title: Detention of People Lost to Follow-Up on TB Treatment in Kenya: The Need for Human Rights-Based Alternatives.
abstract: Adherence to treatment is a key element for global TB control. Public health laws can be used to enforce isolation, adherence, and completion of TB treatment. However, the practical application of public health laws can potentially range from voluntary measures to involuntary detention approaches. This paper explores the potential risks and impacts of using detention approaches to enforce TB treatment adherence. In August 2015, we conducted a literature search regarding the application of public health laws to enforce adherence to TB treatment globally, and specifically in Kenya. Texts were analyzed using narrative synthesis. Results indicated that in Kenya, people lost to follow-up on TB treatment were frequently detained in prisons. However, incarceration and detention approaches curtail the rights to health, informed consent, privacy, freedom from non-consensual treatment, freedom from inhumane and degrading treatment, and freedom of movement of people lost to follow-up. Detention could also worsen social inequalities and lead to a paradoxical increase in TB incidence. We suggest the incorporation of less intrusive solutions in legislation and policies. These include strengthening health systems to reduce dependency on prisons as isolation spaces, decentralizing TB treatment to communities, enhancing treatment education, revising the public health laws, and addressing socioeconomic and structural determinants associated with TB incidence and loss to follow-up.
authors: Senior Advisor for HIV and Health Systems at the International HIV/AIDS Alliance, Brighton, United Kingdom.
authors: Gitau
authors: G
authors: Mburu
authors: Senior Human Rights Advisor at the International HIV/AIDS Alliance, Brighton, United Kingdom.
authors: Enrique
authors: E
authors: Restoy
authors: Chief National Coordinator of the Stop TB Partnership, Kenya.
authors: Evaline
authors: E
authors: Kibuchi
authors: Lecturer in Public Health in the Division of Health Research at Lancaster University, United Kingdom.
authors: Paula
authors: P
authors: Holland
authors: Senior Advisor and Director of the Department of Research at the International Union Against Tuberculosis and Lung Disease, Paris, France, and an honorary professor at the London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors: Anthony D
authors: AD
authors: Harries
mesh_terms: D006806:Human Rights; D006801:Humans; D017053:Infection Control; D007630:Kenya; D059012:Lost to Follow-Up; D011330:Prisons / Q000706:statistics & numerical data; D011634:Public Health / Q000331:legislation & jurisprudence*; D014376:Tuberculosis / Q000188:drug therapy / Q000517:prevention & control*