Cross-sectional assessment of tuberculosis and HIV prevalence in 13 correctional facilities in Zambia

Abstract

ObjectiveTo determine the prevalence of tuberculosis (TB) and HIV in 13 Zambian correctional facilities.MethodsCross-sectional study.Setting13 correctional facilities in seven of the 10 provinces in Zambia.ParticipantsAll incarcerated individuals were eligible for TB and HIV screening and testing. Of the total study population of 9695 individuals, which represent 46.2% of total correctional population at the beginning of the study, 8267 and 8160 were screened for TB and HIV, respectively.InterventionsTB and HIV screening and testing was done between July 2018 and February 2019.Primary outcome measuresAll forms of TB, bacteriologically confirmed TB, drug-resistant TB, HIV.ResultsPrevalence of all forms of TB and bacteriologically confirmed TB was 1599 (1340–1894) per 100 000 population and 1056 (847–1301) per 100 000 population, respectively. Among those with bacteriologically confirmed TB, 4.6% (1.3%–11.4%) had drug-resistant TB.There was no statistically significant difference in the prevalence of all forms of TB, bacteriologically confirmed TB and drug resistant TB between adults and juveniles: (p=0.82), (p=0.23), (p=0.68) respectively. Of the bacteriologically confirmed TB cases, 28.7% were asymptomatic. The prevalence of HIV was 14.3% (13.6%–15.1%). The prevalence of HIV among females was 1.8 times the prevalence of HIV among males (p=0.01).ConclusionCompared with the study in 2011 which screened inmates representing 30% of the country’s inmate population, then the prevalence of all forms of TB and HIV in correctional facilities has reduced by about 75% and 37.6%, respectively. However, compared with the general population, the prevalence of all forms of TB and HIV was 3.5 and 1.3 times higher, respectively. TB/HIV programmes in correctional facilities need further strengthening to include aspects of juvenile-specific TB programming and gender responsive HIV programming.

Experiences of Justice-Involved People Transitioning to HIV Care in the Community After Prison Release in Lusaka, Zambia: A Qualitative Study

“…incarcerated at any given time. 2 HIV prevalence in this population is estimated to range from 14.3% to 27.4%, [3][4][5][6][7] rates that are considerably higher than that seen in the general population. 8 There is increasing recognition that to achieve the "95-95-95" goals set by the Joint United Nations Programme on HIV/AIDS for 2030, 9 greater attention must be given to ensuring high levels of HIV testing, antiretroviral therapy (ART) initiation, and treatment maintenance among incarcerated and other key populations.…”

Human immunodeficiency virus care and management in incarcerated populations in Sub-Saharan Africa between 2010 and 2022: A narrative review

“…Six studies assessed interventions involving screening campaigns that estimated the prevalence of HIV in prisons across different countries. 8,17,24,26,34,36 On the one hand, the studies suggest weak HIV infection control practices in SSA prisons in terms of screening at entry, during incarceration, and at exit from prison. This is reflected in the low proportion of inmates who knew their HIV status prior to screening.…”

“…The most common approach reported in these studies involved mass screening of inmates, with findings indicating a higher prevalence of HIV in prison settings compared to national estimates. 17,24,26,34,36 For example, Maggard et al, reported an HIV prevalence of 22.9% during a mass screening of inmates in six prison facilities in Zambia. 34 In another screening campaign in five South African correctional facilities, Stevenson et al found an estimated HIV prevalence of 17.7% with most (73.4%) being previously undiagnosed.…”

“…26 Prevalence rates of HIV were found to be considerably higher among female prisoners compared to male prisoners. 17,24 Studies that reported screening of new prison entrants suggest lower HIV prevalence rates in these populations compared to existing inmates and those exiting prison. 24,36 Two studies 34,36 included screening of encampment residents with findings suggesting that prevalence rates among encampment residents are relatively higher compared to the general population.…”

Peer community health workers improve HIV testing and ART linkage among key populations in Zambia: retrospective observational results from the Z‐CHECK project, 2019–2020

“…There are an estimated 26,840 people who inject drugs (PWID), with an HIV prevalence of 24% [ 8 ]. Over 22,000 people are incarcerated, with HIV prevalence estimates ranging from 14% to 27% [ 16 , 17 , 18 ]. Overall, KPs face high HIV prevalence resulting from complex determinants of transmission risk, including structural and individual factors [ 19 , 20 ].…”