throughout sub-Saharan Africa to develop country-level policy guidance, build human-resource capacity, and strengthen prison health systems to ensure universal access to HIV and tuberculsosis prevention, treatment, and care of a standard that meets international goals and human rights obligations.
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Details
- Title
- HIV and tuberculosis in prisons in sub-Saharan Africa
- Creators
- Lilanganee Telisinghe - University of BristolSalome Charalambous - Aurum InstituteStephanie M. Topp - James Cook UniversityMichael E. Herce - Centre for Infectious Disease Research in ZambiaChristopher J. Hoffmann - Johns Hopkins MedicinePeter Barron - University of the WitwatersrandErik J. Schouten - Public Health Institute of MalawiAndreas Jahn - Ministry of HealthRony Zachariah - Médecins Sans FrontièresAnthony D. Harries - London School of Hygiene & Tropical MedicineChris Beyrer - Johns Hopkins UniversityJoseph J. Amon - Johns Hopkins University
- Publication Details
- The Lancet (British edition), v 388(10050), pp 1215-1227
- Publisher
- Elsevier
- Number of pages
- 13
- Grant note
- MR/N020618/1 / MRC; UK Research & Innovation (UKRI); Medical Research Council UK (MRC) Open Society Foundations MR/N020618/1 / Medical Research Council; UK Research & Innovation (UKRI); Medical Research Council UK (MRC) 1P30AI094189 / Johns Hopkins University Center for AIDS Research (National-Institutes-of-Health) National Institute on Drug Abuse; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute on Drug Abuse (NIDA) ACF-2012-25-011 / National Institute for Health Research; National Institute for Health Research (NIHR) UN Population Fund
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Community Health and Prevention
- Web of Science ID
- WOS:000383703100035
- Scopus ID
- 2-s2.0-84986254726
- Other Identifier
- 991021895671104721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Infectious Diseases