1. Communicable Diseases in Prisons, Threats and Opportunities
© Carl Cordonnier
© Carl Cordonnier
© Maxim Dondiuk
© Maxim Dondiuk
Communicable Diseases in Prisons, Threats and Opportunities
Vilnius Summit
1 July 2016
Dr Masoud Dara, Team Leader, TB and M/XDR-TB, Joint TB, HIV/AIDS and Malaria programme, WHO Regional Office for Europe

2. Outline of presentation
A short overview of Prison population globally and in WHO European Region
Prisons specifications in relation to communicable diseases
TB as an example of CDs in prison
Factors contributing to prison outcomes
UNION Statement (Time to Act)

3. World Prison Population List (tenth edition), Roy Walmsley
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. 
‘Prison’ is a term used for any place of detention. It includes centres for pre-trial and convicted prisoners as well as centres for juvenile offenders and illegal immigrants.
World Prison Population List (tenth edition), Roy Walmsley

4. Prison population
The highest prison population rate is in USA – per of population.
Prison population increased by 25-30% within 15 years, while world population about 20%.
2014 – prison population rate was about 144 per world population, while the respective rate in 2013 was 136 per
«World Prison Population List (tenth edition) Roy Walmsley»

5. General prison population in Europe*: around ~770 000
2000 prisons in 30 European countries
Prison Population Rate*100,000: : 130
Russia: 475; US: 716
4 % women (~ )
17 countries with overcrowding
16 % average foreigners
1/4 prisoners no final sentence
Mainly short sentences
High recidivism
Sources: SPACE 2014 – Council of Europe
* Europe: 28 EU countries, Norway and Turkey;
International Centre for Prison Studies

6. Threats Vulnerability to communicable disease before imprisonment
Stress, overcrowding, nutrition
High risk behaviors in prisons: peer pressure, smoking, unprotected sex, unsafe injection
Lack of/willingness to access (to) health services, psychological aspects
High mobility and difficulties in integration after release

7. Threats (2) Health often not prioritized (versus security)
Limited staff
Inadequate link of prison and civilian services
Insufficient funding
Difficult working conditions

8. Opportunities Effective prevention and harm reduction
Promoting healthy life style
Collaboration and/or integration of health services in penitentiary and civilian sector
Involving peer-educators and ex-prisoners
Strengthening surveillance
WHO Health in prison Project

9. 6.5% of new TB cases in the WHO European Region are reported from prisons
© Maxim Dondiuk

10. In 10 countries in Region TB rate in prison population exceeds 1000 cases per 100,000
Countries reporting TB notification rate in prisons in WHO European region, 2013
Notification rates of new TB cases in prisons in all reporting countries were multiple times higher than the rates found in general population and were over 1000 per 100,000 detainees in Kosovo, Kazakhstan, Moldova, Azerbaijan, Russia, Kyrgyzstan Ukraine Georgia, Tajikistan, and Latvia.

11. TB Relative Risk in prisons is ranging from 3 to 48
Relative Risk of TB in prison vs. general population, WHO European Region
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

12. Treatment outcome in prison and civilian population, WHO European region, 2013
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.

13. Factors leading to treatment failure
Patients related factors
Medical services related factors
PS related factors

14. Patients related factors Food refusal
HIV infection or other serious co-morbidity
Drug addiction and mental disorders
Retreatment

15. Medical services related factors
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
60-70% ex-prisoners don’t refer to TB facilities after release from prisons
Medical services related factors
Shortages in supply, quality assurance leading to delay in diagnosis and treatment
Insufficiencies in medical
staff
Irregularities in TBD and reagents supply
Poor or non-existent coordination with MoH
Uncontrolled TB therapy

17. UNION Statement call for Action
Adapt stop TB strategy in prisons
Conduct screening
Ensure infection control
Provide access to early diagnosis and treatment
Ensure early start of ARV for TB/HIV coinfected individuals
Provide preventive therapy

18. UNION Statement call of Action (II)
Ensure continuum of care
Monitor the situation
Encourage collaboration between civilian sector and prison services
Provide psychological support
Raise awareness, educate prisoners and staff
Operational research

19. References
World Prison Population List (tenth edition)
Prisons and Health, WHO, 2014
Tuberculosis Incidence in Prisons: A Systematic Review, 2010
GUIDELINES FOR CONTROL OF TUBERCULOSIS IN PRISONS, USAID ,2009
Pitfalls of TB management in prisons, revisited ICRC, 2007
Tuberculosis control in prisons: current situation and research gaps , 2015

20. Acknowledgement
Dr Arax Hovhannesyan , Dr Andrei Dadu, Dr Elmira Gurbanova, Dr Irada Mammadova, Ms Nina Blinkenberg, Dr Lars Moller

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© Carl Cordonnier
© Carl Cordonnier
© Carl Cordonnier
© Carl Cordonnier
© Carl Cordonnier