Implementing a large-scale systematic tuberculosis screening program in correctional facilities in South Africa.

Area of Science:

• Public Health
• Infectious Disease Control
• Correctional Healthcare

Background:

• Tuberculosis (TB) poses a significant health challenge in southern African correctional facilities.
• A program was established to systematically screen inmates for TB symptoms.
• GeneXpert Mycobacterium tuberculosis (MTB)/rifampicin (Rif) was utilized for microbiologic testing.

Purpose of the Study:

• To evaluate the reach, effectiveness, adoption, cost, and sustainability of a TB screening program in South African prisons.
• To assess the impact of systematic screening and GeneXpert testing on TB case detection and treatment initiation.

Main Methods:

• A 5-month program evaluation was conducted across 4 correctional facilities (2 large, 2 small) with a total inmate census of 20,700.
• Screening data from May to September 2013 were analyzed, including inmate demographics and screening percentages.
• TB case detection rates and treatment initiation were documented, alongside cost analysis per identified TB case.

Main Results:

• During the 5-month period, 7426 inmates were screened, achieving 87% of new admissions and 23% of the daily census.
• The program diagnosed 201 cases of pulmonary TB, representing 2.1% of the screened population.
• 93% of diagnosed cases had documented initiation of TB treatment, with a cost per case of $1513 (excluding treatment costs).

Conclusions:

• The TB screening program effectively reached a large inmate population and utilized GeneXpert MTB/Rif for rapid diagnosis.
• The program demonstrated success in initiating TB treatment promptly for diagnosed individuals.
• The cost of the screening program was found to be comparable to other existing TB screening initiatives.