The Guidance provides scientific advice on different options for active case finding among people in prison in order to diagnose a range of communicable diseases early. For this, ECDC and the EMCDDA systematically retrieved and assessed the evidence on the effectiveness of active case finding interventions for blood-borne viruses, sexually transmitted infections and tuberculosis in prison settings in the European Union and European Economic Area.
Interrupting transmission with test-and-treat approach
Compared to the general public, people in prison have a higher burden of communicable diseases such as hepatitis B (HBV), hepatitis C (HCV) and HIV, syphilis, gonorrhoea, chlamydia and tuberculosis (TB). This constitutes a health risk for those living, and working, in prison settings as well as for the general population, given that the majority of people in prisons return to their communities after a short period of incarceration (median length of detention in Europe is less than nine months).
The ECDC–EMCDDA Guidance is based on consultations with a panel of prison experts, and identifies the most (cost-) effective approaches with the aim to interrupt transmission in, and between, prison settings as well as the community, by first testing and then offering treatment to those infected.
Diagnosing infectious diseases in the prison population is challenged by several factors such as the silent nature of many chronic infections, particularly in early stages of infection, limited health literacy and reticent health-seeking behaviour. Suboptimal access to care in prison settings adds to the problem. According to the principle of equivalence of care, people in prison should enjoy an equivalent standard of care as in the community. Yet, their health needs tend to be greater.