Stop TB Partnership

Inmates lead the fight against TB in Zambia's prisons

23 May 2011 - Lusaka - Five inmates at Lusaka Central Prison are about to start an exceptionally busy day that includes activities beyond the bounds of ordinary prison routine. All serve as inmate TB Peer Educators and are specially trained to screen for TB and make referrals. Today's activities will serve a larger goal: to complete TB screening and HIV testing for more than 1500 inmates in less than four months.

By 8:30 they have already collected 100 sputum samples for testing under fluorescence microscopy and assembled the first group of inmates for screening. When the team of clinical officers and nurses arrive they oversee a procession of inmates passing through a series of tents for registration, TB symptom screening, HIV counseling and testing, and then for a chest x-ray inside the mobile digital x-ray unit.

The inmate TB Peer Educator programme is one of the innovative approaches the Centre for Infectious Disease Research in Zambia (CIDRZ) is using to identify more cases of TB in Zambian prisons. Supported by a grant from the Stop TB Partnership's TB REACH initiative, they have been working with the Zambia Prisons Service since August 2010 to carry out TB and HIV screening in three of Zambia's prisons.

"Empowering inmates to lead the fight against TB is a key part of this programme," says Sisa Hatwiinda, Nurse and Program Coordinator. "Without the inmate TB Peer Educators we simply wouldn't be able to reach so many inmates, diagnose as many TB and HIV infections and prevent deaths."

The programme is also using the latest generation of mobile digital radiology equipment to aid in the detection of TB cases. When test results show the need for consultation with a more experienced physician, digital x-ray images are sent via mobile phone network for remote reading. CIDRZ works closely with the Ministry of Health and the Zambia Prisons Medical Service so that inmates diagnosed with TB and/or HIV are referred to the National TB and ART Programmes for treatment and follow-up.

Overcrowding is a major problem in Zambian prisons, making them ideal environments for the spread of TB. CIDRZ and the Zambia Prisons Service are working together to mitigate the situation by improving prison infrastructure. In the short term, cells have been identified where inmates with infectious TB can stay in isolation. Meanwhile, a project to construct screening and isolation facilities in the prisons is underway.

The programme was developed after the Zambia Prisons Service Medical Director, Dr. Chisela Chileshe, contacted CIDRZ in 2010 to call attention to the urgent need to tackle TB and HIV in prisons. His call came just as TB REACH was first announced and the programme was awarded funding shortly thereafter. The programme offers additional benefits for the peer educators themselves. "Helping as a TB Peer Educator has been a good way to increase my skills for a future job. When I get out of here I’ll be able to say that I helped screen the entire prison for TB. Because of this screening programme we all know we are safer during the hours that we spend inside the cells; we know that we are free of TB. It has made a difference in the lives of all the inmates here," said one Inmate TB Peer Educator at Lusaka Central Prison.