Coordinating the prevention, treatment, and care continuum for HIV-associated tuberculosis in prisons: a health systems strengthening approach

Abstract

Purpose of review: To advance a re-conceptualized prevention, treatment, and care continuum (PTCC) for HIV-associated tuberculosis (TB) in prisons, and to make recommendations for strengthening prison health systems and reducing HIV-associated TB morbidity and mortality throughout the cycle of pretrial detention, incarceration, and release.

Recent findings: Despite evidence of increased HIV-associated TB burden in prisons compared to the general population, prisoners face entrenched barriers to accessing anti-TB therapy, antiretroviral therapy, and evidence-based HIV and TB prevention. New approaches, suitable for the complexities of healthcare delivery in prisons, have emerged that may address these barriers, and include: novel TB diagnostics, universal test and treat for HIV, medication-assisted treatment for opioid dependence, comprehensive transitional case management, and peer navigation, among others.

Summary: Realizing ambitious international HIV and TB targets in prisons will only be possible by first addressing the root causes of the TB/HIV syndemic, which are deeply intertwined with human rights violations and weaknesses in prison health systems, and, second, fundamentally re-organizing HIV and TB services around a coordinated PTCC. Taking these steps can help ensure universal access to comprehensive, good-quality, free and voluntary TB/HIV prevention, treatment, and care, and advance efforts to strengthen health resourcing, staffing, information management, and primary care access within prisons.

Figure 1.

A coordinated prevention, treatment, and care continuum for HIV and TB in prisons. (HIV= Human immunodeficiency virus; TB= tuberculosis; HCT= HIV counseling and testing; ART= Anti-retroviral therapy; ATT= Anti-TB therapy; VL= Viral load).

Figure 2.

Operational framework for delivering integrated TB/HIV services linked to care and treatment in prison settings over the period spanning pre-trial detention, incarceration, and release to the community. (ART= antiretroviral therapy; TB= tuberculosis; ATT= anti-tuberculosis therapy; PT= preventive therapy).