title: Implementing a large-scale systematic tuberculosis screening program in correctional facilities in South Africa.
abstract: Background.  Tuberculosis (TB) prevalence is high in correctional facilities in southern Africa. With support from local South African nongovernmental organizations, the South African Department of Correctional Services initiated a program of systematically screening newly admitted and current inmates for symptoms followed by GeneXpert Mycobacterium tuberculosis (MTB)/rifampicin (Rif) for microbiologic testing of symptomatic inmates. Methods.  We conducted a program evaluation during a 5-month window describing program reach, effectiveness, adoption within the facilities, cost, and opportunities for sustainability. This evaluation included 4 facilities (2 large and 2 smaller) with a total daily census of 20 700 inmates. Results.  During the 5-month evaluation window from May to September 2013, 7426 inmates were screened at the 4 facilities. This represents screening 87% of all new admits (the remaining new admits were screened by correctional staff only and are not included in these statistics) and 23% of the daily inmate census, reaching 55% of the overall screening target as calculated per annum. The reach ranged from 57% screened during these 5 months at one of the smaller facilities to 13% at the largest facility. Two hundred one cases of pulmonary TB were diagnosed, representing 2.1% of the screened population; 93% had documented initiation of TB treatment. The cost per TB case identified was $1513, excluding treatment costs (with treatment costs it was $1880). Conclusions.  We reached a large number of inmates with high-volume screening and effectively used GeneXpert MTB/Rif to diagnose pulmonary TB and rapidly initiate treatment. The cost was comparable to other screening programs.
authors.affiliation: The Aurum Institute , Johannesburg , South Africa.
authors.forename: Vincent
authors.initials: V
authors.lastname: Zishiri
authors.affiliation: The Aurum Institute , Johannesburg , South Africa ; School of Public Health , University of Witwatersrand , Johannesburg , South Africa.
authors.forename: Salome
authors.initials: S
authors.lastname: Charalambous
authors.affiliation: School of Public Health , University of Witwatersrand , Johannesburg , South Africa.
authors.forename: Maunank R
authors.initials: MR
authors.lastname: Shah
authors.affiliation: The Aurum Institute , Johannesburg , South Africa.
authors.forename: Violet
authors.initials: V
authors.lastname: Chihota
authors.affiliation: The Aurum Institute , Johannesburg , South Africa.
authors.forename: Liesl
authors.initials: L
authors.lastname: Page-Shipp
authors.affiliation: The Aurum Institute , Johannesburg , South Africa ; School of Public Health , University of Witwatersrand , Johannesburg , South Africa.
authors.forename: Gavin J
authors.initials: GJ
authors.lastname: Churchyard
authors.affiliation: The Aurum Institute , Johannesburg , South Africa ; Johns Hopkins University School of Medicine , Baltimore, Maryland.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Hoffmann
keywords: Africa; correctional facility; implementation; systematic screening; tuberculosis