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

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Open Forum Infectious Diseases

Background: Tuberculosis (TB) prevalence is high in correctional facilities in southern Africa. With support from local South African nongovernmental organizations, the South African Department of Correctional Services initiated a program of systematically screening newly admitted and current inmates for symptoms followed by GeneXpert Mycobacterium tuberculosis (MTB)/rifampicin (Rif) for microbiologic testing of symptomatic inmates.

Methods: We conducted a program evaluation during a 5-month window describing program reach, effectiveness, adoption within the facilities, cost, and opportunities for sustainability. This evaluation included 4 facilities (2 large and 2 smaller) with a total daily census of 20,700 inmates.

Results: During the 5-month evaluation window from May to September 2013, 7426 inmates were screened at the 4 facilities. This represents screening 87% of all new admits (the remaining new admits were screened by correctional staff only and are not included in these statistics) and 23% of the daily inmate census, reaching 55% of the overall screening target as calculated per annum. The reach ranged from 57% screened during these 5 months at one of the smaller facilities to 13% at the largest facility. Two hundred one cases of pulmonary TB were diagnosed, representing 2.1% of the screened population; 93% had documented initiation of TB treatment. The cost per TB case identified was $1513, excluding treatment costs (with treatment costs it was $1880).

Conclusions: We reached a large number of inmates with high-volume screening and effectively used GeneXpert MTB/Rif to diagnose pulmonary TB and rapidly initiate treatment. The cost was comparable to other screening programs.

Zishri V, Charalamous S, Shah M, Chihota V, Page-Shipp L, Churchyard G, Hoffman C. Implementing a large scale systematic tuberculosis screening program in correctional facilities in South Africa. Open Forum Infect Dis. 2015 Jan 8;2(1):ofu121. doi: 10.1093/ofid/ofu121. PMID: 25884008; PMCID: PMC4396427.

  • The Aurum Institute , Johannesburg , South Africa

  • School of Public Health, University of Witwatersrand, Johannesburg , South Africa