1. Prisons and TB in Europe
Riga, 29 May 2008
Lars Moller
Prison Health Manager
WHO-EURO

2. Estimated TB burden; world, 2006
TB incidence stable in Europe, slow decline in other WHO regions
9.2 million new TB cases
(>80% in Asia and Africa)
1.5 million TB deaths ( due to TB/HIV)
TB prevalence and mortality declining faster, but Europe and Africa will not reach the targets by 2015
MDR-TB cases
5% of MDR-TB cases are XDR-TB

3. Estimated TB incidence; EUR, 2006
TB cases (all) per 100,000 pop.
< 10
11-20
21-50
51-100
> 100
new TB cases (49 sick persons every hour)
deaths due to TB (7 deaths every hour)
Russian Fed. 11th among world TB high-burden countries
2  204 new TB cases per (Monaco  Tajikistan)

4. TB challenges in EUR
Economic recession, poverty and existence of socially vulnerable groups (homeless, unemployed, alcohol-dependent)
Health systems poorly developed or under reform, leading to ineffective TB control (non-DOTS)
High prevalence of MDR-TB
Link with HIV epidemic through injecting drugs users
Very large penitentiary system with poor TB services
Migration (East to West, South to North, internal migration)
Most cases occur in eastern Europe and in the former USSR where TB is increasing dramatically. Most countries in the former USSR have rates that are 10 times higher than those in western Europe.

5. New TB cases in prisons; EUR, 2004
37/52 (71%) countries reported to WHO-EURO on new TB cases by penal and civilian system

6. New TB cases in prisons; EEUR+, 2004

7. Main challenges for TB control in prisons
Limited access to TB diagnosis and treatment
Low political commitment (equivalence, equity)
Lack of resources (financial, material, human)
Frequent transfers between prisons
Difficult TB treatment
MDR-TB
Concomitant pathologies (HIV, hepatitis, etc.)
Poor treatment compliance (drug abuse, alcoholism)
Prison dynamics (hierarchies, violence, etc.)
Difficult follow-up after release from prison (no link with civilian system, social stigma, low education)
 Prisons reservoirs of TB in the community

8. Estimated HIV prevalence in new TB cases; EUR, 2006.
HIV in TB cases (%)
no information
<1
1-5
6-10
>10
HIV prevalence in TB cases with 3% regional average
Lack of good, reliable and country-wide information
Limited collaboration between HIV and TB programmes
Different patterns and type of co-infection in W and E
Lack of community and activists involvement

9. TB control in prisons: updating policies
For National TB Programme managers (2000)
For prison administrators (1998)

10. WHO Health in Prisons Project International Conference; Sinaia (Romania), 26 Oct 2006
In relation to the Collaborating Centre on Prison Health in London – WHO is responsible for the overall coordination of the project and
WHO is responsible for the links with governmental and non-governmental bodies at national and international level.

11. Status paper on prisons and tuberculosis (a)
Contents
Introduction
Background and epidemiology
The Stop TB Strategy
Challenges for prevention, diagnosis and treatment of TB in prisons (political commitment, infection control, case detection, standardized treatment, drug supply, monitoring and evaluation, TB/HIV, MDR-TB, community participation, advocacy-communication-social mobilization, research)
TB control in prisons: minimum standards
Also: foreword, acknowledgements, executive summary
In relation to the Collaborating Centre on Prison Health in London – WHO is responsible for the overall coordination of the project and
WHO is responsible for the links with governmental and non-governmental bodies at national and international level.

12. Status paper on prisons and tuberculosis (b)
TB control in prisons: minimum standards
The ideal TB control programme in a prison includes:
Government structures in both prison and civil sector
Written agreement between prison and civil sector
Prevention of TB (early detection, no overcrowding, good nutrition, ventilation and light, infection control)
Access to TB diagnosis and treatment for all prisoners
Equal treatment, including for MDR-TB and TB-HIV
Continued treatment following release from prison
In relation to the Collaborating Centre on Prison Health in London – WHO is responsible for the overall coordination of the project and
WHO is responsible for the links with governmental and non-governmental bodies at national and international level.

13. Status paper on prisons and tuberculosis (c)
TB control in prisons: minimum standards
The penitentiary system must have:
Adequate number of staff with updated training
Mechanism for timely investigation of TB suspects
Quality-assured smear microscopy
Quality drug susceptibility testing in reference laboratory
Supply of quality second-line drugs
Recording and reporting shared with the civil sector
In relation to the Collaborating Centre on Prison Health in London – WHO is responsible for the overall coordination of the project and
WHO is responsible for the links with governmental and non-governmental bodies at national and international level.

14. HIV prevalence (%) in selected countries

15. New cases of HIV
26%
12%
16%
32%

16. HIV prevalence in Spanish prisons