Book traversal links for 2.5.2 Implementation considerations
A prisoner is anyone held in a criminal justice facility or correctional facility during the investigation of a crime, anyone awaiting trial and anyone who has been sentenced. In addition, people residing in a correctional facility are almost always in close contact with several other inmates; thus, whenever a person residing in a prison is diagnosed with TB, prisoners who have been in close contact with that person should be investigated (see Recommendation 4). People who work in prisons and other penitentiary institutions are also at high risk of exposure to TB and should also be eligible for screening.
At a minimum, screening in prisons and other penitentiary institutions should always include screening when a person enters a detention facility, annual screening and screening upon release to prevent the reintroduction of TB into the broader community. Treatment and follow up after release should also be ensured.
Screening in prisons should be combined with efforts to improve living conditions and provide infection control measures. If possible, TB screening in prisons and other penitentiary institutions should be combined with screening for other diseases, including HIV, and health-promotion activities targeted towards people in these institutions. When starting screening, it is important to ensure that high-quality treatment and effective case management are in place, as well as effective mechanisms for continuing treatment after transfer or release. For recommendations on and operational aspects associated with TB care and prevention in prisons and other penitentiary institutions, see WHO’s Guidelines for the control of tuberculosis in prisons (29). However, even if TB management practices are suboptimal, screening may be initiated to assess the burden of undetected TB among inmates to provide a rationale for strengthening general diagnostic and treatment services for TB, as well as implementing measures to improve infection control and living conditions. In addition to systematic screening, any inmate who develops symptoms suggestive of TB should have easy access to diagnostic testing. People identified through screening and presumed to have TB disease but in whom active TB has not been diagnosed, should be informed about the importance of seeking medical care if TB symptoms continue, emerge, re-emerge or worsen.