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)
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