Active Health Service Provision Scale up for HIV and Tuberculosis in 16 Prisons, Iran

Background: In most countries, the prevalence of HIV and tuberculosis (TB) among prisoners are higher than those in the general population. Nevertheless, the prison setting presents not only challenges, but also opportunities for the prevention and treatment of TB and HIV. Therefore, this program was designed to scale up a previously piloted guideline to screen and diagnose people living with HIV (PLWH) and those with TB diseases and then provide them actively needed health services. Methods: Since the beginning of March 2015 the program for active health service provision (AHSP) for TB and HIV was started. This guideline was based on a model that provide diagnostic, treatment and follow-up services actively including all aspects of HIV/TB diagnosis, treatment and care services. Also major HIV/TB-related topics are described in it. In order to carry out the scaling up of the implementation of the guideline, following steps were taken: Formation of the Steering Committee, establishing required structures and holding workshops to train staff. Results: The mean number of HIV tests done before the intervention, was 163.9 per season in 16 prisons, while this figure was 1106.5 per season after the intervention. The mean number of patients receiving antiretroviral therapy (ART) increased after the intervention. The numbers are, respectively, 10.8, and 16.4 person per season, before and after the intervention. Conclusion: The changes of target variables before and after the program within 16 prisons in 13 provinces in Iran show the efficiency of AHSP. Since the prevalence of HIV and TB among prisoners are high and HIV infection, itself, is the greatest risk factor for developing TB, prisons as well as challenges are opportunities for the prevention and treatment of TB and HIV. Actively health services provided in prisons show positive results and suggest an efficient way of dealing with these infections