Mitigation of COVID-19 During Dental Treatment in a State Prison System.

In congregate living settings when active coronavirus disease 2019 (COVID-19) transmission is present, limiting the scope of dental care to urgent and emergent treatment minimizes exposure risk for patients and staff. Engineering controls to mitigate aerosol production during dental procedures, including enhanced high-volume evacuation, high-efficiency particulate absorbing air filtration, and the use of a dental dam provide additional protection for dental providers and staff. Properly fitted N-95 respirators are of particular importance to limit COVID-19 transmission when SARS-CoV-2 containing aerosols may be present. When patients are known to be COVID-19 positive, the use of powered air-purifying respirators is appropriate. Further protection against the spread of disease among patients and staff may be provided by point-of-care testing for patients prior to dental procedures during outbreaks.

Decreasing the Risk for Transmission of SARS-CoV-2 During In-Person Visitation Within a State Prison System.

To decrease the introduction of COVID-19, in-person visitation programs were temporarily limited at California Department of Corrections and Rehabilitation facilities. After consultation with the California Department of Public Health, and in accordance with Centers for Disease Control and Prevention guidelines, in-person visitation was reintroduced on April 10, 2021, with COVID-19 mitigation strategies. To assess the risk of visitation as a mode of entry for COVID-19 into a prison setting, data were gathered demonstrating the number of visitors who were not allowed into the prison due to a positive COVID-19 test prior to visitation. The number of patients who tested positive for COVID-19 after interaction with visitors was also assessed. Between April 10 and June 27, 2021, 33,212 visitors participated in the in-person visiting program. Eight visitors received positive test results prior to entry. Between January 1 and October 1, 2021, 19,025 patients received a total of 93,135 visitations. Of these, 66 patients received positive test results from post-visit testing. These data suggest that when appropriate mitigation strategies are implemented, the visitation process is not a significant contributor to COVID-19 entry into the prison facility when compared with the total number of COVID-19 cases among patients.

California's Prisoner Protections for Family and Community Health Act : Implementing a Mandated Condom Access Program in State Prisons, 2015-2016.

In 2014, California passed Assembly Bill 966, which required condom access for persons incarcerated in all 35 California state prisons (33 men's and 2 women's prisons). The California Correctional Health Care Services and the Sexually Transmitted Disease Control Branch and the Office of AIDS of the California Department of Public Health collaborated in a prison administration-led multidisciplinary implementation workgroup. Our workgroup, representing public health, correctional health, legal and legislative affairs, labor relations, and prison staff members, participated in 4 planning meetings during May-September 2015. We surveyed prison staff members and incarcerated men to identify and address potential challenges; conceptualized a tamper-resistant condom dispenser; developed educational materials, frequently asked questions for staff members, and fact sheets for the public; and conducted forums for custody and medical staff members at each prison. Key lessons learned included the need for high-level custody support, engagement of labor unions early in the decision-making process, and flexibility within defined parameters for sites to determine best practices given their unique institutional population, culture, and physical layout. Condom access was initiated at 4 prisons in July 2015 and expanded incrementally to the remaining 29 men's prisons through July 2016. A total of 243 563 condoms were accessed in the men's prisons, for an average of 354 condoms per 1000 population per month. The start-up dispenser cost was $69 825 (735 dispensers at $95 each). We estimated an annual condom cost of $0.60 per person. Although staff members and incarcerated men expressed concern that this legislation would condone sex and provide repositories for contraband, no serious adverse incidents involving condoms were reported. California demonstrated that condom access is a safe, low-cost intervention with high uptake for a large correctional system and provided a replicable implementation model for other states. Prison condom programs have the potential to decrease transmission of sexually transmitted infections (STIs) among incarcerated persons and their communities, which are often disproportionately affected by STIs, HIV, and other chronic diseases.

Infection control in jails and prisons.

At the end of 2005, approximately 7 million people (or 1 of every 33 American adults) were either in jail, in prison, or on parole. Compared with the general public, newly incarcerated inmates have an increased prevalence of human immunodeficiency virus infection, hepatitis B virus infection, hepatitis C virus infection, syphilis, gonorrhea, chlamydia, and Mycobacterium tuberculosis infection. While incarcerated, inmates are at an increased risk for the acquisition of blood-borne pathogens, sexually transmitted diseases, methicillin-resistant Staphylococcus aureus infection, and infection with airborne organisms, such as M. tuberculosis, influenza virus, and varicella-zoster virus. While incarcerated, inmates interact with hundreds of thousands of correctional employees and millions of annual visitors. Most inmates are eventually released to interact with the general public. Tremendous opportunities exist for infectious diseases specialists and infection-control practitioners to have an impact on the health of correctional employees, the incarcerated, and the communities to which inmates return. This article presents a brief review of some of the most important infection-control challenges and opportunities within the correctional setting.

Healthcare resources are inadequate to address the burden of illness among HIV-infected male prisoners in Malaysia.

Purpose Criminalization of drug use in Malaysia has concentrated people who inject drugs (PWID) and people living with HIV into prisons where health services are minimal and HIV-related mortality is high. Few studies have comprehensively assessed the complex health needs of this population. The paper aims to discuss these issues. Design/methodology/approach From October 2012 through March 2013, 221 sequentially selected HIV-infected male prisoners underwent a comprehensive health assessment that included a structured history, physical examination, and clinically indicated diagnostic studies. Findings Participants were mostly PWID (83.7 percent) and diagnosed with HIV while incarcerated (66.9 percent). Prevalence of hepatitis C virus (90.4 percent), untreated syphilis (8.1 percent), active (13.1 percent), and latent (81.2 percent) tuberculosis infection was several fold higher than non-prisoner Malaysian adults, as was tobacco use (71.9 percent) and heavy drinking (30.8 percent). Most (89.5 percent) were aware of their HIV status before the current incarceration, yet few had been engaged previously in HIV care, including pre-incarceration CD4 monitoring (24.7 percent) or prescribed antiretroviral therapy (ART) (16.7 percent). Despite most (73.7 percent) meeting Malaysia's criteria for ART (CD4 <350 cells/ µL), less than half (48.4 percent) ultimately received it. Nearly one-quarter (22.8 percent) of those with AIDS (<200 cells/ µL) did not receive ART. Originality/value Drug addiction and communicable disease comorbidity, which interact negatively and synergistically with HIV and pose serious public health threats, are highly prevalent in HIV-infected prisoners. Interventions to address the critical shortage of healthcare providers and large gaps in treatment for HIV and other co-morbid conditions are urgently needed to meet the health needs of HIV-infected Malaysian prisoners, most of whom will soon transition to the community.

Confronting the HIV, Tuberculosis, Addiction, and Incarceration Syndemic in Southeast Asia: Lessons Learned from Malaysia.

Throughout Southeast Asia, repressive drug laws have resulted in high rates of imprisonment in people who inject drugs (PWID) and people living with HIV (PLH), greatly magnifying the harm associated with HIV, tuberculosis, and addiction. We review findings from Malaysia's largest prison to describe the negative synergistic effects of HIV, tuberculosis, addiction, and incarceration that contribute to a 'perfect storm' of events challenging public and personal health and offer insights into innovative strategies to control these converging epidemics. The majority of PLH who are imprisoned in Malaysia are opioid dependent PWID. Although promoted by official policy, evidence-based addiction treatment is largely unavailable, contributing to rapid relapse and/or overdose after release. Similarly, HIV treatment in prisons and compulsory drug treatment centers is sometimes inadequate or absent. The prevalence of active tuberculosis is high, particularly in PLH, and over 80 % of prisoners and prison personnel are latently infected. Mandatory HIV testing and subsequent segregation of HIV-infected prisoners increases the likelihood of tuberculosis acquisition and progression to active disease, amplifying the reservoir of infection for other prisoners. We discuss strategies to control these intersecting epidemics including screening linked to standardized treatment protocols for all three conditions, and effective transitional programs for released prisoners. For example, recently introduced evidence-based interventions in prisons like antiretroviral therapy (ART) to treat HIV, isoniazid preventive therapy to treat latent tuberculosis infection, and methadone maintenance to treat opioid dependence, have markedly improved clinical care and reduced morbidity and mortality. Since introduction of these interventions in September 2012, all-cause and HIV-related mortality have decreased by 50.0 % and 75.7 %, respectively. We discuss the further deployment of these interventions in Malaysian prisons.

Tuberculosis outbreak in a housing unit for human immunodeficiency virus-infected patients in a correctional facility: transmission risk factors and effective outbreak control.

In 1995, an outbreak of tuberculosis (TB) occurred among residents of a correctional-facility housing unit for inmates infected with human immunodeficiency virus (HIV). We isolated and treated patients who were suspected to have TB. To determine risk factors for in-prison transmission of TB, we conducted a case-control study to compare inmate case patients infected with a distinct outbreak strain of TB with control subjects who resided in the HIV unit. We identified 15 case patients during a 4-month period. Among inmates with a CD4 count of <100 cells/mm(3), case patients were more likely than control subjects to spend >/=20 hours per week in a communal day room (odds ratio, 42; P=.002) and were less likely to have a television in their single-person room (odds ratio, 0.10; P=.003). The communal day room was a likely site of transmission. Successful collaboration between the correctional system and public health departments halted the outbreak.