Epidemiology of HIV and tuberculosis in five South African correctional facilities Open Access

Stevenson, Kelsey (2017)

Permanent URL: https://etd.library.emory.edu/concern/etds/kd17ct18s?locale=en


Background: South Africa is home to the world's largest HIV epidemic, and has one of the highest TB incidence rates in the world. An estimated 73% of TB patients in South Africa are coinfected with HIV. Throughout the world, prisoners are more susceptible to HIV and TB than the general public because of both the congregate nature of the prison setting, and the prevalence of high-risk behaviors among prisoners.

Objectives: This analysis aimed to compare actual practices for the HIV and TB cascades of with the official policy for screening, care, treatment, and retention of HIV and TB in correctional facilities; to determine the prevalence and proportion of persons living with HIV, TB, and HIV/TB coinfection within five facilities; and to evaluate the cross-sectional prevalence of HIV, TB, and HIV/TB coinfection, as well as any associations between demographic and clinical risk factors.

Methods: Programmatic data was collected from five South African prisons during the implementation of a program for TB screening and HIV counseling and testing. Crude associations between HIV infection, TB, HIV/TB coinfection and each independent variable were identified, and descriptive statistics were used to determine the proportion of HIV infection, TB, and HIV/TB coinfection. Logistic regression models were created to determine factors associated with HIV, TB, and coinfection.

Results: Retention in the TB cascade of care was better than that in the HIV cascade, but both cascades lost a proportion of those eligible at each step. Overall prevalence for HIV was found to be 17.1%, and TB prevalence was 0.5% with variability across facilities. Logistic models demonstrated associations between risk factors at varied on the basis of known disease status.

Conclusion: Due to the amount of previously undiagnosed HIV and TB detected through this screening program, routine screening is recommended for all prisoners upon entry and routinely throughout the period of incarceration. Incarceration can be a valuable opportunity for identifying and treating patients that would otherwise be difficult to reach. This is key, as failing to address these infections in prison is a risk not only to the health of prisoners and prison workers, but to the broader public.

Table of Contents

HIV, globally and in sub-Saharan Africa...3
Tuberculosis, globally and in sub-Saharan Africa...5
HIV and tuberculosis in correctional settings...8
HIV and tuberculosis in South African correctional settings...10
Current HIV and tuberculosis testing and care algorithms in South African correctional facilities...11
Objective and aims...15
Data source...16
Study population...17
Sampling frame...17
Cascades of care...24
HIV cascade...24
TB cascade...24
HIV/TB coinfection cascade...25
HIV, TB, and HIV/TB coinfection prevalence and proportion...26
Associations between HIV and demographic and clinical factors...26
Associations between TB and demographic and clinical factors...27

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