South Africa’s overcrowded prisons have become breeding grounds for tuberculosis (TB), putting thousands of inmates and people who work at the Department of Correctional Services (DCS) at high risk of contracting the infectious disease.

However, South Africa’s prisons are making notable strides in the fight against TB through the National TB Programme, which focuses on TB and HIV/AIDS. The programme addresses TB risks in the prison system where inmates and DCS workers face overcrowded conditions and where the prison design of many facilities can exacerbate the problem, which in turn can filter back into their communities.

According to non-profit organisation that supports and delivers prevention, care and treatment services for HIV and TB, Right to Care, the programme is showing significant results.

The organisation supports 81 correctional centres in 13 management areas in two of six regions; KwaZulu-Natal and Free State/Northern Cape.

According to the data, TB screening of inmates has increased to more than 90% on admission with almost 180,000 screened on admission for TB since the programme began in 2014. Almost 32,000 people were screened for TB using chest x-rays in this financial year after exceeding previous targets.

This was revealed at a five day TB and HIV/AIDS meeting with representation from DCS in three provinces, the National Department of Health Global Fund, Right to Care and various other partners.

Some highlights include that based on preliminary data available from the Free State/Northern Cape and Kwa-Zulu Natal regions, 82% of inmates on antiretroviral therapy (ART) are virally suppressed.  In line with the National Development Plan 2030, the UN Sustainable Development Goals and UNAIDS 90-90-90 targets of 2020, Universal Test and Treat was also implemented last September within correctional centres. This strategy aims at ensuring that all people who test HIV positive are initiated immediately on ART regardless of CD4 count, increasing health outcomes and reducing the transmission of HIV.

Furthermore, waiting lists for ART initiation has also been reduced due to 105 nurses who have been specifically trained to initiate antiretroviral treatment.

In nine months, all supported centres have transitioned onto the National Department of Health electronic patient database. Infection prevention and control activities and support is being implemented across supported facilities by committees and pharmacy therapeutic committees have been established.

There has been an increase in peer educators who are fellow inmates and officials being trained on adherence and support groups have also helped to improve inmate access to care and treatment adherence.

Targets achieved by Right to Care include:

  • HIV counselling and testing (HCT) = 133 654 (July 2014 – Jan 2017)
  • Comprehensive prevention package = 9785 (Nov 2016 – Jan 2017)
  • TB screened = 430 106 (July 2014 – Jan 2017)
  • Initiated on antiretroviral treatment on Universal Test and Treat = 2 445 (Sept 2016 – Jan 2017)
  • Initiated on TB treatment = 1239 (July 2014 – Jan 2017)
  • Trained on TB/HIV = 2644 (April 2016 – Jan 2017)
  • On the Department of Health’s electronic patient database phase 3 & 4 = 79 facilities (March 2016 – Jan 2017)

The impetus for this programme is to align with the WHO guidelines and the United Nation’s Sustainable Development Goal 3, which ensures healthy lives and promotes well-being for all and to end the epidemics of AIDS, TB and other communicable diseases by 2030. It also addresses the UNAIDS Fast-Track strategy to end AIDS by 2030 and the 90-90-90 targets for 2020. DCS continues to work towards achieving these targets.

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