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TB in prisons
IUATLD Webinar, 9 March 2016
IUATLD Webinar
9 March 2015
Dr Masoud Dara, Senior Advisor, WHO Office at European Union,
programme manager a.i. TB and M/XDR-TB programme, WHO Regional
Office for Europe
Tuberculosis in prisons
© Maxim Dondiuk
© Carl Cordonnier
© Carl Cordonnier
© Maxim Dondiuk
TB in prisons
IUATLD Webinar, 9 March 2016
Outline of presentation
• A short overview of global and Regional TB
epidemiology
• Prison data worldwide
• European data
• Factors contributing to prison outcomes
• UNION Statement (Time to Act)
TB in prisons
IUATLD Webinar, 9 March 2016
The Global Burden of TB -2014
Estimated
number of cases
Estimated
number of deaths
All forms of TB
HIV associated TB
MDR TB
9.6 million
1.2 million (12%)
480,000
1.7 million
390,000
190,000
TB in prisons
IUATLD Webinar, 9 March 2016
Prisons
• ‘Prison’ is a term used for any place of detention.
• On any day, it is estimated that the world’s prisons hold
8-10 million prisoners.
• 4-6 times this number pass through prisons each year,
because of the high turnover of the population.
World Prison Population List (tenth edition), Roy Walmsley
TB in prisons
IUATLD Webinar, 9 March 2016
Prison population
• The highest prison population rate is in USA – 716
per 100 000 of population.
• Prison population increased by 25-30% within 15
years, while world population about 20%.
• 2014 – prison population rate was about 144 per
100 000 world population, while the respective rate in
2013 was 136 per 100 000.
«World Prison Population List (tenth edition) Roy Walmsley»
5
TB in prisons
IUATLD Webinar, 9 March 2016
Distribution of TB and MDR TB burden
across the WHO Regions
281
28
117
37
211
85
133
0
50
100
150
200
250
300
AFR AMR EMR EUR SEAR WPR Global
Incid
ence r
ate
per
100,0
00
AFR 11%
AMR 2%
EMR 5%
EUR 24% SEAR
34%
WPR 24%
Estimated incidence rate of TB in WHO Regions, 2014 Distribution of MDR TB cases per WHO Regions, 2014
TB in prisons
IUATLD Webinar, 9 March 2016
TB burden is unequally distributed across
countries at the Region
Source: European Centre for Disease Prevention and Control/WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2016.
Stockholm: European Centre for Disease Prevention and Control; 2016
WHO European Region, 1980-2014
Notification (18 High-priority
countries)
Estimated incidence (53
Member States)
Notification rate (53 Member
States)
Notification (European
Union/European Economic
Area (EU/EEA))
30.5 37
58.9
12.2
0
10
20
30
40
50
60
70
80
90
Rate
per
100 0
00 p
opula
tion
TB in prisons
IUATLD Webinar, 9 March 2016
TB in prisons
IUATLD Webinar, 9 March 2016
Although anyone can be infected by TB, it is mostly a disease that is
associated with social exclusion, vulnerability and imprisonment
6.5% of
new TB cases in
the Region occur
in prisons
© Maxim Dondiuk
TB in prisons
IUATLD Webinar, 9 March 2016
In 10 countries in Region TB rate in prison
population exceeds 1000 cases per 100,000
0
500
1,000
1,500
2,000
2,500
TB
rate
in
pri
so
n p
er
100,0
00
Countries reporting TB notification rate in prisons in WHO European region,
2013
TB in prisons
IUATLD Webinar, 9 March 2016
Relative Risk of TB in prison vs. general population,
WHO European Region
3.1
22.3
24.1
48.1
1 11 21 31 41 51
United Kingdom
Bosnia and Herzegovina
Turkey
Ireland
Hungary
Belarus
Netherlands
Romania
Croatia
Estonia
Poland
Serbia
Armenia
Lithuania
Kyrgyzstan
Georgia
Israel
Ukraine
Tajikistan
Moldova
Kazakhstan
Portugal
Czech Republic
Macedonia
18 HPCs
Russia
Bulgaria
WHO Region
Latvia
Azerbaijan
Luxembourg
Belgium
Kosovo
Slovakia
Relative Risk
TB Relative Risk in prisons
is ranging from 3 to 48
Overall, in the Region the
TB rate in prisons about 24
times is higher compared to
general population in 2013
TB in prisons
IUATLD Webinar, 9 March 2016
Treatment outcome in prison and civilian
population, WHO European region, 2013
62.1 76.9
8.7
4.9
3.5
7.4
3.9
6.0 21.8
4.8
Prison Civilian Population
Not-evaluated
Lost
Died
Failed
Success
Chance of positive treatment outcome
among new and relapse TB cases
among prisoners is only
62% vs.77% observed in civilian
population in WHO European
Region.
TB in prisons
IUATLD Webinar, 9 March 2016
Factors leading to treatment failure
Patients related factors
Medical services related factors
13
PS related
factors
TB in prisons
IUATLD Webinar, 9 March 2016
Patients related factors
Food refusal
HIV infection or other co-
morbidities
Drug addiction
and mental disorders
Retreatment
TB in prisons
IUATLD Webinar, 9 March 2016
Medical services related factors
Shortages in supply, quality assurance leading to delay in
diagnosis and treatment
Insufficiencies in medical staff
Inadequate commitment
Poor or non-existent coordination with MoH
Uncontrolled TB therapy
Tuberculosis control in prisons: current situation and research gaps, Dara M et al,
International Journal of Infectious Diseases March 2015, Volume 32, Pages 111–117
TB in prisons
IUATLD Webinar, 9 March 2016
TB in prisons
IUATLD Webinar, 9 March 2016
UNION Statement call for Action
1. Adapt Stop/End TB strategy in prisons
2. Conduct screening
3. Ensure infection control
4. Provide access to early diagnosis and treatment
5. Ensure early start of ARV for TB/HIV co-infected
individuals
6. Provide preventive therapy
TB in prisons
IUATLD Webinar, 9 March 2016
UNION Statement call of Action (II)
7. Ensure continuum of care
8. Monitor the situation
9. Encourage collaboration between civilian sector and
prison services
10. Provide psychological support
11. Raise awareness, educate prisoners and staff
12. Operational research
TB in prisons
IUATLD Webinar, 9 March 2016
References
http://www.prisonstudies.org/sites/prisonstudies.org/files/resources/downloads/wppl_10.pdf World
Prison Population List (tenth edition)
http://www.euro.who.int/__data/assets/pdf_file/0005/249188/Prisons-and-Health.pdf?ua=1 Prisons and
Health, WHO, 2014
http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1000381 Tuberculosis Incidence
in Prisons: A Systematic Review, 2010
http://pdf.usaid.gov/pdf_docs/PNADP462.pdf GUIDELINES FOR CONTROL OF TUBERCULOSIS IN
PRISONS, USAID ,2009
https://www.icrc.org/eng/assets/files/other/reyes_ijph_march2007.pdf Pitfalls of TB management in
prisons, revisited ICRC, 2007
http://www.ijidonline.com/article/S1201-9712(14)01747-0/fulltext Tuberculosis control in prisons:
current situation and research gaps , 2015
19
TB in prisons
IUATLD Webinar, 9 March 2016
Acknowledgement
• Dr Arax Hovhannesyan, Dr Andrei Dadu, Dr Elmira Gurbanova,
Dr Irada Mammadova
TB in prisons
IUATLD Webinar, 9 March 2016
Thank you very much
for your attention
Email: [email protected]
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© Carl Cordonnier
© Carl Cordonnier
© Carl Cordonnier
© Carl Cordonnier
© Carl Cordonnier
