Improving case detection and strengthening systems: working with prisoners

ICDDR,B has been involved in a two-year study to be completed in late 2007, providing active screening of the entire prison population of Dhaka Central Jail. A congested environment, prevalent drug use and a population in flux are factors contributing to making prisoners especially vulnerable to TB infection. In a collaboration with Dhaka Central Jail and the National TB Programme, which has been providing DOTS services in the prison for the last few years, ICDDR,B is contributing its diagnostic facilities to the existing programme in order to strengthen detection capacity. In return, this is providing an insight into TB prevalence in the largest prison in Bangladesh, rates of drug-resistant infection and understanding of transmission mechanisms.

Patients with coughs longer than three weeks have sputum samples taken for testing at the ICDDR,B tuberculosis laboratory: AFB microscopy, culture analysis, PCR, antibiotic susceptibility, and DNA fingerprinting of M. tuberculosis strains are performed.

Over 6000 of the prisoners have been screened to date. Over 20% of these have been investigated for suspected tuberculosis, and 9% have tested positive for infection. Researchers have found a significant number of prisoners who test positive using ICDDR,B’s diagnostic tools, after initial tests fail to detect infection. The other key finding to date has been the prevalence rate, which at 1855 infections per 100,000 people, is twenty times higher than the rate found in ICDDR,B prevalence studies in the rural area of Matlab.

This active screening has facilitated an increased detection rate of TB in the Dhaka Central Jail, and many prisoners who were previously suffering from unidentified infection, are now able to seek appropriate DOTS treatment. This early detection may lead to decreased transmission within this confined environment, but more will be understood at the conclusion of the study. For further information about this research, contact Dr Sayera Banu.