title: Screening for tuberculosis and testing for human immunodeficiency virus in Zambian prisons.
abstract: OBJECTIVE
  To improve the Zambia Prisons Service's implementation of tuberculosis screening and human immunodeficiency virus (HIV) testing.
  
  
  METHODS
  For both tuberculosis and HIV, we implemented mass screening of inmates and community-based screening of those residing in encampments adjacent to prisons. We also established routine systems – with inmates as peer educators – for the screening of newly entered or symptomatic inmates. We improved infection control measures, increased diagnostic capacity and promoted awareness of tuberculosis in Zambia's prisons.
  
  
  RESULTS
  In a period of 9 months, we screened 7638 individuals and diagnosed 409 new patients with tuberculosis. We tested 4879 individuals for HIV and diagnosed 564 cases of infection. An additional 625 individuals had previously been found to be HIV-positive. Including those already on tuberculosis treatment at the time of screening, the prevalence of tuberculosis recorded in the prisons and adjacent encampments – 6.4% (6428/100,000) – is 18 times the national prevalence estimate of 0.35%. Overall, 22.9% of the inmates and 13.8% of the encampment residents were HIV-positive.
  
  
  CONCLUSIONS
  Both tuberculosis and HIV infection are common within Zambian prisons. We enhanced tuberculosis screening and improved the detection of tuberculosis and HIV in this setting. Our observations should be useful in the development of prison-based programmes for tuberculosis and HIV elsewhere.
authors.affiliation: Centre for Infectious Disease Research in Zambia, 5032 Great North Road, PO Box 34681, Lusaka, 10101, Zambia .
authors.forename: Katie R
authors.initials: KR
authors.lastname: Maggard
authors.affiliation: Centre for Infectious Disease Research in Zambia, 5032 Great North Road, PO Box 34681, Lusaka, 10101, Zambia .
authors.forename: Sisa
authors.initials: S
authors.lastname: Hatwiinda
authors.affiliation: University of Alabama at Birmingham, Birmingham, United States of America .
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: Harris
authors.affiliation: Centre for Infectious Disease Research in Zambia, 5032 Great North Road, PO Box 34681, Lusaka, 10101, Zambia .
authors.forename: Winifreda
authors.initials: W
authors.lastname: Phiri
authors.affiliation: Centre for Infectious Disease Research in Zambia, 5032 Great North Road, PO Box 34681, Lusaka, 10101, Zambia .
authors.forename: Annika
authors.initials: A
authors.lastname: Krüüner
authors.affiliation: Centre for Infectious Disease Research in Zambia, 5032 Great North Road, PO Box 34681, Lusaka, 10101, Zambia .
authors.forename: Kaunda
authors.initials: K
authors.lastname: Kaunda
authors.affiliation: University of Alabama at Birmingham, Birmingham, United States of America .
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: Topp
authors.affiliation: National Tuberculosis and Leprosy Control Programme, Ministry of Health, Lusaka, Zambia .
authors.forename: Nathan
authors.initials: N
authors.lastname: Kapata
authors.affiliation: Zambia AIDS Related Tuberculosis Project, Lusaka, Zambia .
authors.forename: Helen
authors.initials: H
authors.lastname: Ayles
authors.affiliation: Zambia Prisons Service, Ministry of Home Affairs, Kabwe, Zambia .
authors.forename: Chisela
authors.initials: C
authors.lastname: Chileshe
authors.affiliation: University of Alabama at Birmingham, Birmingham, United States of America .
authors.forename: German
authors.initials: G
authors.lastname: Henostroza
authors.affiliation: Centre for Infectious Disease Research in Zambia, 5032 Great North Road, PO Box 34681, Lusaka, 10101, Zambia .
authors.forename: Stewart E
authors.initials: SE
authors.lastname: Reid
mesh_terms: D000328:Adult; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology; D006266:Health Education / Q000458:organization & administration; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D017053:Infection Control / Q000458:organization & administration; D008297:Male; D008403:Mass Screening / Q000458:organization & administration*; D008875:Middle Aged; D015995:Prevalence; D011330:Prisons / Q000458:organization & administration*; D014376:Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology; D015024:Zambia / Q000453:epidemiology