Telisinghe, L., Charalambous, S., Topp, S.M., et al. The Lancet (July), doi: 10.1016/S0140-6736(16)30578-5.
This review of 48 grey and white articles published between 2011 and 2015 examined HIV and TB epidemiology, services, and research priorities in sub-Saharan African (SSA) prisons. Data were available for 24 of 49 countries. The authors found higher HIV and TB prevalence in imprisoned populations generally, and in incarcerated females, relative to non-incarcerated populations. Policies for HIV and TB testing, care, and treatment in SSA prisons are scarce. Most prisoners with TB also experienced HIV coinfection; one study estimated that the spread of TB could be as high as 90 percent in prison. Shortages of health staff, and transfers within and out of prisons, present challenges for treatment continuity. Prisoners are often in and out of prison, indicating that addressing HIV and TB in prisons will also benefit the communities to which they return. International recommendations, which are rarely followed due to financial and policy challenges, include structural interventions that reduce the spread of TB, harm reduction/HIV prevention activities, and voluntary testing and treatment for both HIV and TB. The authors concluded that improving the HIV/TB situation in prisons would require significant political commitment, including sustainable funding, strong management, and research, along with prison system reforms to decrease exposure by reducing pre-trial court delays, and reduced sentences to limit the duration of imprisonment.