The Impact of Ventilation and Early Diagnosis on Tuberculosis Transmission in Brazilian Prisons

Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2017-06-06T12:40:30Z No. of bitstreams: 1 Urrego J The impact of ventilation....pdf: 1153577 bytes, checksum: 95797857548916ef7fe2d91a260efbcf (MD5)Approved for entry into archive by Ana Maria Fiscina Sampaio ([email protected]) on 2017-06-06T13:05:14Z (GMT) No. of bitstreams: 1 Urrego J The impact of ventilation....pdf: 1153577 bytes, checksum: 95797857548916ef7fe2d91a260efbcf (MD5)Made available in DSpace on 2017-06-06T13:05:14Z (GMT). No. of bitstreams: 1 Urrego J The impact of ventilation....pdf: 1153577 bytes, checksum: 95797857548916ef7fe2d91a260efbcf (MD5) Previous issue date: 2015Foundation for the Development of Teaching, Science, and Technology of the State of Mato Grosso do Sul (0067/12 and 0059/13); Secretariat of Health Surveillance, Brazilian Ministry of Health (20/2013); Ciências sem Fronteiras Program of the Brazilian National Research Council; Fogarty Global Health Equity Scholars Program (NIH 1 R25 TW009338); Jan A. J. Stolwijk Fellowship at the Yale School of Public Health (to J.U.); and National Institute of Allergy and Infectious Disease (K01 AI104411 to J.R.A.)Yale School of Public Health. New Haven, CTYale School of Public Health. New Haven, CT / Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, BA, BrasilHospital Universitário de Dourados. Dourados, MS, BrasilHospital Universitário de Dourados. Dourados, MS, BrasilHospital Universitário de Dourados. Dourados, MS, BrasilYale School of Public Health. New Haven, CTStanford University School of Medicine. Stanford, CAUniversidade Federal da Grande Dourados. Faculdade de Ciências da Saúde. Dourados, MS, BrasilPrisoners have among the highest incidence of tuberculosis (TB) globally. However, the contribution of the prison environment on transmission is not well understood and structural characteristics have received little attention as effective epidemiological interventions in TB control. We evaluated architectural characteristics and estimated ventilation rates in 141 cells in three prisons in central west Brazil using steady-state exhaled carbon dioxide (CO2) levels. We used a modified Wells-Riley equation to estimate the probability of infection for inmates sharing a cell with an infectious case and projected the impact of interventions, including early diagnosis and improved ventilation. Overall, prison cells were densely populated (mean 2.1 m(2) per occupant) and poorly ventilated, with only three cells meeting World Health Organization (WHO) standards for per-person ventilation (60 L/s) applied in infection control settings. In the absence of interventions, projected mean risk of infection was 78.0% during a 6-month period. Decreasing time-to-diagnosis by 25% reduced transmission risk by 8.3%. Improving ventilation to WHO standards decreased transmission by 38.2%, whereas optimizing cross-ventilation reduced transmission by 64.4%. Prison environments promote high infection risk over short-time intervals. In this context, enhanced diagnostics have a limited impact on reducing transmission. Improving natural ventilation may be required to effectively control TB in prisons

A Cross-Sectional Survey of HIV Testing and Prevalence in Twelve Brazilian Correctional Facilities

<div><p>Background</p><p>Prior studies have reported higher HIV prevalence among prisoners than the general population in Brazil, but data have been derived from single prisons. The aim of this study was to evaluate HIV testing practices, prevalence and linkage to care among inmates in a network of 12 prisons.</p><p>Methods</p><p>We administered a questionnaire to a population-based sample of inmates from 12 prisons in Central-West Brazil and collected sera for HIV and syphilis testing from January to December 2013. We evaluated factors associated with HIV testing and infection using multivariable logistic regression models. Six months after HIV testing, we assessed whether each HIV-infected prisoner was engaged in clinical care and whether they had started antiretroviral therapy.</p><p>Results</p><p>We recruited 3,362 inmates, of whom 2,843 (85%) were men from 8 prisons, and 519 (15%) were women from 4 prisons. Forty-five percent of participants reported never having been tested for HIV previously. In multivariable analysis, the variables associated with previous HIV testing were lack of a stable partner (adjusted odds ratio [AOR]: 1.38; 95% CI: 1.18–1.60), completed more than four years of schooling (AOR 1.40; 95% CI: 1.20–1.64), history of previous incarceration (AOR: 1.68; 95% CI: 1.43–1.98), history of mental illness (AOR 1.52; 95% CI: 1.31–1.78) and previous surgery (AOR 1.31; 95% CI: 1.12–1.52). Fifty-four (1.6%) of all participants tested positive for HIV; this included 44 (1.54%) men and 10 (1.92%) women. Among male inmates, HIV infection was associated with homosexuality (AOR 6.20, 95% CI: 1.73–22.22), self-report of mental illness (AOR 2.18, 95% CI: 1.13–4.18), history of sexually transmitted infections (AOR 3.28, 95% CI: 1.64–6.56), and syphilis sero-positivity (AOR 2.54, 95% CI: 1.20–5.39). Among HIV-infected individuals, 34 (63%) were unaware of their HIV status; only 23 of these 34 (68%) newly diagnosed participants could be reached at six month follow-up, and 21 of 23 (91%) were engaged in HIV care.</p><p>Conclusions</p><p>HIV testing rates among prison inmates are low, and the majority of HIV-infected inmates were unaware of their HIV diagnosis. Incarceration can be an opportunity for diagnosis and treatment of HIV among vulnerable populations who have poor access to health services, but further work is needed on transitional HIV care for released inmates.</p></div

Flow chart of the study enrollment and screening process for HIV.

<p>Flow chart of the study enrollment and screening process for HIV.</p

Active and latent tuberculosis in Brazilian correctional facilities: a cross-sectional study

Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2016-07-06T17:19:10Z No. of bitstreams: 1 Carbone ASS Active and latent tuberculosis....pdf: 656948 bytes, checksum: 20358a6375fe15ab98c0fbc0c89a17e3 (MD5)Approved for entry into archive by Ana Maria Fiscina Sampaio ([email protected]) on 2016-07-06T17:33:37Z (GMT) No. of bitstreams: 1 Carbone ASS Active and latent tuberculosis....pdf: 656948 bytes, checksum: 20358a6375fe15ab98c0fbc0c89a17e3 (MD5)Made available in DSpace on 2016-07-06T17:33:37Z (GMT). No. of bitstreams: 1 Carbone ASS Active and latent tuberculosis....pdf: 656948 bytes, checksum: 20358a6375fe15ab98c0fbc0c89a17e3 (MD5) Previous issue date: 2015Made available in DSpace on 2016-07-07T19:04:21Z (GMT). No. of bitstreams: 3 Carbone ASS Active and latent tuberculosis....pdf.txt: 35956 bytes, checksum: d6c018bc1eeed9eab1932d6ae359841d (MD5) Carbone ASS Active and latent tuberculosis....pdf: 656948 bytes, checksum: 20358a6375fe15ab98c0fbc0c89a17e3 (MD5) license.txt: 2991 bytes, checksum: 5a560609d32a3863062d77ff32785d58 (MD5) Previous issue date: 2015Federal University of Grande Dourados. University Hospital. Dourados, MS, BrasilFederal University of Grande Dourados. University Hospital. Dourados, MS, BrasilFederal University of Grande Dourados. University Hospital. Dourados, MS, BrasilFederal University of Grande Dourados. Faculty of Health Sciences.Federal University of Grande Dourados. Faculty of Health Sciences.Federal University of Grande Dourados. Faculty of Health Sciences.Federal University of Grande Dourados. Faculty of Health Sciences.Federal University of Grande Dourados. Faculty of Health Sciences.Federal University of Grande Dourados. Faculty of Health Sciences.Federal University of Grande Dourados. Faculty of Ambiental and Biological Sciences. Dourados, MS, BrasilFederal University of Mato Grosso do Sul. Department of Biochemical Pharmacy. Campo Grande, MS, Brasil / Fundação Oswaldo Cruz. Campo Grande, MS, BrasilFederal University of Mato Grosso do Sul. Faculty of Medicine. Campo Grande, MS, BrasilFederal University of Mato Grosso do Sul. University Hospital. Campo Grande, MS, BrasilFundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, BA, Brasil / Yale School of Public Health. Department of Epidemiology of Microbial Disease. New Haven, CT, USA.Stanford University School of Medicine. Division of Infectious Diseases and Geographic Medicine. Stanford, CA, USAFederal University of Grande Dourados. Faculty of Health Sciences. Dourados, MS, Brasil / Fundação Oswaldo Cruz. Campo Grande, MS, BrasilBackground: Tuberculosis (TB) rates among prisoners are more than 20 times that of the general population in Brazil, yet there are limited data available to facilitate the development of effective interventions in this high-transmission setting. We aimed to assess risk factors for TB infection and evaluate the yield of mass screening for active disease among inmates. Methods: We administered a questionnaire and tuberculin skin test (TST) to a population-based sample of inmates from 12 prisons in Central-West Brazil and collected sera for HIV testing and two sputum samples for smear microscopy and culture from participants reporting a cough of any duration. Hierarchical Poisson regression models were used to evaluate factors associated with latent tuberculosis infection (LTBI). Results: We recruited 3,380 inmates, of which 2,861 (84.6%) were males from 8 prisons, and 519 (15.4%) were females from 4 prisons. Among the 1,020 (30%) subjects who reported a cough, we obtained sputum from 691 (68%) and identified 31 cases of active TB for a point prevalence of 917 (95% CI, 623–1302) per 100,000 prisoners. Evaluation of the two sputum smear samples failed to identify 74% of the TB cases, and 29% of the cases reported less than 2 weeks of symptoms. Obtaining a second culture identified an additional 7 (24%) cases. The prevalences of LTBI were 22.5% and 11.7% for male and female prisoners, respectively and duration of incarceration (in years) was associated with LTBI in male and female in the multivariable model (1.04, 95% CI, 1.01-1.07 and 1.34, 95% CI, 1.06-1.70, respectively). The prevalence of LTBI is 8.6% among newly incarcerated inmates, among whom LTBI prevalence significantly increased by 5% with each year of incarceration. Conclusions: Although the overall LTBI prevalence among inmates in Central-West Brazil is low, tuberculosis incidence is high (>1,800/100,00), likely due to the high force of infection among a largely susceptible inmate population. Efforts to reduce transmission in prisons may require mass screening for active TB, utilizing sputum culture in case-detection protocols

Sociodemographic and risk behaviors variables in 4 female Brazilian prisons.

<p>Abbreviations: HIV- Human Immunodeficiency vírus, SD–Stardard deviation, IDU–Intravenous drug user, STI–Sexually transmitted infections, EPFCAJG—Estabelecimento Penal Feminino Carlos Alberto Jonas Giordano, EPFTL—Estabelecimento Penal Feminino de Três Lagoas, EPFPP—Estabelecimento Penal Feminino de Ponta Porã, EPFIIZ—Estabelecimento Penal Feminino Irmã Irma Zorzi.</p><p>Sociodemographic and risk behaviors variables in 4 female Brazilian prisons.</p

Variables associated with previous HIV testing among prisoners (N = 3,362).

<p>Abbreviations: OR—odds ratio, IDU—intravenous drug user, STI—sexually transmitted infections.</p><p>Variables associated with previous HIV testing among prisoners (N = 3,362).</p

Risk factors associated with HIV among male and female prisoners (N = 3,362).

<p>Abbreviations: OR—odds ratio, IDU—intravenous drug user, STI—sexually transmitted infections.</p><p>Risk factors associated with HIV among male and female prisoners (N = 3,362).</p

Sociodemographic and risk behaviors variables in 8 male Brazilian prisons.

<p>Abbreviations: HIV- Human Immunodeficiency vírus, SD–Stardard deviation, IDU–Intravenous drug user, STI–Sexually transmitted infections, EPC—Estabelecimento Penal de Corumbá, PTL—Penitenciária de Três Lagoas, EPRB—Estabelecimento Penal Ricardo Brandão, CTAL—Centro de Triagem Anízio Lima, PTCG—Presídio de Transito de Campo Grande, IPCG—Instituto Penal de Campo Grande, PHAC—Penitenciária Harry Amorim Costa and EPJFC—Estabelecimento Penal Jair Ferreira de Carvalho.</p><p>Sociodemographic and risk behaviors variables in 8 male Brazilian prisons.</p