Prison populations are disproportionally affected by communicable diseases when compared with the general community because of a complex mix of socioeconomic determinants and environmental factors. Tailored and adequate health care provision in prisons has the potential to reach vulnerable and underserved groups and address their complex needs. We investigated the available evidence on modalities and effectiveness of active case-finding interventions in prisons by searching PubMed, Embase, and the Cochrane Library for records on prison and active case finding with no language limit. Conference abstracts and unpublished research reports also were retrieved.We analyzed the findings by testing modality, outcomes, and study quality. The included 90 records-63 peer-reviewed, 26 from gray literature, and 1 systematic review-reported variously on viral hepatitis, human immunodeficiency virus, sexually transmitted infections, and tuberculosis. No records were retrieved for other communicable diseases. Provider-initiated opt-in testing was the most frequently investigated modality. Testing at entry and provider-initiated testing were reported to result in comparatively higher uptake ranges. However, no comparative studies were identified that reported statistically significant differences between testing modalities. Positivity rates among tested inmates ranged broadly but were generally high for all diseases. The evidence on active case finding in correctional facilities is limited, heterogeneous, and of low quality, making it challenging to draw conclusions on the effect of different testing modalities. Scale-up of provider-initiated testing in European correctional facilities could substantially reduce the undiagnosed fraction and, hence, prevent additional disease transmission in both prison settings and the community at large.
Bibliographical noteFunding Information:
The project was funded by the European Centre for Disease Prevention and Control (ECDC; framework contract number ECDC/2015/028; specific contract number ECD.5855) and is part of a wider joint undertaking with the European Monitoring Centre on Drugs and Drug Addiction to develop European guidance on the prevention of communicable diseases in the prison setting. E.O. was the chair of the ECDC expert panel and wrote on their behalf. Invaluable inputs were received from the following members of the guidance ad hoc scientific panel: Barbara Janíková, Dr. Viktor Mravcik (Czech Republic); Kristel Kivimets (Estonia); Dr. Fadi Meroueh, Dr. Laurent Michel (France); Prof. Heino Stöver, PeterWiessner, Dr. Ruth Zimmermann (Germany); Dr. Roberto Ranieri (Italy); Erica Cardoso, Dr. Rui Morgado (Portugal); Dr. Lucia Mihailescu (Romania); Dr. Jose-Manuel Royo (Spain), Stefan Enggist, Prof. HansWolff (Switzerland); Prof. Sharon Hutchinson (United Kingdom); Alison Hannah (Penal Reform International); Jan Malinowski (Council of Europe); Dr. Lars Møller (World Health Organization); and Dr. Ehab Salah (United Nations Office on Drugs and Crime). The authors would like to acknowledge the European Centre for Disease Prevention and Control (ECDC) library and ECDC and European Monitoring Centre on Drugs and Drug Addiction staff who contributed to the project: Dr. Andrew Amato, Dr. Helena de Carvalho Gomes, Dr. Erika Duffell, Teymur Noori, Dr. Anastasia Pharris, Prof. Jan Semenza, Ettore Severi, Dr. Gianfranco Spiteri, Dr. Judit Takacs, Dr.Marieke van derWerf, Linda Montanari, Marica Ferri, and Dr. Liesbeth Vandam. The authors thank the field researchers who contributed to the project: Ruth Gray, Sofia Victoria Casado Hoces, LeonWeichert, and Deborah Iwanikow.
Authors affiliations: Surveillance and Response Unit, European Centre for Disease Prevention and Control, Solna, Sweden (Lara Tavoschi, Netta Beer, Joana Gomes Dias); Pallas, Health Research and Consultancy B.V., Rotterdam, the Netherlands (Hilde Vroling, Marije Vonk Noordegraaf-Schouten, Anouk Oordt-Speets); Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy (Giordano Madeddu, Sergio Babudieri); Health Without Barriers – European Federation for Prison Health, Viterbo, Italy (Roberto Monarca); Department of Health & Justice, Public Health England, London, UK (Éamonn O’Moore); and Public Health Unit, European Monitoring Centre on Drugs and Drug Addiction, Lisbon, Portugal (Dagmar Hedrich). The project was funded by the European Centre for Disease Prevention and Control (ECDC; framework contract number ECDC/2015/028; specific contract number ECD.5855) and is part of a wider joint undertaking with the European Monitoring Centre on Drugs and Drug Addiction to
© 2018 The Author(s). Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health.
- communicable diseases