BACKGROUND: Tuberculosis (TB) is more than ten times higher in prisons compared to the general population, and HIV-infected persons are at increased risk of developing active TB and death. In the World Health Organization (WHO) African region, however, where the TB and HIV coinfections are highest, and prisons rarely factored in national disease surveillance, epidemiological data to inform TB control interventions in correctional facilities is limited. In this study, we assessed the prevalence of TB and HIV coinfections, as well as the factors associated with coinfections in our study setting.
METHODS: This was a prospective cross-sectional study among 157 adult (≥ 18 years) prisoners presenting with symptoms of pulmonary TB at Shimo La Tewa Prison, Kenya, between January and June 2023. The study excluded those with a history of anti-TB drugs use or on treatment follow-up and collected demographic and clinical characteristics data using a questionnaire. Sputum samples were collected and processed immediately using Xpert® MTB/RIF assay or stored at 4 °C for three (3) days in case of delay.
RESULTS: The overall prevalence of TB among inmates with presumptive pulmonary TB was 10.2%, 95% CI 6.37-16.91% (16/157), HIV 19.1%, 95% CI 13.73-25.97% (30/157). All the TB cases were positive for HIV (16/16, 100%), translating to TB/HIV coinfection of 10.2%, 95% CI 6.37-16.91% (16/157), and there was no rifampicin resistance. TB and HIV coinfection cases were found among underweight (100%, 16/16) prisoners. The independent factors associated with TB and HIV coinfections were education level (adjusted OR = 0.17, p = 0.007), smoking history (adjusted OR = 3.01, p = 0.009) and illegal drug use history (adjusted OR = 4.55, p = 0.044).
CONCLUSIONS: We report a high prevalence of pulmonary TB and HIV coinfections among adult inmates with presumptive pulmonary TB in Kenya, with education level, smoking status, and illegal drug use as the independent factors associated with the coinfection. The authority should take measures to protect HIV-positive prisoners from TB, focusing on education, nutrition, smoking, and illegal drug use.

BACKGROUND: The rate of TB in prison institutions is estimated to be 23 times higher than in the general population. Limited documentation exists regarding TB screening in Tajikistan\'s prisons. This study aims to report findings from a TB screening conducted in prison facilities in Tajikistan.
METHODS: A systematic TB screening was conducted between July 2022 and September 2023, following a locally adapted algorithm based on WHO recommendations. The screening yield was calculated as the proportion of confirmed TB cases, with categorical variables compared using a χ2 test.
RESULTS: A total of 7,223 screenings were conducted, identifying 31 TB cases, including 17 drug-susceptible TB cases, eight drug-resistant TB cases, and six clinically diagnosed cases. The overall screening yield was 0.43%. Notably, the screening yield was 3.4% among individuals with at least one TB symptom and 0.03% among those without TB symptoms (P < 0.001).
CONCLUSIONS: The identified rate of TB in these prisons is five times higher than in the general population. Symptomatic individuals had a higher likelihood of TB diagnosis, and using chest X-rays significantly improved screening yield. We recommend increasing the capacity for chest X-ray testing to enhance TB prevention and control within prison settings.
BACKGROUND: On estime que le taux de TB dans les établissements pénitentiaires est 23 fois plus élevé que dans la population générale. Il existe peu de documentation sur le dépistage de la TB dans les prisons du Tadjikistan. Cette étude vise à rendre compte des résultats d\'un dépistage de la TB mené dans des établissements pénitentiaires au Tadjikistan.
UNASSIGNED: Un dépistage systématique de la TB a été réalisé entre juillet 2022 et septembre 2023, selon un algorithme adapté localement et basé sur les recommandations de l\'OMS. Le rendement du dépistage a été calculé comme la proportion de cas confirmés de TB, avec des variables catégorielles comparées à l\'aide d\'un test χ2.
UNASSIGNED: Au total, 7 223 dépistages ont été effectués, permettant d\'identifier 31 cas de TB, dont 17 cas de TB sensible aux médicaments, 8 cas de TB résistante aux médicaments et 6 cas diagnostiqués cliniquement. Le rendement global du criblage était de 0,43%. Notamment, le rendement du dépistage était de 3,4% chez les personnes présentant au moins un symptôme de la TB et de 0,03% chez celles ne présentant pas de symptômes de la TB (P < 0,001).
CONCLUSIONS: Le taux de TB identifié dans ces prisons est cinq fois plus élevé que dans la population générale. Les personnes symptomatiques avaient une probabilité plus élevée d\'être diagnostiquées comme atteintes de TB, et l\'utilisation de radiographies pulmonaires améliorait considérablement le rendement du dépistage. Nous recommandons d\'augmenter la capacité de dépistage par radiographie thoracique afin d\'améliorer la prévention et le contrôle de la TB en milieu carcéral.

BACKGROUND: Primary care plays a central role in most, if not all, health care systems including the care of vulnerable populations such as people who have been incarcerated. Studies linking incarceration records to health care data can improve understanding about health care access following release from prison. This review maps evidence from data-linkage studies about primary care use after prison release.
METHODS: The framework by Arksey and O\'Malley and guidance by the Joanna Briggs Institute (JBI) were used in this review. This scoping review followed methods published in a study protocol. Searches were performed (January 2012-March 2023) in MEDLINE, EMBASE and Web of Science Core Collection using key-terms relating to two areas: (i) people who have been incarcerated and (ii) primary care. Using eligibility criteria, two authors independently screened publication titles and abstracts (step 1), and subsequently, screened full text publications (step 2). Discrepancies were resolved with a third author. Two authors independently charted data from included publications. Findings were mapped by methodology, key findings and gaps in research.
RESULTS: The database searches generated 1,050 publications which were screened by title and abstract. Following this, publications were fully screened (n = 63 reviewer 1 and n = 87 reviewer 2), leading to the inclusion of 17 publications. Among the included studies, primary care use after prison release was variable. Early contact with primary care services after prison release (e.g. first month) was positively associated with an increased health service use, but an investigation found that a large proportion of individuals did not access primary care during the first month. The quality of care was found to be largely inadequate (measured continuity of care) for moderate multimorbidity. There were lower levels of colorectal and breast cancer screening among people released from custody. The review identified studies of enhanced primary care programmes for individuals following release from prison, with studies reporting a reduction in reincarceration and criminal justice system costs.
CONCLUSIONS: This review has suggested mixed evidence regarding primary care use after prison release and has highlighted challenges and areas of suboptimal care. Further research has been discussed in relation to the scoping review findings.

UNASSIGNED: Little is known about the impact of the COVID-19 pandemic on hepatitis C (HCV) screening efforts in carceral settings. We explored the impact of the pandemic on HCV screening in two of Quebec\'s largest provincial prisons.
UNASSIGNED: Retrospective data of HCV-related laboratory tests between July 2018 and February 2022 at l\'Établissement de détention de Montréal (EDM) and l\'Établissement de détention de Rivière-des-Prairies (EDRDP) were obtained. To examine the association between the pandemic and the number of HCV-antibody (HCV-Ab) tests, a three-level time period variable was created: pre-outbreak, outbreak, and post-outbreak. Negative binomial regression (with monthly admissions as an offset) was used to assess the change in HCV-Ab tests across time periods and by prisons. Adjusted odds ratios (aOR) with 95% confidence intervals (95% CI) were calculated.
UNASSIGNED: A total of 1,790 HCV-Ab tests were performed; 56 (3%) were positive. Among these, 44 (79%) HCV RNA tests were performed; 23 (52%) were positive. There was a significant decrease in HCV-Ab screening at EDM during the outbreak (aOR 0.29; 95% CI 0.17-0.48) and post-outbreak (aOR 0.49; 95% CI 0.35-0.69) periods, compared to the pre-outbreak period. There was no significant change in HCV-Ab screening at EDRDP during the outbreak (aOR 0.98; 95% CI 0.49-2.11) but a significant increase in HCV-Ab screening post-outbreak (aOR 1.66; 95% CI 1.04-2.72).
UNASSIGNED: The COVID-19 pandemic negatively affected HCV screening at EDM but had minimal impact at EDRDP. To eliminate HCV from carceral settings, minimizing screening interruptions during future outbreaks and combined HCV/SARS-CoV-2 screening should be prioritized.

UNASSIGNED: Sexually transmitted infections (STIs) cause considerable morbidity worldwide and, depending on the specific pathogen, may lead to serious complications in the female reproductive tract. Incarcerated women are particularly vulnerable to health problems with a disproportionate high rate of STIs, including infections with human papillomavirus (HPV).
UNASSIGNED: Here, cervical swab samples collected from 299 women (18 to 64 years) living in one of the women\'s prisons of São Paulo, Brazil were submitted for liquid-based cytology to determine the prevalence of precancerous lesions. Furthermore, direct detection of 30 genital HPV genotypes (18 high-risk and 12 low-risk types) and 11 additional STIs (Chlamydia trachomatis, Neisseria gonorrhoeae, Herpes simplex virus 1 and 2, Haemophilus ducreyi, Mycoplasma genitalium and hominis, Treponema pallidum, Trichomonas vaginalis, Ureaplasma parvum and urealyticum) were performed by molecular typing using two PCR-based DNA microarray systems, i.e., EUROArray HPV and EUROArray STI (EUROIMMUN), respectively.
UNASSIGNED: The overall prevalence of cytological abnormalities was 5.8%, including five women with low-grade and five women with high-grade squamous intraepithelial lesions. The overall prevalence of HPV was 62.2, and 87.1% of the HPV-positive women were infected with oncogenic high-risk (HR) HPV types. HPV types 16 (24.1%), 33 and 52 (both 10.4%) were the most frequently detected. The prevalence of the other STIs was 72.8%. Up to four different pathogens were found in the infected women, the most frequent being Ureaplasma parvum (45.3%), Mycoplasma hominis (36.2%) and Trichomonas vaginalis (24.8%).
UNASSIGNED: The high number of HR-HPV infections and other STIs described here highlights the fact that the Brazilian female prison population requires more attention in the country\'s health policies. The implementation of screening programs and treatment measures might contribute to a decrease in the incidence of STIs and cervical cancer in this vulnerable population. However, for such measures to be effective, further studies are needed to investigate the best practice to get more women to engage in in-prison prevention programs, e.g., through offering further sexual health education and self-sampling.

UNASSIGNED: The post-release period is associated with an increased risk of morbidity and mortality. Previous studies have identified deficits in pre-release planning for mentally ill people in prison, particularly in remand settings.
UNASSIGNED: We aimed to determine the proportion of mentally ill people in Ireland\'s main remand prison who were referred for mental health follow up in community and prison settings, who achieved face to face contact with the receiving service.
UNASSIGNED: This retrospective observational cohort study was based in Ireland\'s main male remand prison, Cloverhill. Participants included all those individuals on the caseload of the prison inreach mental health team who were referred for mental health follow up in community and prison settings at the time of discharge, prison transfer or release from custody over a three-year period, 2015 - 2017. Successful transfer of care (TOC) was defined as face-to-face contact with the receiving service, confirmed by written correspondence or by follow up telephone call. Clinical, demographic and offence related variables were recorded for all participants.
UNASSIGNED: There were 911 discharges from the prison inreach mental health team within the three-year study period. Of these, 121 were admitted to hospital, 166 were transferred to other prison inreach mental health services and 237 were discharged to community based mental health follow up in psychiatric outpatient or primary care settings. One third (304/911) had an ICD-10 diagnosis of schizophreniform or bipolar disorder (F20-31) and 37.5% (161/911) were homeless. Over 90% (152/166) of those referred to mental health teams in other prisons achieved successful TOC, with a median of six days to first face-to face assessment. Overall, 59% (140/237) of those referred to community psychiatric outpatient or primary care services achieved TOC following referral on release from custody, with a median of nine days from release to assessment. Clinical and demographic variables did not differ between those achieving and not achieving successful TOC, other than having had input from the PICLS Housing Support Service.
UNASSIGNED: Successful transfer of care can be achieved in remand settings using a systematic approach with an emphasis on early and sustained interagency liaison and clear mapping of patient pathways. For incarcerated individuals experiencing homelessness and mental health disorders, provision of a housing support service was associated with increased likelihood of successful transfer of care to community mental health supports.

BACKGROUND: Elimination of bloodborne viruses including HIV and hepatitis C virus from prisons requires high coverage of evidence-based interventions that prevent bloodborne virus transmission, including needle and syringe programs. Canada launched a Prison Needle Exchange Program (PNEP) in nine federal prisons in 2018; however, uptake among people who inject drugs in prison remains low. We aimed to explore barriers and facilitators to improving PNEP uptake identified by correctional officers and healthcare workers.
METHODS: Participants from nine federal prisons with PNEP completed focus groups using nominal group technique, a rapid mixed-method consensus strategy. Responses were generated, rank-ordered, and prioritized by each stakeholder group. We identified the highest-ranking responses (≥10 % of the overall votes) to questions about barriers and facilitators to PNEP uptake.
RESULTS: Between September 2023 and February 2024, 16 focus groups were conducted with 118 participants (n = 51 correctional officers; n = 67 healthcare workers). Among correctional officers, the top perceived barriers were bullying from peers (22 %), fear of being targeted by correctional officers (14 %), and fear of repercussions due to drug use (13 %). The top facilitators were safe injection sites (30 %), provision of wrap-around services (16 %), and education of correctional officers (10 %). Among healthcare workers, the top perceived barriers were lack of confidentiality (16 %), fear of being targeted by correctional officers (12 %), and a long and complex application process (11 %). The top facilitators were education of correctional officers (29 %), delivery of PNEP by an external provider (15 %), automatic approval for participation in the PNEP (13 %), and safe injection sites (12 %).
CONCLUSIONS: Multiple modifiable barriers and solutions to improving PNEP uptake in Canadian federal prisons were identified by correctional employees. Both participant groups identified the potential for safe injection sites and education to correctional officers as enabling PNEP uptake. These data will inform Canadian efforts to improve engagement and to expand PNEP coverage.

UNASSIGNED: As the number of people ageing in prison with complex healthcare needs continues to increase, so does the need for palliative care in the restrictive prison context. Palliative care for people in prison is facilitated by correctional officers, and prison- and hospital-based clinicians. A collective analysis of existing research to identify common experiences of these stakeholders globally has not been completed.
UNASSIGNED: To explore the perceptions and experiences of correctional officers and prison- and hospital-based clinicians who facilitate palliative care for people in prison.
UNASSIGNED: A systematic review and meta-synthesis.
UNASSIGNED: Keywords and subject headings related to palliative care and prisons were used to search seven databases with no time limitations. Peer-reviewed research in English, containing qualitative data from stakeholders facilitating palliative care for people in prison were included, and appraised using the CASP tool.
UNASSIGNED: Two analytical themes emerged: (i) a prison lens on a palliative approach and (ii) coping complexities. Palliative care is \'translated\' into the prison setting according to security and environmental constraints. Stakeholders experienced ethical, personal and professional difficulties, because prison-based palliative care did not align with community norms. Ambiguous policy and expectations regarding prioritising care needs and balancing custodial rules led to role stress.
UNASSIGNED: Providing palliative care for people in prison is complex and impacts stakeholders and people in prison with palliative care needs. Supporting person-centred care through a multi-service approach, stakeholder education and standards will improve the quality and accessibility of care.

This study examines the epidemiological and genomic characteristics, along with the transmission dynamics, of SARS-CoV-2 within prison units I and II in Campo Grande, Mato Grosso do Sul, Brazil. Conducted between May and October 2022, it reveals how the virus spreads in the confined settings of prisons, emphasizing the roles of overcrowded cells, frequent transfers, and limited healthcare access. The research involved 1927 participants (83.93% of the total prison population) and utilized nasopharyngeal swabs and RT-qPCR testing for detection. Contact tracing monitored exposure within cells. Out of 2108 samples, 66 positive cases were identified (3.13%), mostly asymptomatic (77.27%), with the majority aged 21-29 and varying vaccination statuses. Next-generation sequencing generated 28 whole genome sequences, identifying the Omicron variant (subtypes BA.2 and BA.5) with 99% average coverage. Additionally, the study seeks to determine the relationship between immunization levels and the incidence of SARS-CoV-2 cases within this enclosed population. The findings underscore the necessity of comprehensive control strategies in prisons, including rigorous screening, isolation protocols, vaccination, epidemiological monitoring, and genomic surveillance to mitigate disease transmission and protect both the incarcerated population and the broader community.

OBJECTIVE: Prisoners\' common mental disorders (CMDs) and their social contacts are a complex and significant concern. We have systematically investigated the relationship between social contacts (i.e. perceived, and objective social support, and loneliness) and prisoners\' mental health.
METHODS: This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA).
METHODS: A protocol was developed and registered in PROSPERO (CRD42023372942). A search strategy was applied across four databases (namely MEDLINE [via OVID SP], APA PsycINFO, Scopus, and Web of Science). The quality assessment entailed the critical appraisal skills program (CASP) Checklist for cohort studies. The data were presented through a narrative synthesis.
RESULTS: After screening, 32 studies that fulfilled the inclusion criteria were included in this review. Most were cross-sectional (k = 27), while five had a longitudinal design. The total number of study participants was 10,613. The majority of the studies reported negative correlations between perceived and objective social support and symptoms of common mental disorders (CMDs), specifically, depression, anxiety, and post-traumatic stress disorder (PTSD). The included studies appeared to indicate a correlation between loneliness and PTSD symptoms.
CONCLUSIONS: The lack of social support was linked to the development or exacerbation of CMDs in prisoners. Initiatives, such as reducing visitation barriers and providing access to technology for remote communication, can assist prisoners in strengthening their support systems and enhancing their opportunities for reintegration into society.