Public health guidance on active case finding of communicable diseases in prison settings

public health guidance
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European Centre for Disease Prevention and Control, European Monitoring Centre for Drugs and Drug Addiction. Public health guidance on active case finding of communicable diseases in prison settings. Stockholm and Lisbon: ECDC and EMCDDA; 2018

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This document provides EU/EEA Member States with evidence-based scientific advice on active case finding options. These options can be applied to the planning and implementation of interventions that promote the early diagnosis of communicable diseases in prison settings.

Executive summary

Compared with the general public, people in prison in the EU/EEA have a higher burden of communicable diseases such as human immunodeficiency virus (HIV), hepatitis B, hepatitis C, syphilis, gonorrhoea, chlamydia and tuberculosis (TB). Increased disease prevalence in this population is recognised as a significant public health concern, both for people living and working in prisons and for the general population at large because the vast majority of people held in prisons eventually return to their communities. Yet, incarceration may represent a unique opportunity to make adequate healthcare services available to people and target groups that are usually hard to reach when in the community. Active case finding is one of the key measures for the prevention and control of communicable diseases that should be considered for broader implementation in prison settings. It supports early diagnosis, ensures that infected people can receive early treatment and care, and thus contributes to prevent onward disease transmission. The successful implementation of evidence-based interventions in prison settings requires an in-depth knowledge of structural hurdles, individual barriers, and the characteristics and behaviours of the prison population.

To this aim, the European Centre for Disease Prevention and Control (ECDC) and the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) have joined forces to develop a common evidence-based guidance for the prevention and control of communicable diseases in prison settings in the EU/EEA. This document provides EU/EEA Member States with evidence-based scientific advice on active case finding options. These options can be applied to the planning and implementation of interventions that promote the early diagnosis of communicable diseases in prison settings.

Scope

This guidance focuses on high-burden communicable diseases in prison settings. It covers diseases for which evidence on active case finding interventions in prison settings could be retrieved though a systematic review of the literature, i.e. viral hepatitis (B and C), HIV, sexually transmitted infections (STIs) and TB.  This guidance focuses on adults aged 18 years or older who are detained in prison for custody, remand, or awaiting trial. In certain instances, people visiting correctional facilities or intervening in various capacities, and prison staff may be included.  

Target audience

The target audiences for this guidance are national policymakers, professionals and institutions responsible for the planning of healthcare services in the national/subnational custodial system, professionals and entities responsible for the planning and provision of healthcare services in prison institutions, civil society organisations, and nongovernmental organisations with an interest in prison health.

Evidence-based public health guidance

Research findings relevant to this guidance have been reviewed and assessed using evidence-based medicine (EBM) principles adapted to a public health framework. To produce this guidance, scientific evidence from peer-reviewed and grey literature was assessed. Results were combined with expert advice and considerations on harms and benefits, human rights, equity, ethics, and user preferences. Country-specific care models also contributed to the development of intervention options for national and subnational public health programmes in European prison settings. 

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