Tuberculosis in a South African prison - a transmission modelling analysis

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dc.contributor.authorJohnstone-Robertson S.
dc.contributor.authorLawn S.D.
dc.contributor.authorWelte A.
dc.contributor.authorBekker L.-G.
dc.contributor.authorWood R.
dc.date.accessioned2012-02-22T09:27:08Z
dc.date.available2012-02-22T09:27:08Z
dc.date.issued2011
dc.description.abstractBackground. Prisons are recognised internationally as institutions with very high tuberculosis (TB) burdens where transmission is predominantly determined by contact between infectious and susceptible prisoners. A recent South African court case described the conditions under which prisoners awaiting trial were kept. With the use of these data, a mathematical model was developed to explore the interactions between incarceration conditions and TB control measures. Methods. Cell dimensions, cell occupancy, lock-up time, TB incidence and treatment delays were derived from court evidence and judicial reports. Using the Wells-Riley equation and probability analyses of contact between prisoners, we estimated the current TB transmission probability within prison cells, and estimated transmission probabilities of improved levels of case finding in combination with implementation of national and international minimum standards for incarceration. Results. Levels of overcrowding (230%) in communal cells and poor TB case finding result in annual TB transmission risks of 90% per annum. Implementing current national or international cell occupancy recommendations would reduce TB transmission probabilities by 30% and 50%, respectively. Improved passive case finding, modest ventilation increase or decreased lock-up time would minimally impact on transmission if introduced individually. However, active case finding together with implementation of minimum national and international standards of incarceration could reduce transmission by 50% and 94%, respectively. Conclusions. Current conditions of detention for awaitingtrial prisoners are highly conducive for spread of drug-sensitive and drug-resistant TB. Combinations of simple well-established scientific control measures should be implemented urgently.
dc.identifier.citationSouth African Medical Journal
dc.identifier.citation101
dc.identifier.citation11
dc.identifier.citation809
dc.identifier.citation813
dc.identifier.issn2569574
dc.identifier.urihttp://hdl.handle.net/10019.1/19851
dc.subjecttuberculostatic agent
dc.subjectantibiotic resistance
dc.subjectarticle
dc.subjectbacterial transmission
dc.subjectcontrolled study
dc.subjectcrowding
dc.subjecthealth care planning
dc.subjecthealth program
dc.subjecthuman
dc.subjectinfection risk
dc.subjectinternational cooperation
dc.subjectmathematical model
dc.subjectmultidrug resistant tuberculosis
dc.subjectprison
dc.subjectprocess development
dc.subjectrisk assessment
dc.subjectrisk factor
dc.subjectroom ventilation
dc.subjectshort course therapy
dc.subjectSouth Africa
dc.subjectsputum smear
dc.subjecttuberculosis control
dc.titleTuberculosis in a South African prison - a transmission modelling analysis
dc.typeArticle
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