The End Tuberculosis Strategy by the World Health Organization (WHO) aims to gain a 90% reduction in TB incidence by 2035. However, achieving this target requires more than the current 2% annual decline, according to Mabud et al. (2019). Additionally, a significant obstacle that needs to be overcome is the elimination of institutional amplifiers. Institutional amplifiers are high-burden populations and sub-populations that serve as reservoirs or amplifiers for TB epidemics. Low and middle-income countries and prisons are plausible candidates as institutional amplifiers for TB, according to Mabud et al., 2019). According to WHO (2016), male correctional facilities in the US account for up to 25% of the total TB cases in the country. This, therefore, leads to the research question on what measures should be taken to mitigate the spread of tuberculosis in all-male correctional facilities.
Answering the research question, however, requires looking into why TB is more common in correctional facilities as well as the challenges preventing tuberculosis control. In correctional facilities, inmates live in close quarters. According to Lambert et al. (2016), these living quarters are poorly ventilated, thus creating the requisite conditions that favor the growth and spread of TB.
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Secondly, offenders are often moved between facilities. If they have TB, they will not only spread the disease but also risk the lives of the public when infected inmates have served their sentences or are released on parole. However, the same happens in the community, people sometimes live and work in close quarters, yet these environments do not qualify as institutional amplifiers. What makes prisons different is that some of the incarcerated people have risk factors or comorbidities for TB, such as substance abuse (Dara et al., 2015).
Additionally, most of these inmates are more likely to have latent TB, which may develop to active TB months or years later, sometimes when still incarcerated or when living in the community. According to Mabud et al. (2019), such cases occur because prisons rely on passive case detection. Therefore, unless an inmate becomes symptomatic or during a diagnostic workup, an inmate with TB will remain a risk for themselves and others around them. WHO recommends that prisons switch to active case detection, which includes screening upon entry and regular screening of inmates for latent tuberculosis (Mabud et al., 2019).
Theoretically, these active case management measures could enable not only early detection and treatment but also enable evidence-based preventative measures to be taken. Additionally, they could potentially eliminate prisons as institutional amplifiers. There is low evidence, however, that prisons are implementing the recommended preventative and protective measures (Mabud et al., 2019). This, therefore, requires an examination of the challenges and factors that prevent the implementation of the recommendations made by WHO.
The first challenges are not financial in that the prison systems are unreluctant to invest in the health outcomes of their guests. Instead, it is the unavailability of adequate medical staff. As a result, on-site medical staff might be intermittent, making it impossible to actively monitor inmate health and treat all latent cases of TB before it becomes active (Sarang et al., 2016). Secondly, transporting off-site for medical appointments is not only expensive and time-consuming but also risky in that the low-security environment could result in the inmates escaping from custody.
Besides, after being released from the facility, there are no mechanisms to locate them in the community to follow-up. Additionally, these mechanisms also lack release planning while referring to the recently released inmates to public health practitioners and services that takes additional time and resources. Given the challenges outlined, it is still unclear how research has yet to go mainstream and prompt regulatory bodies to create policies that enforce the implementation of measures to mitigate the spread of tuberculosis in all-male correctional facilities.
Research into prison systems, however, is faced with several problems. For instance, data on TB is not available in the public sphere. Additionally, there are no studies that have used data to correlate the release of inmates from prison and community epidemics (Mabud et al., 2019). This lack of data also leaves researchers unable to quantitatively study tuberculosis dynamics in prisons and in the community. This, therefore, impedes the development of interventions to fight TB in correctional facilities. This study aims to fill this gap using existing data and studies to determine the measures that should be taken to mitigate the spread of tuberculosis in all-male correctional facilities.
References
Dara, M., Acosta, C. D., Melchers, N. V. V., Al-Darraji, H. A., Chorgoliani, D., Reyes, H., ... & Migliori, G. B. (2015). Tuberculosis control in prisons: current situation and research gaps. International Journal of Infectious Diseases , 32 , 111-117.
Lambert, L. A., Armstrong, L. R., Lobato, M. N., Ho, C., France, A. M., & Haddad, M. B. (2016). Tuberculosis in Jails and Prisons: United States, 2002−2013. American Journal of Public Health, 106 (12), 2231-2237. doi:https://dx.doi.org/10.2105%2FAJPH.2016.303423
Mabud, T. S., de Lourdes Delgado Alves, M., Ko, A. I., Basu, S., Walter, K. S., Cohen, T., ... & Andrews, J. R. (2019). Evaluating strategies for control of tuberculosis in prisons and prevention of spillover into communities: An observational and modeling study from Brazil. PLoS medicine , 16 (1), e1002737.
Sarang, A., Platt, L., Vyshemirskaya, I., & Rhodes, T. (2016). Prisons as a source of tuberculosis in Russia. International journal of prisoner health .
WHO. (2016, April 19). Tuberculosis in Prisons . Retrieved from World Health Organization: https://www.who.int/tb/areas-of-work/population-groups/prisons-facts/en/
