Risk factors and prevalence of tuberculosis, human immunodeficiency virus, syphilis, hepatitis B virus, and hepatitis C virus among prisoners in Pakistan

Abstract

Background We evaluated the burden of sexual- or injection drug use (IDU)-related infections in male prisoners in Karachi, Pakistan. Methods We administered a structured questionnaire in a cross-sectional survey of 365 randomly selected imprisoned men. We analyzed blood for human immunodeficiency virus (HIV) and Hepatitis B and C by ELISA, and for syphilis by rapid plasma reagin and Treponema pallidum hemagglutination assay confirmation. Subjects with possible tuberculosis (WHO criteria) provided sputum samples for an acid fast bacillus smear and culture. Results Prevalence of tuberculosis was 2.2% (95%CI: 0.71, 3.8). HIV infected 2.0% (95%CI: 0.55, 3.4) of 357 randomly selected prisoners (8 refused to give blood), with confirmed syphilis in 8.9% (95%CI: 6.0, 11.8), hepatitis B virus in 5.9% (95%CI: 3.5, 8.3), and hepatitis C virus in 15.2% (95%CI: 11.7, 18.8). By self-report, 59.0% had used any illicit drugs, among whom 11.8% (95%CI: 8.5, 15.0) had injected drugs. The median length of stay in the prison had been 3.2 (range 1-72) months. Conclusions All four infections were prevalent among the prisoners in Pakistan. Prisons are excellent venues for infectious disease screening and intervention given conditions of poverty and drug addiction. Collaboration with community-based health providers is vital for post-discharge planning.

Tuberculosis control in prisons: current situation and research gaps

“…1,4,20,22,33,34 In addition, a systematic review found that approximately 21% of all studies reporting on TB screening in prisons described the lack of a well-organized health system, 31 potentially leading to the ongoing spread of TB to other prisoners, prison staff, visitors, and to the general population upon release from the prison. 23,35,36 In the absence of adequate diagnostic tools in the prison services, health professionals attempt to use the diagnostic capacity of the civilian sector through national TB programmes (NTPs), such as sputum smear microscopy, chest radiography, and sputum culture. 34 The use of diagnostic services external to the prison system may, however, lead to a delay in diagnosis due to a lack of coordination between the prison and the civilian sector laboratory networks.…”

“…31 Therefore, TB control efforts should focus on the provision of effective treatment and/or increasing effectiveness of treatment to TB patients, 22,23,38,50 treatment adherence, and clinical case management. 19,35 The high turnover of the prison population, between prisons and to the wider community, is a major challenge. This facilitates transmission and consequently the spread of both drug-sensitive and drug-resistant forms of TB.…”

Status of HIV and hepatitis C virus infections among prisoners in the Middle East and North Africa: review and synthesis

“…Continued use of drugs while in prison was reported by 67% of incarcerated drug users in Algeria [53]; 18.7% [54] and 91% [55] in Iran; 26 to 44% in Oman [50]; 15.1% [56] and 59.2% [57] in Pakistan; and 22% in Syria [58]. Similarly, history of previous incarceration was reported by over half of PWID [59] in Afghanistan; 40.4 [60], 41.0 [55], 75.3 [54], 76.2 [61], and 94.0% [62] in Iran; 45.9% in Morocco [63]; and 14.0 [64], 33 [65], 40.0 [64], and 84.0% [57] in Pakistan.…”

“…Use of non-sterile injecting equipment in prisons has been reported by 30% of PWID in Afghanistan [69]; 6.1 [70], 12 [71], 16.8 [72], 27.1 [54], 36 [73], 47.3 [74], and 48.5% [61] in Iran; 7% in Lebanon [49]; 3 to 11% in Oman [50]; 46% in Pakistan [57]; and 80% in Syria [48]. In Sudan, 3.2% of prisoners reported use of non-sterile syringes while in prison [75].…”

Change in attitudes and knowledge of problem drug use and harm reduction among a community cohort in Kabul, Afghanistan

“…More participants believed that sadness over loss of home and family or imprisonment were reasons for initiating drug use, and this change may also reflect fears surrounding displacement from the family unit. Drug use in prisons has been documented in various settings, including countries bordering Afghanistan, and knowledge of this has potentially permeated into the community (19)(20)(21)(22). Peer pressure increased as a perceived reason to initiate drug use, perhaps due to media coverage of the issue or to respondents' direct experiences (23,24).…”