Active Case Finding for Communicable Diseases in Prison Settings: Increasing Testing Coverage and Uptake Among the Prison Population in the European Union/European Economic Area

Abstract

Prison populations are disproportionally affected by communicable diseases when compared with the general community because of a complex mix of socioeconomic determinants and environmental factors. Tailored and adequate health care provision in prisons has the potential to reach vulnerable and underserved groups and address their complex needs. We investigated the available evidence on modalities and effectiveness of active case-finding interventions in prisons by searching PubMed, Embase, and the Cochrane Library for records on prison and active case finding with no language limit. Conference abstracts and unpublished research reports also were retrieved. We analyzed the findings by testing modality, outcomes, and study quality. The included 90 records—63 peer-reviewed, 26 from gray literature, and 1 systematic review—reported variously on viral hepatitis, human immunodeficiency virus, sexually transmitted infections, and tuberculosis. No records were retrieved for other communicable diseases. Provider-initiated opt-in testing was the most frequently investigated modality. Testing at entry and provider-initiated testing were reported to result in comparatively higher uptake ranges. However, no comparative studies were identified that reported statistically significant differences between testing modalities. Positivity rates among tested inmates ranged broadly but were generally high for all diseases. The evidence on active case finding in correctional facilities is limited, heterogeneous, and of low quality, making it challenging to draw conclusions on the effect of different testing modalities. Scale-up of provider-initiated testing in European correctional facilities could substantially reduce the undiagnosed fraction and, hence, prevent additional disease transmission in both prison settings and the community at large.

Understanding and Improving the Health of People Who Experience Incarceration: An Overview and Synthesis

“…Realizing this important public health opportunity is contingent on reliably identifying those with infections. In their review of active case finding for infectious diseases in prisons, Tavoschi et al ( 27 ) found evidence that both testing at prison reception and provider-initiated testing in prison were associated with higher uptake of testing. However, the proportion of prisoners undergoing testing varied markedly between studies, and the methodological quality of most included studies was rated as very poor.…”

Modelling Cost-Effectiveness of Syphilis Detection Strategies In Prisoners: Exploratory Exercise In A Chilean Male Prison

“…Studies show that available evidence on the implementation of cases nding strategies in penitentiary settings is limited and inconclusive. However, it is recognized that active case-nding, when comparing with passive case-nding, promotes early diagnosis and allows the treatment of affected individuals, even in asymptomatic stages, therefore, preventing disease transmission both within the prison and to the general population [26][27][28]. The studies have also pointed out that the use of less invasive and rapid tests has proven to be successful in prison environments, reaching greater acceptability to the application of tests [26,29].…”

Modelling Cost-Effectiveness Of Syphilis Detection Strategies In Prisoners: Exploratory Exercise In A Chilean Male Prison

“…Studies on diagnosis and treatment strategies in penitentiary settings are limited. However, it is recognized that active case-nding, when comparing with passive case-nding, promotes early diagnosis and allows the treatment of affected individuals, even in asymptomatic stages, therefore, preventing disease transmission both within the prison and to the general population [26][27][28].…”

“…The studies have also pointed out that the use of less invasive and rapid tests has proven to be successful in prison environments, resulting in increased application of testing [26,29].…”