title: Tuberculosis and HIV control in sub-Saharan African prisons: "thinking outside the prison cell".
abstract: Tuberculosis is one of the fastest-growing epidemics in prison populations in sub-Saharan Africa (SSA), constituting a threat to both inmates and the wider community. Various factors have contributed to the breakdown of tuberculosis control in prison facilities in SSA, including slow and insensitive diagnostics, failing prison infrastructure, inadequate funding, and weak prevention and treatment interventions for human immunodeficiency virus (HIV). In this article, we describe the challenges inherent in current approaches to tuberculosis control in prisons and consider the alternatives. We argue that although improved implementation of conventional tuberculosis control activities is necessary, considerable investment in a broader range of public health interventions, including infrastructure and staffing upgrades, cutting-edge tuberculosis diagnostics, and combination prevention for HIV, will be equally critical. This combination response to tuberculosis in prisons will be essential for tackling existing and nascent prison tuberculosis epidemics and will require high-level political support and financing.
authors.affiliation: Centre for Infectious Disease Research in Zambia, Lusaka, Zambia. stewart.reid@cidrz.org
authors.forename: Stewart E
authors.initials: SE
authors.lastname: Reid
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: Topp
authors.forename: Eleanor R
authors.initials: ER
authors.lastname: Turnbull
authors.forename: Sisa
authors.initials: S
authors.lastname: Hatwiinda
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: Harris
authors.forename: Katie R
authors.initials: KR
authors.lastname: Maggard
authors.forename: Sarah T
authors.initials: ST
authors.lastname: Roberts
authors.forename: Annika
authors.initials: A
authors.lastname: Krüüner
authors.forename: Jill C
authors.initials: JC
authors.lastname: Morse
authors.forename: Nathan
authors.initials: N
authors.lastname: Kapata
authors.forename: Chileshe
authors.initials: C
authors.lastname: Chisela
authors.forename: German
authors.initials: G
authors.lastname: Henostroza
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D019380:Anti-HIV Agents / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use; D035843:Biomedical Research / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control*; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D011159:Population Surveillance; D011330:Prisons; D014376:Tuberculosis / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control*
chemical_list: D019380:Anti-HIV Agents; D000995:Antitubercular Agents