Since 2001, the Gorgas Tuberculosis Initiative at the University of Alabama at Birmingham has been assisting the Honduran National TB Program (NTP) and Ministry of Security (MOS) to implement the Directly Observed Therapy Strategy (DOTS) in Honduran prisons.
Honduras's 24 prisons (housing some 11,200 inmates) were integrated into the NTP during three phases, each of which involved training, development of action plans, implementation of TB control activities, monitoring, supervision, and evaluation. In general, a decentralized approach was used to link regional TB control structures with the prisons in their areas.
During 2001-03, case detection increased significantly, then began to decrease, as transmission was interrupted. However, prison rates are still some 15 times as high as civilian rates. Cure rates increased 53% to 94%; default rates fell 12% to 0%, and mortality fell 4.8% to .07%.
A number of staff- and prisoner-initiated activities grew out of the Honduras project, including creative fundraising techniques, simple measures to improve infection control, and a variety of information, education, and communication methods and materials.
During the final phase, the Gorgas Tuberculosis Initiative:
- provided technical assistance to the prison TB control program
- promoted stronger links between the MOS and NTP to ensure the sustainability of prison TB
- continued to document and evaluate the effectiveness of the Honduran model for the purpose of national and international dissemination
The TB in prisons project has achieved 100% DOTS coverage. However, it requires continued monitoring and stronger oversight by the regional and local TB control programs of the Ministry of Health. This University of Alabama at Birmingham-supported project ended in September 2005.
Michael E. Kimerling, MD, MPH (University of Alabama at Birmingham)
Publications:Mangan JM, Arias MS, Sierra T, Perez M, Medina RL, Yanez R, Kimerling ME. Evaluating the strengths and weaknesses of tuberculosis educational activities for prisoners in Honduras. Int J Tuberc and Lung Dis. 2006 Oct;10(10):1152-8.
Arias MS, Branigan E, Ramon-Pardo P, Rodriguez R, Kimerling ME. Training and advocacy for improved tuberculosis control in prisons in Latin America and the Caribbean. Int J Tuber and Lung Dis. 2004;8(11):S169.