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Coordinating the prevention, treatment, and care continuum for HIV-associated tuberculosis in prisons

a health systems strengthening approach

Herce, Michael E.a,b; Muyoyeta, Mondea; Topp, Stephanie M.c; Henostroza, Germand; Reid, Stewart E.a,d

Current Opinion in HIV and AIDS: November 2018 - Volume 13 - Issue 6 - p 492–500
doi: 10.1097/COH.0000000000000505
TUBERCULOSIS AND HIV: Edited by Richard E. Chaisson and Haileyesus Getahun

Purpose of review To advance a re-conceptualized prevention, treatment, and care continuum (PTCC) for HIV-associated tuberculosis (TB) in prisons, and to make recommendations for strengthening prison health systems and reducing HIV-associated TB morbidity and mortality throughout the cycle of pretrial detention, incarceration, and release.

Recent findings Despite evidence of increased HIV-associated TB burden in prisons compared to the general population, prisoners face entrenched barriers to accessing anti-TB therapy, antiretroviral therapy, and evidence-based HIV and TB prevention. New approaches, suitable for the complexities of healthcare delivery in prisons, have emerged that may address these barriers, and include: novel TB diagnostics, universal test and treat for HIV, medication-assisted treatment for opioid dependence, comprehensive transitional case management, and peer navigation, among others.

Summary Realizing ambitious international HIV and TB targets in prisons will only be possible by first addressing the root causes of the TB/HIV syndemic, which are deeply intertwined with human rights violations and weaknesses in prison health systems, and, second, fundamentally re-organizing HIV and TB services around a coordinated PTCC. Taking these steps can help ensure universal access to comprehensive, good-quality, free and voluntary TB/HIV prevention, treatment, and care, and advance efforts to strengthen health resourcing, staffing, information management, and primary care access within prisons.

aCentre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia

bDivision of Infectious Diseases, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA

cCollege of Public Health, Medical and Veterinary Sciences, James Cook University, Queensland, Australia

dDivision of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, School of Medicine, Birmingham, Alabama, USA

Correspondence to Michael E. Herce, MD, MPH, MSc, Centre for Infectious Disease Research in Zambia, Plot #34620 Off Alick Nkhata Road, Mass Media, P.O. Box 34681, Lusaka 10101, Zambia. Tel: +260 962 220 145; fax: +1 919 966 6714; e-mail:

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