Early TB case detection in pre-trial detention centers (SIZOs) and

prison colonies in Ukraine

46th Union World Conference on Lung HealthCape Town, South AfricaDecember 4, 2015

2000-2012: No defined TB control in the pre-trial detention system in Ukraine• Pre-trial detention centers (SIZOs): fall between the prison

and civil TB control systems, no improvements in TB case detection and management practices over the decades

• TB case detection in SIZOs: limited to fluorography screening upon entry

• Smear microscopy in SIZOs: indicated if fluorography or symptoms suggested active TB

• Follow-up algorithms for detainees with presumptive TB: poorly developed and followed

• TB treatment for detainees: might not become available until after sentencing, when the detainee was either transferred to a prison or civil TB hospital or released

May 2013: Project “Increasing TB Case Detection in the Ukrainian Detention System”

• Funding:

• Project Duration: 2013-2015

• Project Geography: National LevelRegional Level - Kherson, Mykolaiv and Lviv regions (intervention regions); Kirovograd and Poltava regions (control regions)

• Intervention Sites: 3 SIZOs and 5 prison colonies in three intervention regions

Project Goal:Improve the early TB diagnosis and increase the yield of bacteriologically confirmed TB cases among pre-trial detainees in SIZOs and prisoners in prison colonies in Kherson, Mykolaiv and Lviv regions, and ensure timely treatment start.

РАТН Project Partners

Ukrainian Center for Control of Socially Dangerous Diseases of the Ministry of Health of Ukraine

State Penitentiary Service of Ukraine Regional Health Care Departments Regional Civil TB Clinics The All-Ukrainian Network of Organizations Working in

the Penal System (PSN) International Charitable Fund “Organization for

Appropriate Technology in Health”

Intensified Case Finding:

• Develop and pretest among detainees and prisoners a verbal screening tool

• Implement systematic verbal screening for symptoms and risk factors of TB, followed by the sputum smear microscopy and further GeneXpert, culture/DST, if indicated

• Establish prompt referral to timely treatment.

Arrest and Detention (upon

entry at SIZO)

X-ray screening

Verbal screening for TB symptoms and risk factors by

trained personnel

TB symptoms (isolated)

SIZO 1st level Lab: sputum microscopy, clinical

examination; VCT for HIV

No TB symptoms

Prison or civil 3rd level Lab: GeneXpert MTB RIF

examination, Bactec (liquid media) with the following DST for the 1st and 2nd line drugs

Repeated TB screening in 3

monthsTB treatment at the civil or

prison health system

No TB TB

Year 1 Results (3 SIZOs)• Across 12 months, 8,361 detainees were verbally screened

upon entry ---> identification of 3,280 (39.2%) individuals with suspected TB ---> referred for further evaluation (smear microscopy, culture/DST) ---> 120 TB patients were diagnosed.

• This translates into a TB prevalence of 1,435 patients per 100,000 population, more than 10-fold higher than the national prevalence estimate. All TB patients were initiated on treatment in SIZO or in civil TB hospitals.

Year 2 Results (3 SIZOs and 5 Prison Colonies)

Population14,654

Screened11,964 (82%)

Diagnosed all forms of TB

309 осіб (7%)

Confirmed TB SS+/B+

68 cases

TB symptoms4,427 (37%)

Project Outcomes• Early TB case detection algorithm among detainees based on

the verbal screening tool with further lab diagnostic developed and implemented.

• Significant increase of the number of TB cases detected and referred for immediate treatment.

• Interruption of TB transmission inside and outside the detention and prison settings.

• Introduction of early TB case detection in all penitentiary institutions of Ukraine and institutionalization of the algorithm.

• Improved monitoring system of TB case detection in pre-trial detention centers.

Thank you!PATH www.path.orgKateryna Gamazinakgamazina@path.orgOleksiy Bogdanovabogdanov@path.org

ICF “Organization for Appropriate Technology in Health”, UkraineSvitlana Leontyevasleontyeva@oath.org.ua

All-Ukrainian Penitentiary NetworkMykola Gagarkinp.i@mail.ru