South Africa: Thousands of prisoners may have undiagnosed TB

Seven of the country’s 287 GeneXpert rapid TB testing machines have been located in prisons

Thousands of prisoners across South Africa may have tuberculosis (TB) and have no idea, if recent studies are any indication. Now, the Department of Justice and Correctional Services (DJCS) promises an action plan to control the TB epidemic raging behind bars.

Yesterday AIDS lobby group the Treatment Action Campaign (TAC) and public interest organisation Section27 delivered the second of two memorandums at the South African TB Conference, which ends today in Durban.

Alongside the formation of an action plan to be shared with the groups, the memorandum demanded, for instance, better and more transparent monitoring of TB in prisons and its role in fueling the country’s larger TB epidemic.

The document also demanded that the DJCS follow the law and abide by its own regulations. A litany of court cases against the former Department of Correctional Services (DCS) warned the department to do the same after judgements found that

Historically, several courts have issued stern warnings to the former Department of Correctional Services that it was failing to, for instance, offer inmates appropriate health care, and regular health education and screenings. Most recently the Constitutional Court said that in contesting allegations of poor health care within its prisons that it was “defending the indefensible”.

“We can’t afford to work with a department that refuses to acknowledge the problem,” Section27 legal researcher John Stephens told Health-e News. “An alcoholic will tell you the first step to recovery is admitting you have a problem.“

€Prison overcrowding still rife

Pholo Mbele went into prison alongside his friend and co-accused. Nine years later, he walked out a free man alone after surviving three bouts of the TB that had killed his friend.

Sleeping 19 men to a cell in Durban’s Westville Prison, Mbele said that a set of three, triple-tiered bunk beds accommodated at least 12 of his cellmates. The rest bedded down nightly on foam mattresses laid out on the floor, packed so tightly that their occupants had to be awakened and asked to move if anyone needed the toilet.

“When I was diagnosed with TB I had to go back into that same cell,” said Mbele who added that he often did not have food to take with his daily TB treatment in the evenings. “You have to change the system.”

The nongovernmental organisation TB/HIV Care Association works in prisons predominately in the Eastern and Western Capes. The association’s Chief Executive Officer Harry Hausler often cells at double their capacity.

Daily food was largely limited to pap, rice, boiled cabbage and eggs, and chicken, Mbele adds. The last of this food was served at 1pm, hours before Mbele took his last daily dose of TB treatment, which clinicians instructed him should be taken with food.

A recent study by the Johannesburg-based TB research organisation Aurum Institute found that about four percent of surveyed inmates at one prison had TB and did not know it. About a quarter of inmates were also HIV-positive, doubling their TB risk.

Changes afoot in prisons

At the conference, representative from the US Centres for Disease Control (CDC), which is currently working with the Department of Health in prisons, highlighted challenges in HIV and TB care. Challenges included staff shortages, sporadic HIV and TB testing, drug stock outs and poor linkages to care for released prisoners.

To respond to challenges, seven of the country’s 287 GeneXpert rapid TB testing machines have been located in prisons, according to data from the National Health Laboratory Services (NHLS). Prisons are also being linked to national HIV and TB treatment databases to improve patients tracking and monitoring.

South Africa now has a GeneXpert machine in every public sector laboratory nationwide, according to Dr Lesley Scott who works with the NHLS and is also a professor at the University of the Witswatersrand’s Department of Molecular Medicine and Haematology.

A national task team on TB in prisons has also been formed including representatives from the DJCS, Department of Health, Right to Care and Section27.

Donor dollars usher in condoms and lubricant

Currently donor funding from the US President’s Emergency Plan for AIDS Relief and the international financing mechanism the Global Fund to Fight AIDS, TB and Malaria is set to support further improvement in prisons through local nongovernmental organisations such as Aurum, Right to Care and the TB/HIV Care Association.

The TB/HIV Care Association is currently training prison nurses to initiate HIV treatment and offering medical male circumcisions. Donor has also been used to procure male condoms and lubricant for distribution in prisons. This involved a special tender to purchase thicker and larger condoms to accommodate anal sex, according to Right to Care Development Manager Ian Ralph.

He added that the roll out of GeneXpert machines in prisons has led to a massive increase in inmates being screened for TB in just eight months.

In practice however, TAC researcher Lieve Vanleeuw says TAC continues to receive reports from prisoners describing instances in which access to TB diagnosis and care is hindered by prison officials or a lack of understanding among facility health care workers about how to use GeneXpert machines.

It is unclear whether any concrete plans have yet been presented to address overcrowding.

Source: Health-e