Poor continuity of care for TB diagnosis and treatment in Zambian Prisons: a situation analysis

Authors

Hatwiinda S, Topp SM, Siyambango M, Harris JB, Maggard KR, Chileshe C, Kapata N, Reid SE, Henostroza G.

Journal

Trop Med Int Health. 2017 Dec 12. doi: 10.1111/tmi.13024. [Epub ahead of print]

OBJECTIVES:

Prisons act as infectious disease reservoirs. We aimed to explore the challenges of TB control and continuity of care in prisons in Zambia.

METHODS:

We evaluated treatment outcomes for a cohort of inmates diagnosed with TB during a TB REACH-funded screening program initiated by the Zambia Prisons Service and the Centre for Infectious Disease Research in Zambia (CIDRZ).

RESULTS:

Between October 2010 and September 2011, 6,282 inmates from six prisons were screened for TB, of whom 374 (6.0%) were diagnosed. TB treatment was initiated in 345/374 (92%) inmates. Of those, 66% were cured or completed treatment, 5% died and 29% were lost-to-follow-up. Amongst those that were lost-to-follow-up, 11% were released into the community and 13% were transferred to other prisons.

CONCLUSIONS:

Weak health care within the Zambian prison service currently undermines continuity of care, despite intensive TB screening and case finding interventions. In order to prevent TB transmission and the development of drug resistance, we need sufficient numbers of competent staff for health care, reliable health information systems including electronic record keeping for prison facilities, and standard operating procedures to guide surveillance, case-finding and timely treatment initiation and completion.