title: An audit of tuberculosis health services in prisons and immigration removal centres.
abstract: Tuberculosis (TB) is the second leading cause of death worldwide due to a single infectious agent. Rates of active TB in places of prescribed detention (PPD), which include Prisons, Young Offender Institutions and Immigration Removal Centres, are high compared with the general population. PPD therefore present an opportunity to develop targeted health programmes for TB control. This audit aims to assess current service provisions and identify barriers to achieving best practice standards in PPD across London.
  
  
  
  Twelve healthcare teams within PPD commissioned by NHS England (London Region) were included in the audit. Services were evaluated against the National Institute for Health and Care Excellence standards for TB best practice.
  
  
  
  None of the health providers with a digital X-ray machine were conducting active case finding in new prisoners and no health providers routinely conduct Latent TB infection testing and preventative treatment. Barriers to implementing standards include the lack of staff skills and staff skills mix, structural and technical barriers, and demands of custodial and health services.
  
  
  
  This audit restates the importance of national public health TB strategies to consider healthcare provisions across PPD.
authors.affiliation: School of Law, Royal Holloway University of London, Egham Hill, Egham, Surrey, TW20 0EX, UK.
authors.forename: Anita
authors.initials: A
authors.lastname: Mehay
authors.affiliation: Public Health England (London Region), 4th Floor, Southside, 105, Victoria Street, London, SW1E 6QT, UK.
authors.forename: Thara
authors.initials: T
authors.lastname: Raj
authors.affiliation: NHS England and Public Health England, PHE Colindale, 61 Colindale Avenue, London NW9 5EQ, UK.
authors.forename: Lynn
authors.initials: L
authors.lastname: Altass
authors.affiliation: Wellington House, 135-155 Waterloo Road, London SE1 8UG, UK.
authors.forename: Autilia
authors.initials: A
authors.lastname: Newton
authors.affiliation: Public Health England, Premier House, 60 Caversham Road, Reading RG1 7EB, UK.
authors.forename: Eamonn
authors.initials: E
authors.lastname: O'Moore
authors.affiliation: Public Health England, Block 2, FERA, Sand Hutton, York YO41 1LZ, UK.
authors.forename: Cathie
authors.initials: C
authors.lastname: Railton
authors.affiliation: NHS England (London Region) 4th Floor, Southside, 105, Victoria Street, London, SW1E 6QT, UK.
authors.forename: Hong
authors.initials: H
authors.lastname: Tan
authors.affiliation: University College Hospital, 235 Euston Road, London NW1 2BU, UK.
authors.forename: Al
authors.initials: A
authors.lastname: Story
authors.affiliation: School of Law, Royal Holloway University of London, Egham Hill, Egham, Surrey, TW20 0EX, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Frater
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000627:therapeutic use*; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D004641:Emigration and Immigration / Q000706:statistics & numerical data*; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D008131:London; D008297:Male; D008875:Middle Aged; D011329:Prisoners / Q000706:statistics & numerical data*; D011330:Prisons / Q000706:statistics & numerical data*; D014376:Tuberculosis / Q000188:drug therapy*
chemical_list: D000995:Antitubercular Agents
keywords: health services; management and policy; prisons