Prevalence of tuberculosis, HIV/AIDS, and hepatitis; in a prison of Balochistan: a cross-sectional survey.

BACKGROUND: Human Immunodeficiency Virus (HIV), Hepatitis, and Tuberculosis (TB) are three primary communicable infections have the likely potential to cause severe morbidity in prison settings. The prison has the most favorable environment for the transmission of infections. We conducted this survey to determine the prevalence and feasibility of rapid diagnostic tests in an active screening of these infectious diseases in prison. METHODS: This cross-sectional survey conducted in central Jail Gaddani, one of the largest prisons in the Balochistan province of Pakistan. All prisoners, jail staffs, and staff's family members participated. Informed consent obtained from each participant before the screening. Van equipped with digital X-ray linked with Computer-Aided Detection for TB (CAD4TB) software used for testing. Sputum samples tested on Xpert for MTB/RIF assay and blood specimens collected for HIV and hepatitis serology. Diagnosed TB patients enrolled for treatment at Basic Management Unit (BMU), reactive on hepatitis Rapid Diagnostic Tools (RDTs) were referred for further testing and management, while HIV reactive referred to Anti Retro Viral (ARV) center for Anti Retro Viral Treatment (ART). RESULTS: A total of 567 participants offered screening, 63% (356) prisoners, 23% (129) staff's family members, and 14% (82) jail staffs. Among tested 10.3% (58/562) were hepatitis seropositive (Hepatitis-C 41 [7.29%] Hepatitis-B, 16 [2.84%] Hepatitis B&C both, 01 [0.17%]). In reactive participants, 49 were prisoners, 08 were jail staffs, and 01 was the staff's family member. HIV seropositive was 4% (24/566), and all were prisoners. Almost 99% (565/567) screened by digital X-ray, 172 (30%) were with abnormal CAD4TB suggestion (score > 50), out of them sputum of 26% (148) tested on Xpert, and 2% (03) found Mycobacterium tuberculosis Positive (MTB+). A total of five TB patients were detected; out of two were diagnosed clinically. Co-morbidities observed in 15 patients, (01 TB/HIV co-infected, 12 HIV/HCV, 01 HIV/HBV, and 01 HBV/HCV). CONCLUSION: The high frequency of infectious diseases in prison is alarming. For limiting the transmission of infections among prison and community, immediate steps are needed to be taken for improvement of prisons condition by application of recommended screening protocols at the time of the first entry of prisoners in prisons.

SOCIO-ECONOMIC CONSTRAINS FACED BY TB PATIENTS THAT LEAD TO NON-COMPLIANCE - A CROSS SECTIONAL STUDY IN SOUTHERN PUNJAB, PAKISTAN.

Tuberculosis (TB) is an infectious disease that is communicable from one person to another. Pakistan stands forefront among few unfortunate countries that still have heavy burden of TB infection. Being a developing country, TB patients in Pakistan have to face different socio-economic constraints that upset life of the patients as well as their families. A cross sectional survey was conducted in three selected districts, Lodharan, Bahawalpur and Bahawalnagar during February 2011 to June 2011. From three hundred selected patients 210 Were enrolled in study after receiving written consents. Data were collected though structured questionnaire and verbal-interviews and statistically analyzes by using the univariate analysis. The survey results showed that the low educational status (p < 0.0012, CI 95%), unawareness of disease (88.7%), crowded population (p = 0.0000, CI, 95%), poverty, high treatment cost and distant access to public health facilities were directly related to prevalence of TB. Different disease related constraints including poor attitude of family members, colleagues, society and even health care professionals (p = 0.0000, CI 95%) were also found to be major social factors leading to non-compliance and denial of TB treatment. Socio-economic constraints such as low literacy rate, unemployment, unawareness of disease, high treatment cost, poor attitude of family, society and healthcare professionals were directly related to noncompliance and should be given high priority consideration for achieving better TB management and mitigation.