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Good afternoon RejinaI live in sa can I be of assistance to you,We are in Johannesburg
Good afternoon Robert,I'm Regina Loprang, from indonesia.Right now i assist the ministry of health and also ministry of law and human right for TB Control in Prison.Do you have experience for TB IC in prison?Thank you
Hi Regina,I have been in Indonesia on several occasions under TBCAP/TBCARE for KNCV Indonesia. If you have any specific technical questions, you can contact me on my email. Hans Mulder
Good Afternoon Regina Because ventilation is limited due to security reasons a number of prisonsacross the world have installed ultraviolet systems(UVGI). This seems to bethe only solution to the problem.If you require I can assist you with the modelling of the fixtures for thisparticular situation. We have experience of installations into correctionalfacilities.
With regard to your other question about the prisoner with MDR TB, a low cost method for improving infection control is natural ventilation - if possible, would try to keep the patient with MDR TB in a separate ward/room/cell from others particularly at night or when indoors and maximize the windows (perhaps bars across the windows would address the security concerns?) being open. We have recently evaluated the impact of this on risk of TB transmission in homes and ventilation can be a powerful adjunctive tool to screening all for symptoms, offering HIV testing (to identify those at higher risk and starting ART if possible) and facilitating rapid diagnosis. Is there a health care facility with an isolation ward that could be used for this patient? I have sent the multiple references separately - would consider initiating symptom screening all of prisoners and if they have symptoms, obtain sputum for Mtb testing, ideally through a rapid test if available. Additionally, would try to screen the prison staff as well.
Hi Regina, Have you searched in the online community? I remember several discussions in the past on TB IC in prisons so you should totally go to http://www.ghdonline.org/ic and search - remember that this is not a list serv but a web community with search and archives and lots more!Also thanks Hans for the quick response and sharing your contact info and invite to email directly for technical assistance - all can share their email info but please remember that your contact info is thus shared with all and posted online. Let's also remember that the whole point of this online community is to share openly our experience and knowledge and "pool" it in a collective database of knowledge that we can then search and refer to later on so if you could share your technical advice here we would highly appreciate. Very sincerely, Sophie
Hi Regina,I have visited several prisons in the Philippines and in Central Asia and I guess they might be rather similar to the ones in Indonesia. Although it is not always easy to make use of natural ventilation, I have seen some good design elements that could help. I can forward some pictures if you interested. I know there are people trying to solve every problem with UVGI, but for me it is questionable if it is the right solution in a prison. From my experience prisons are very overcrowded and ways to introduce addition UVGI lights in prison cells and ceiling fans to move the air around might be very limited and costly.Why having UVGI in one room, when we put all inmates together in big crowded dining halls or exercise halls during the day. Or for that matter the other way around. Have protection in the big crowded areas and put 6 people in small cell block or even 100 in one big unit. It is very important to understand and see how inmates move around the cell blocks and their activities during the day. Try to protect on one side and have no protection on the other side renders any improvement to zero. The best way, as it is with all TB Infection Control, is early detection. Inmates should be screened in a proper way up on arrival and in case of uncertain TB status, the inmate should be hold in “quarantine” or in separate block/building until their status is sure. In this way we avoid to bring in new TB cases into the prison. To address the cases that already could be in prison, we can only screen or try to look for the typical symptoms. An observation I made in Manila was that the “natural” hierarchy in prison was used to detect possible TB cases. Some inmates (the “gang” leader, sorry for my words) would get certain benefits to report about the health status of his group of inmates or about the typical TB symptoms. In my opinion, I think a lot can be done with administrative controls, although this involves a lot of parties, Ministry of Health AND Ministry of Justice and if you unfortunate the Ministry of Works if they are the owner of the buildings. But basics can be done always. Screening on arrival, observation of inmates, separation and treatment. If these controls are in place we can look into further improvement of buildings, create natural ventilation, create rooms/structures for separation and as last resource have a look into UVGI or mechanical ventilation if the other controls don’t give the results you expect. If you need any more input I could maybe forward part of the reports written for KNCV and WHO regarding Philippines and Indonesia. Best Regards,Hans Mulder.
This makes absolute sense. Get the basic right before going for more sophisticated and expensive interventions! applies to many areas of health ccre
Thanks Hans. This issue is also highly relevant and topical in the South African context.
Dear HansMany thanks for the information about TB in prisons. I would like to havethe reports from Indonesis also shared with me. I work in Sub-SaharanAfrica with an organization called East, Central & Southern Africa HealthCommunity (ECSA HC) as the program Manager for the HIV/AIDS, TB & MalariaProgram, bases in Arusha, Tanzania. As you may be aware, TB in this regionis a big threat especially with congested prisons and poor health sysytemCurrently we are looking at ways to address cross border TB and will beglad to receive comments and experiences on the sameRgds
TB IC in prisons is harder than in health facilities especially regarding instituting environmental controls. But a lot of administrative controls can be done pretty easily (and they are the best of all TB IC measures). In Uganda, the following has helped:1- Brought on board Prison Health Services through TB IC and TB-HIV training. Initially, we involved top management staffs who later helped us to identify trainers of trainees whom we trained and they subsequently trained health staffs working in prison health service.2. The trained staff conduct on entry screening for all prisoners using a standard tool. This screening covers three main issues : a) TB, b) HIV, c) Malnutrition - mainly assessed by ascertaining BMI. Identified prisoners are fully investigated and treated. Those with TB are separated from other prisoners whenever facilities allow.3- Periodic screening is done at least every quarter in all prisons by prison health service staff. However, prison warders are also trained to identify coughers on routine (daily) basis and refer suspects to prison health services for complete investigations and management.4- On exit, another screening is done if there is an opportunity because, some prisoners are release from Courts of law and there is no way a prisoner can be taken back for this screening to happen. All TB and HIV positive prisoners are officially transferred to public health facilities near their homes on discharge.5.Other interventions like use of PPEs are employed. In Uganda, a senior/responsible prisoner is identified to enforce use of disposable face masks among suspects. Health staffs in prison health facilities are offered N95 respirators.6- NTP staffs do make joint supervisions with top prison staffs to guide TB IC implementation in these places. 7-What is also being done, is to influence management is improve natural ventilation in new prisons under construction and in old ones during renovations. But this largely depends on availability of funds and on the administrators in decision making position.I hope this helps. Thank you for this discussion