TY - JOUR
T1 - HIV and tuberculosis in prisons in sub-Saharan Africa
AU - Telisinghe, Lilanganee
AU - Charalambous, Salome
AU - Topp, Stephanie M.
AU - Herce, Michael E.
AU - Hoffmann, Christopher J.
AU - Barron, Peter
AU - Schouten, Erik J.
AU - Jahn, Andreas
AU - Zachariah, Rony
AU - Harries, Anthony D.
AU - Beyrer, Chris
AU - Amon, Joseph J.
N1 - Funding Information:
Estimation of total national funding for prevention and treatment services for HIV and tuberculosis in prisons is complicated by multiple funding sources and frequent lack of transparency in the reporting of funding. Funding can come from domestic government, NGOs, and international donor sources, and could be channelled through health, justice, or interior ministries, or through NGO interventions. Available data for domestic funding, although sought, were not comprehensive and therefore are not presented. We also sought information about international donor funding from four major funders, which is presented. Among the Global Fund to Fight AIDS, Tuberculosis and Malaria's grant agreements to 49 sub-Saharan African countries between 2005 and 2015, only 24 included indicators of prison-related HIV or tuberculosis initiatives. Total funding for these activities was less than $100 000 in seven countries; another five countries reported more than $1 000 000 in prison-related funding ( table ). In 15 countries, less than 5% of the total budget for HIV and tuberculosis programmes was allocated to interventions in prisons. Planning and budgeting documents for 2007–14 for the 21 sub-Saharan African countries that are part of the US President's Emergency Plan for AIDS Relief included references to HIV or tuberculosis programmes, or both, addressing prisoners in all countries, except South Sudan. The most frequently proposed intervention was HIV testing (16 [80%] of 20 countries). Other frequently proposed programmes mentioning prisons included HIV treatment, technical assistance, and research (11 countries [55%]); tuberculosis case-finding, abstinence, and general education about HIV prevention (eight countries [40%]); programmes for prison staff (six countries [30%]); and tuberculosis treatment (five countries [25%]). With the exception of Ethiopia and Kenya, prison-related funding for HIV and tuberculosis was rarely continuous (data not shown). Many of the interventions in which detainees were mentioned were part of larger programmes targeting most-at-risk populations, making it difficult to determine if—and the extent to which—programme activities actually included prison-specific activities. Only one prison-related programme supported by the UK Department for International Development was identified: the Evidence for HIV Prevention in Southern Africa project. This initiative provides funding for research into HIV prevention in key populations, including detainees, in sub-Saharan Africa, with two research projects funded in 2015. Although the European Union did not provide information about prison programmes funded in sub-Saharan Africa, experts in the field report two projects funded by them—a 3 year project targeting health-systems strengthening in Zambian prisons, which began in February, 2013, and a multi-year project to build prison-service capacity to protect detainees' human rights in Uganda. 103,104
Funding Information:
Good-quality data for HIV and tuberculosis in prisons in sub-Saharan Africa are rare; recent (ie, in the past 5 years) research is lacking in more than half the countries, and capacity to determine national estimates or monitor trends is limited. Available data suggest inadequate health services incommensurate with high disease burden. Funding is minimal, and policies guiding service implementation are often missing. Although some promising practices exist, increased political commitment and dedicated resources are needed to ensure universal access to high-quality prevention, treatment, and care of HIV and tuberculosis for detainees in sub-Saharan Africa. Contributors All authors contributed to the design of the study. LT, SC, SMT, MEH, CJH, and JJA undertook the searches and case studies, interpreted the findings, and wrote the Series paper. EJS, RZ, and ADH provided data or information for the study. All authors reviewed and edited the final paper. Declaration of interests We declare no competing interests. Acknowledgments This Series on HIV and prisoners was supported by grants to the Center for Public Health and Human Rights at Johns Hopkins Bloomberg School of Public Health from the National Institute on Drug Abuse, the Open Society Foundations, the UN Population Fund, and the Johns Hopkins University Center for AIDS Research (a National-Institutes-of-Health-funded programme; 1P30AI094189). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. We thank detainees throughout sub-Saharan Africa who participated in the studies cited in this paper.
Publisher Copyright:
© 2016 Elsevier Ltd
PY - 2016/9/17
Y1 - 2016/9/17
N2 - Given the dual epidemics of HIV and tuberculosis in sub-Saharan Africa and evidence suggesting a disproportionate burden of these diseases among detainees in the region, we aimed to investigate the epidemiology of HIV and tuberculosis in prison populations, describe services available and challenges to service delivery, and identify priority areas for programmatically relevant research in sub-Saharan African prisons. To this end, we reviewed literature on HIV and tuberculosis in sub-Saharan African prisons published between 2011 and 2015, and identified data from only 24 of the 49 countries in the region. Where data were available, they were frequently of poor quality and rarely nationally representative. Prevalence of HIV infection ranged from 2·3% to 34·9%, and of tuberculosis from 0·4 to 16·3%; detainees nearly always had a higher prevalence of both diseases than did the non-incarcerated population in the same country. We identified barriers to prevention, treatment, and care services in published work and through five case studies of prison health policies and services in Zambia, South Africa, Malawi, Nigeria, and Benin. These barriers included severe financial and human-resource limitations and fragmented referral systems that prevent continuity of care when detainees cycle into and out of prison, or move between prisons. These challenges are set against the backdrop of weak health and criminal-justice systems, high rates of pre-trial detention, and overcrowding. A few examples of promising practices exist, including routine voluntary testing for HIV and screening for tuberculosis upon entry to South African and the largest Zambian prisons, reforms to pre-trial detention in South Africa, integration of mental health services into a health package in selected Malawian prisons, and task sharing to include detainees in care provision through peer-educator programmes in Rwanda, Zimbabwe, Zambia, and South Africa. However, substantial additional investments are required throughout sub-Saharan Africa to develop country-level policy guidance, build human-resource capacity, and strengthen prison health systems to ensure universal access to HIV and tuberculsosis prevention, treatment, and care of a standard that meets international goals and human rights obligations.
AB - Given the dual epidemics of HIV and tuberculosis in sub-Saharan Africa and evidence suggesting a disproportionate burden of these diseases among detainees in the region, we aimed to investigate the epidemiology of HIV and tuberculosis in prison populations, describe services available and challenges to service delivery, and identify priority areas for programmatically relevant research in sub-Saharan African prisons. To this end, we reviewed literature on HIV and tuberculosis in sub-Saharan African prisons published between 2011 and 2015, and identified data from only 24 of the 49 countries in the region. Where data were available, they were frequently of poor quality and rarely nationally representative. Prevalence of HIV infection ranged from 2·3% to 34·9%, and of tuberculosis from 0·4 to 16·3%; detainees nearly always had a higher prevalence of both diseases than did the non-incarcerated population in the same country. We identified barriers to prevention, treatment, and care services in published work and through five case studies of prison health policies and services in Zambia, South Africa, Malawi, Nigeria, and Benin. These barriers included severe financial and human-resource limitations and fragmented referral systems that prevent continuity of care when detainees cycle into and out of prison, or move between prisons. These challenges are set against the backdrop of weak health and criminal-justice systems, high rates of pre-trial detention, and overcrowding. A few examples of promising practices exist, including routine voluntary testing for HIV and screening for tuberculosis upon entry to South African and the largest Zambian prisons, reforms to pre-trial detention in South Africa, integration of mental health services into a health package in selected Malawian prisons, and task sharing to include detainees in care provision through peer-educator programmes in Rwanda, Zimbabwe, Zambia, and South Africa. However, substantial additional investments are required throughout sub-Saharan Africa to develop country-level policy guidance, build human-resource capacity, and strengthen prison health systems to ensure universal access to HIV and tuberculsosis prevention, treatment, and care of a standard that meets international goals and human rights obligations.
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U2 - 10.1016/S0140-6736(16)30578-5
DO - 10.1016/S0140-6736(16)30578-5
M3 - Review article
C2 - 27427448
AN - SCOPUS:84986254726
SN - 0140-6736
VL - 388
SP - 1215
EP - 1227
JO - The Lancet
JF - The Lancet
IS - 10050
ER -