Status of Tuberculosis services in Indian Prisons.
BACKGROUND
Prisons are known to be a high risk environment for tuberculosis (TB) due to overcrowding, low levels of nutrition, poor infection control and lack of accessible healthcare services. India has nearly 1400 prisons housing 0.37 million inmates. However, information on, availability of diagnostic and treatment services for TB in the prison settings is limited. This study examined the availability of TB services in prisons of India. Simultaneously, prison inmates were screened for tuberculosis.


METHODS
The study was conducted in 157 prisons across 300 districts between July-December 2013. Information on services available and practices followed for screening, diagnosis and treatment of TB was collected. Additionally, the inmates and prison staff were sensitised on TB using interpersonal communication materials. The inmates were screened for cough ≥2 weeks as a symptom of TB. Those identified as presumptive TB patients (PTBP) were linked with free diagnostic and treatment services.


RESULTS
Diagnostic and treatment services for TB were available in 18% and 54% of the prisons respectively. Only half of the prisons screened inmates for TB on entry, while nearly 60% practised periodic screening of inmates. District level prisons (OR, 6.0; 95% CI, 1.6-22.1), prisons with more than 500 inmates (OR, 52; 95% CI, 1.4-19.2), and prisons practising periodic screening of inmates (OR, 2.7; 95% CI, 1.0-7.2) were more likely to diagnose TB cases. 19% of the inmates screened had symptoms of TB (cough ≥2 weeks) and 8% of the PTBP were diagnosed with TB on smear microscopy.


CONCLUSIONS
The TB screening, diagnostic and treatment services are sub-optimal in prisons in India and need to be strengthened urgently.
International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India. Electronic address: BMPrasad@theunion.org.
Banuru Muralidhara
BM
Prasad
International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India.
Badri
B
Thapa
International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India.
Sarabjit Singh
SS
Chadha
International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India.
Anand
A
Das
International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India.
Entoor Ramachandra
ER
Babu
International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India.
Subrat
S
Mohanty
International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India.
Sripriya
S
Pandurangan
International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India.
Jamhoih
J
Tonsing
D000995:Antitubercular Agents / Q000627:therapeutic use; D003371:Cough / Q000382:microbiology; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007194:India; D017053:Infection Control / Q000458:organization & administration; D008400:Mass Chest X-Ray / Q000706:statistics & numerical data; D008403:Mass Screening; D008853:Microscopy; D009752:Nutritional Status; D015995:Prevalence; D011329:Prisoners; D011330:Prisons; D014374:Tuberculin Test / Q000706:statistics & numerical data; D014376:Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy* / Q000517:prevention & control
D000995:Antitubercular Agents
Active Case Finding; India; Prison; Project Axshya; Tuberculosis