TB REACH PROGRAMME
Enhancing Tuberculosis Services in Zambian Prisons
“Good prisoner health is good public health. Prisoners come from and mostly return to the community, carrying infectious diseases from one to the other. Prison officers are also daily exposed to the conditions and health risks in prison and can expose their families and contacts outside of prison. We must ensure basic minimum standards for detainees and medical care at least equivalent to that available in the general population, in order to protect both prisoners’ rights and public health.”
(Human Rights Watch Report 2010, page 6)
The purpose of the Enhancing Tuberculosis Services in Zambian Prisons Programme is to improve the screening, diagnosis and treatment of tuberculosis (TB) infection within the Zambian Prison system focusing on 6 prisons: Lusaka Central Prison (Chimbokaila), Kabwe Complex Prisons, and Livingstone Central Prison. The aim is to identify and treat both new and existing TB infections within the inmate, prison staff, and prison camp communities and refer anyone found with TB to a district clinic for treatment under the National TB Program. A prison is not a contained space separate from the community. Individuals move regularly between the two and undiagnosed or untreated illness found in either setting moves with them. Transmission of TB infection is widespread within the prison, and if not stopped by rigorous screening and treatment, will threaten communities outside the prisons. To improve the health of Zambia, the health of Zambia’s prisoners must also improve.
Recognizing the important link between HIV and TB infection, the programme provided voluntary HIV counseling and testing to all inmates and prison staff, and referred anyone testing positive for care and treatment.
Activity: Sensitize prison officers, inmates, & community members surrounding the prisons
Result: 14,787 individuals sensitized about TB & HIV
Activity: Train prison officers & clinicians to implement the Prisons TB screening program
Result: 98 prison officers & 43 clinicians trained
Activity: Implement an inmate TB Peer Educator program
Result: 197 inmates trained as TB Peer Educators
Activity: Implement TB screening and provider initiated HIV testing & counseling (PITC) for all inmates and community members surrounding the prisons
Result: 8,026 inmates & community members underwent TB screening & PITC
7 of every 100 persons tested had TB (531 TB cases)
21 of every 100 persons tested had HIV
Activity: Improve prison infrastructure to assist in diagnosis & treatment of TB
Result: 2 TB smear microscopy laboratories built at Lusaka & Kabwe prison clinics
1 TB screening & isolation ward built at Lusaka Central Prison
From left to right: Dr. Namwinga Chintu - Deputy Director, CIDRZ; Honorable Obvious Mwaliteta, Deputy Minister of Home Affairs; Percy Chato - Commissioner of prisons; Sisa Hatwiinda - TB REACH project Coordinator
From left to right: Dr. Chileshe Chisela – Director Medical Services, Prisons; Katie Maggard- TB REACH program Manager, CIDRZ; Winifreda Phiri – Former TB REACH assistant project coordinator, CIDRZ; Marcellina Hamikondo – TB REACH nurse, CIDRZ; Gift Mulenga– TB REACH nurse, CIDRZ; Jill Morse – HIVCorps Fellow
WHO’s Stop TB Strategy was adopted by the Stop TB Partnership of which TB REACH is a programme, funded by the Canadian International Development Agency. TB REACH aims to increase early detection of infectious TB, and ensure timely treatment and high cure rates through use of Directly Observed Therapy (DOTS). TB Reach encourages the development and application of innovative techniques, interventions, approaches and activities to detect TB cases, lead to a reduced rate of transmission and prevent emergence of drug-resistant forms of TB. TB Reach focuses on contributing to health system strengthening by engaging all care providers, empowering people with TB and communities, and enabling and promoting TB research. Zambia is one of fifteen African countries that were successful in the first round of TB REACH funding.