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Implementing a Large-Scale Systematic

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MAJOR ARTICLE

Implementing a Large-Scale Systematic
Tuberculosis Screening Program in Correctional
Facilities in South Africa
Vincent Zishiri,1 Salome Charalambous,1,2 Maunank R. Shah,2 Violet Chihota,1 Liesl Page-Shipp,1 Gavin J. Churchyard,1,2 and Christopher J. Hoffmann1,3
1

The Aurum Institute, Johannesburg, South Africa; 2School of Public Health, University of Witwatersrand, Johannesburg, South Africa; and 3Johns Hopkins
University School of Medicine, Baltimore, Maryland

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Background. Tuberculosis (TB) prevalence is high in correctional facilities in southern Africa. With support from local South African nongovernmental organizations, the South African Department of Correctional Services initiated a program of systematically screening newly admitted and current inmates for symptoms followed by GeneXpert Mycobacterium tuberculosis (MTB)/rifampicin (Rif ) for microbiologic testing of symptomatic inmates.
Methods. We conducted a program evaluation during a 5-month window describing program reach, effectiveness, adoption within the facilities, cost, and opportunities for sustainability. This evaluation included 4 facilities (2 large and 2 smaller) with a total daily census of 20 700 inmates.
Results. During the 5-month evaluation window from May to September 2013, 7426 inmates were screened at the 4 facilities. This represents screening 87% of all new admits (the remaining new admits were screened by correctional staff only and are not included in these statistics) and 23% of the daily inmate census, reaching 55% of the overall screening target as calculated per annum. The reach ranged from 57% screened during these 5 months at one of the smaller facilities to 13% at the largest facility. Two hundred one cases of pulmonary TB were diagnosed, representing 2.1% of the

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