TB and HIV in prison

Romania

Basic information about Romania

• Total population of country: – Total population at 01.01.2011 (provided by the

National Institute of Statistics): 21,413,815 – According to the last census (2011): 19 million

(provisional data)

• 44 facilities– 6 Prison Hospitals, out of which 2 has TB beds– 3 Reeducation Centers– 3 Prisons for Minors and Juveniles– 21 Prisons for adult males– 1 Prison for adult females

Basic information about Romania

• Number of prisoners per 100 000 population:

• Turnover of prisoners per year: not known

2011 2010 2009

number of prisoners 29,263 27,559 26,716

general population 21,413,815 21,462,186 21,498,616

number of prisoners per 100,000 population 136.7 128.4 124.3

TB IN PRISON SECTOR

TB management in prison sector

Local/county TB dispensary

1. Diagnosis of suspects

From police stations

From prisons

At entering in prison

While executing punishment

2. Coordinate & conduct contact tracing in prisons

3. Monitoring TB treatment

Prison TB hospital

1. Confirms diagnosis of patients

From police stations

From prisons

At entering in prison

While executing punishment

2. Register and notify TB cases in prison sector

3. Monitoring TB treatment

TB management in prison sector

• TB is diagnosed both upon arrival and during the imprisonment in each prison

• TB confirmed patients are referred to the 2 TB penitentiary hospitals in order to be treated and monitor during treatment period

• TB diagnose is based on sputum examination (microscopy, culture and DST for 1st and 2nd

line drugs) and Rx

TB management in prison sector

• Theoretically, treatment regimen (TB and MDR TB) are prescribed according to WHO guidelines, but not all 2nd line drugs are available in Romania (Capreomicin, PAS, Kanamicyn, etc)

• Except for Amikacyn not other injectible is available, so often the regimen prescribed is based on the availability of drugs and not based on the resistance identified in DST.

• If the prisoner is released before ending the treatment, he is referred to the TB dispensary from civil sector

Notification Rate in prisons compared with general population 2000 – 2011

907.7

119,9

1099.4

122,4

2154.5

134,1

2966.7

142,7

2235

135,61328.8

134.6

865.2

123.7

848.2

117.8

650

110.1

864

107.8

810

99.4

642

90.5

588

82.4

0

500

1000

1500

2000

2500

3000

glo

ba

l /

pp

ris

on

s (

%.o

oo

)

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

prisons General population

Table 2. Incidence, prevalence and mortality rates of TB (past three years) in prison sector

Year Notification Prevalence Mortality

no ofcases

Rate(at 100.000)

no ofcases

Rate(at 100.000)

no ofdeath

Rate(at 100.000)

2009 - prison population average 26649

191 717 393 1474.7 3 11

2010 - prison population average 27559

177 642 293 1063.2 2 7

2011 - prison population average 29263

172 588 304 1038.9 2 7

TB in prison sector

• Socio-demographic information

2011

Sex 11% women 89% men

Age 82%: 20-45 years old

18% over 45 years old

IDUs 28% are IDUs 72% are not IDUs

Roma population 56% declaredthemselves are roma

44% do not declared us roma

MDR TB

MDR TB cases notified:

• 2009: 10 out of 191 (5.2%)

• 2010: 7 out of 177 (4%)

• 2011: 6 out of 172 (3.5%)

HIV/AIDS IN PRISON SECTOR

HIV/AIDS management

• HIV is diagnosed both upon arrival and during the imprisonment in each prison (rapid tests)

• HIV confirmed patients (in Matei Bals institute) are referred to Jilava penitentiary hospital in order to be treated and monitor (CD4)

• Total number of HIV-infected prisoners: – 2011: 99 prisoners– 2012 (1st of October 2012): 160 prisoners

• Isoniazid preventive therapy among HIV positive prisoners is available (in the last 5 years it was not used)

HIV/AIDS prevalence (number of cases)

Year Total number of HIV/AIDS cases

2005 47

2006 46

2007 57

2008 52

2009 68

2010 76

2011 99

01.10.2012 160

HIV/AIDS prevalence (per 100,000 prisoners)

• 2009: 241 per 100,000 prisoners

• 2010: 275 per 100,000 prisoners

• 2011: 338 per 100,000 prisoners

• 2012: 500 per 100,000 prisoners

HIV/AIDS in prisons

• Socio-demographic information

Sex 91 men8 women

Age 65: 20-30 years old24: 30-40 years old9: 40-50 years old1:

IDUS IN PRISON

Situation of IDU-s in the prison

• In one penitentiary a syringes exchange program is implemented since 2008

• Substitution treatment with methadone available in 3 hospital penitentiaries and in 7 penitentiaries. Substitution treatment started in 2008

• Therapeutically communities opened in 3 penitentiaries • In 2010, 2043 inmates were registered as drug users. Since

2001, the number of drug users in penitentiary is double, but the number of inmates decreased from 50.000 to 27.559

• Psychological counseling for drug users are available by request or at medical recommendation

PRISON SYSTEM INTEGRATION

Prison system integration

• All the laws, orders released by the Ministry of Heath are “mandatory” also for the prison sector

• TB services are financed through: – National TB Programme for drugs, consumables for

diagnosis; – National Administration of Penitentiaries and the

Insurance House of the Ministry of Justice for the rest of the services

• HIV services are financed through:– National HIV Programme for drugs; – National Administration of Penitentiaries and the

Insurance House of the Ministry of Justice for the rest of the services

OCCUPATIONAL HEALTH

Occupational health

• Trainings re. TB and HIV are available financed by the Global Fund or from the public budget

• HIV post-exposure prophylaxis: available

• TB prophylactic treatment: available

• TB or HIV cases post exposure among prisons’ staff: yes (not statistics are available)

• Regular check-ups including TB and HIV testing for prisons staff: yes (1/year)