Analysis of a Large Severe Acute Respiratory Syndrome Coronavirus 2 (Alpha) Outbreak in a Catalan Prison Using Conventional and Genomic Epidemiology.

Enforcing strict protocols that prevent transmission of airborne infections in prisons is challenging. We examine a large severe acute respiratory syndrome coronavirus 2 outbreak in a Catalan penitentiary center in February-April 2021, prior to vaccination deployment. The aim was to describe the evolution of the outbreak using classical and genomic epidemiology and the containment strategy applied. The outbreak was initially detected in 1 module but spread to 4, infecting 7 staff members and 140 incarcerated individuals, 6 of whom were hospitalized (4.4%). Genomic analysis confirmed a single origin (B.1.1.7). Contact tracing identified transmission vectors between modules and prevented further viral spread. In future similar scenarios, the control strategy described here may help limit transmission of airborne infections in correctional settings.

HIV Care Continuum and Preexposure Prophylaxis Program in Federal Bureau of Prisons, United States.

In 2019, the US Department of Health and Human Services launched the Ending the HIV Epidemic in the US initiative (EHE) with the goal of reducing new HIV infections by 90% by 2030. This initiative identifies 4 pillars (diagnose, treat, prevent, and respond) to address the HIV epidemic in the United States. To advance the EHE goals, the Federal Bureau of Prisons (FBOP) has implemented interventions at all points of the HIV care continuum. The FBOP has addressed the EHE pillar of prevention through implementing preexposure prophylaxis, developing a strategy to decrease the risk of new HIV infection, and providing guidance to FBOP healthcare providers. This article describes the implementation of programs to improve the HIV care continuum and end the epidemic of HIV within the FBOP including a review of methodology to implement an HIV preexposure prophylaxis program.

Outbreak of Invasive Serratia marcescens among Persons Incarcerated in a State Prison, California, USA, March 2020-December 2022.

Serratia marcescens is an environmental gram-negative bacterium that causes invasive disease in rare cases. During 2020-2022, an outbreak of 21 invasive Serratia infections occurred in a prison in California, USA. Most (95%) patients had a history of recent injection drug use (IDU). We performed whole-genome sequencing and found isolates from 8 patients and 2 pieces of IDU equipment were closely related. We also identified social interactions among patients. We recovered S. marcescens from multiple environmental samples throughout the prison, including personal containers storing Cell Block 64 (CB64), a quaternary ammonium disinfectant solution. CB64 preparation and storage conditions were suboptimal for S. marcescens disinfection. The outbreak was likely caused by contaminated CB64 and propagated by shared IDU equipment and social connections. Ensuring appropriate preparation, storage, and availability of disinfectants and enacting interventions to counteract disease spread through IDU can reduce risks for invasive Serratia infections in California prisons.

Candida auris in US Correctional Facilities.

Candida auris is an emerging fungal pathogen that typically affects patients in healthcare settings. Data on C. auris cases in correctional facilities are limited but are needed to guide public health recommendations. We describe cases and challenges of providing care for 13 patients who were transferred to correctional facilities during January 2020-December 2022 after having a positive C. auris specimen. All patients had positive specimens identified while receiving inpatient care at healthcare facilities in geographic areas with high C. auris prevalence. Correctional facilities reported challenges managing patients and implementing prevention measures; those challenges varied by whether patients were housed in prison medical units or general population units. Although rarely reported, C. auris cases in persons who are incarcerated may occur, particularly in persons with known risk factors. Measures to manage cases and prevent C. auris spread in correctional facilities should address setting-specific challenges in healthcare and nonhealthcare correctional environments.

Lessons Learned from Public Health and State Prison Collaborations during COVID-19 Pandemic and Multifacility Tuberculosis Outbreak, Washington, USA.

The large COVID-19 outbreaks in prisons in the Washington (USA) State Department of Corrections (WADOC) system during 2020 highlighted the need for a new public health approach to prevent and control COVID-19 transmission in the system's 12 facilities. WADOC and the Washington State Department of Health (WADOH) responded by strengthening partnerships through dedicated corrections-focused public health staff, improving cross-agency outbreak response coordination, implementing and developing corrections-specific public health guidance, and establishing collaborative data systems. The preexisting partnerships and trust between WADOC and WADOH, strengthened during the COVID-19 response, laid the foundation for a collaborative response during late 2021 to the largest tuberculosis outbreak in Washington State in the past 20 years. We describe challenges of a multiagency collaboration during 2 outbreak responses, as well as approaches to address those challenges, and share lessons learned for future communicable disease outbreak responses in correctional settings.

Screening for Chlamydia and Gonorrhea in Youth Correctional Facilities, Utah, USA.

We reviewed data obtained in October 2021-May 2023 from youth who reported a history of sexual activity upon admission to 1 of 12 juvenile justice facilities in Utah, USA, that offered screening for Chlamydia trachomatis and Neisseria gonorrhoeae. Urinalysis revealed C. trachomatis positivity of 10.77%, N. gonorrhoeae positivity of 1.08%, and coinfection C. trachomatis N. gonorrhoeae) of 0.90%. Prevalence of infection was similar for youths in rural and urban facilities. A total of 12.01% of those identifying as male and 14.01% of those identifying as female tested positive for C. trachomatis, N. gonorrhoeae, or coinfection. Of young adults who tested positive, 74.65% received their results while incarcerated, all of whom accepted treatment. Our research underscores the feasibility of providing prompt C. trachomatis/N. gonorrhoeae screening and treatment in juvenile correctional facilities. The pervasiveness of infection emphasizes the urgent need for early identification and treatment for C. trachomatis and N. gonorrhoeae in incarcerated youth nationwide.

Expanding Hepatitis C Virus Treatment in the New Mexico State Prison System: Using the ECHO Model for Provider and Prison Peer Education.

It is critical to address hepatitis C virus (HCV) in carceral settings to achieve worldwide elimination of the virus. We describe New Mexico's (NM) experience expanding HCV treatment in state prisons, supplemented with Project ECHO (ECHO; virtual mentorship through guided practice) and the NM Peer Education Program (NMPEP). We describe how using these programs may be a model for expanding treatment in prisons globally. ECHO, NM Corrections Department (NMCD) and Wexford Health Services (WHS) collaborate to treat HCV in state prisons and increase HCV knowledge among incarcerated persons using NMPEP. Each person arriving in prison is tested for HCV and those with active infection receive baseline labs, which are reviewed. Patients not meeting criteria for simplified treatment are presented to ECHO for expert guidance. Otherwise, patients are treated by WHS without consultation. NMPEP provides patient-to-patient education in prisons, addressing HCV myths and exploring treatment refusals. From December 2020 to June 2023, 3603 people had HCV viremia. In this study, 1685 people started treatment: 1280 were treated using the simplified algorithm and 405 were presented to ECHO. Of the 988 people who completed treatment and had sustained virologic response (SVR) labs drawn, 89.2% achieved SVR (i.e., cure). Most of the 107 people who did not achieve SVR had presumed reinfection. NMPEP trained 148 peer educators who educated 3832 peers about HCV prevention and treatment. HCV treatment in prisons can be expanded by implementing simplified treatment algorithms, use of the ECHO model for patients with advanced disease and peer education.

How do people in prison access palliative care? A scoping review of models of palliative care delivery for people in prison in high-income countries.

BACKGROUND: An ageing prison population with complex health needs combined with punitive sentencing practices means palliative care for incarcerated individuals is increasingly important. However, there is limited evidence regarding the models of care delivery in high-income countries, and their associated challenges and benefits. AIM: To develop a typology of models of palliative care provision for incarcerated individuals, synthesise evidence of their outcomes and describe facilitators of and challenges in delivering different models of palliative and end-of-life care in prisons. DESIGN: Scoping review following Arksey and O'Malley, with narrative synthesis. The protocol was registered prospectively (reviewregistry1260). DATA SOURCES: MEDLINE, EMBASE, CINAHL, PsycINFO, the Social Sciences Citation Index and grey literature were searched on 15th March 2023. The Mixed Methods Appraisal Tool (MMAT) was used for quality appraisal. RESULTS: A total of 16,865 records were screened; 22 peer-reviewed articles and 18 grey literature sources met the inclusion criteria. Three models were identified: Embedded Hospice, Outsourcing Care and Community Collaboration. The Embedded Hospice model shows potential benefits for patients and prisons. Outsourcing Care may miss opportunities for comprehensive care. Collaborative Care relies on proactive prison-community relationships that could be formalised for improvement. Psychosocial and bereavement needs of those dying in prison and their caregivers lack sufficient documentation. CONCLUSION: Further research is needed to evaluate prison hospice costs and examine how prison hospices impact compassionate release usage. Beyond the USA, policies might formalise care pathways and recognise best practices. Further investigation to address psychosocial needs of people in prison with life-limiting illnesses and post-death bereavement support is required.

Prisoners' perceived oral and general health and their experience with accessing, understanding and assessing health information: A qualitative study.

Prisoners' oral health and general health are closely connected and generally poorer than that of the wider population. Moreover, knowledge of prisoners' health literacy is scarce. This study aimed to explore prisoners' perceived oral and general health and how they accessed, understood and assessed health information to gain insight into their health literacy. Twelve prisoners in a high-security prison and a halfway house participated in individual semi-structured interviews. Data was analysed through thematic analysis, which identified five themes: inconsistent self-reporting of general and oral health; autonomous health behaviour through utilizing personal resources; preference for personalized adapted health information; psychological and physical proximity; and barriers. The prisoners perceived their oral and general health as good despite several health problems. They expressed scepticism towards health information from public authorities and made their own health-related choices based on previous experiences, their own 'common sense' and the experiences of people they trusted. Health information was considered useful when adjusted to their needs. Obtaining health-related information through physical encounters was considered more accessible than through online platforms. Adapting the communication to prisoners' expressed needs and their health literacy can enhance the accessibility to improve their oral and general health. In-person encounters would be preferable.

Board game on sexually transmitted infections for imprisoned women.

INTRODUCTION: The board games is an educational technology that represents an appealing, active and playful pedagogical strategy and may be capable of motivating imprisoned women to learn about Sexually Transmitted Infections. METHODS: A methodological study to develop and evaluate a board game, following these stages: 1. Integrative literature review to identify educational technologies on Sexually Transmitted Infections used by imprisoned women; 2. Development of the board game; and 3. Content validation performed by 23 evaluators and semantic evaluation carried out with 10 imprisoned women who were enrolled in a school located within a female prison unit in the city of Recife, state of Pernambuco, Brazil. RESULTS: The board game consisted of the following: 01 board; 01 instructions manual; 05 pawns; 52 cards; and 01 dice. A global Content Validity Index of 0.966 was reached in the content validation process performed by health and education professionals. In the validation of the board game content regarding appearance, performed by designers/developers, most of the items obtained a Content Validity Coefficient below 0.85, which resulted in the need for adjustments and a new validation round with these professionals, in which Content Validity Coefficient = 0.917 was obtained. In the semantic evaluation, all the women stated that they improved their knowledge, increased their motivation to attend the class and would like to play the board game again. CONCLUSIONS: The "Previna" board game has been validated and can be considered an important pedagogical tool in the construction of knowledge in relation to the prevention, treatment and control of Sexually Transmitted Infections in the female prison context. The quality of this educational technology is directly related to its development based on an appropriate theoretical and methodological framework, in addition to satisfactory feedback from the target audience. TRIAL REGISTRATION: Not applicable.

Development and psychometric evaluation of the sexual and reproductive health needs of incarcerated women scale: a methodological study.

BACKGROUND: This study aimed to develop and validate a comprehensive tool designed to assess the sexual and reproductive health (SRH) needs of incarcerated women. METHODS: A methodological study was conducted from January to March 2023 in two female prisons in Tehran and Hamedan, Iran. The participant pool consisted of women who had been incarcerated for a minimum of 6 months and were aged between 15 and 49 years. The instrument development involved two phases. Phase I involved a literature review and interviews with incarcerated women to understand their SRH needs. Phase II assessed psychometric properties to establish the scale's validity and reliability. RESULTS: The SRH Needs of Incarcerated Women (SRH-NIW) scale was refined, comprising 37 items across six domains: pregnancy and childbirth services, parenting services, family planning and sexual health services, personal and medical care services, screening services and infection control services. Exploratory factor analysis explained 66.15% of variance. The Content Validity Ratio and Content Validity Index were 0.8 and 0.94, respectively, indicating high content validity. Average Variance Extracted values ranged from 0.592 to 0.698. The whole scale showed a Cronbach's alpha of 0.823, and the Intra-class Correlation Coefficient was 0.879. CONCLUSION: The SRH-NIW scale is a valid and reliable tool for assessing the SRH needs of incarcerated women. It can enhance healthcare services and interventions for incarcerated women, potentially leading to policy improvements within the prison system.

Healthcare professionals perspectives on tuberculosis barriers in Portuguese prisons-a qualitative study.

BACKGROUND: Tuberculosis (TB) remains a significant public health concern, particularly within prison settings, where the confluence of adverse health factors and high-risk behaviors contribute to a heightened risk of transmission. This study delves into the perspectives of medical doctors, regarding the implementation of the 2014 TB protocol in Portugal. METHODS: The study has a qualitative, descriptive design. Individual semi-structured interviews with medical doctors from TB outpatient centers in Porto and Lisbon were used for data collection. For the analysis thematic analysis method was used. RESULTS: The study population comprised 21 medical doctors with the majority being female (61.9%) and 57.1% specializing in pulmonology. The results indicate varied perceptions of the protocol's usefulness, with positive impacts on coordination reported by some participants. Improved communication and evolving collaboration between TB outpatient centers and prisons were highlighted, although challenges in contact tracing and resource constraints were acknowledged. The study also sheds light on the role of nurses in patient education. CONCLUSION: Despite overall positive perceptions, challenges such as sustaining therapy post-symptomatic improvement and delays in diagnostic methods were identified. The findings underscore the importance of continuous collaboration between prisons and TB control programs to address challenges, improve disease control and prevent TB transmission.

Non-injection drug use among incarcerated people in Iran: Findings from three consecutive national bio-behavioral surveys.

BACKGROUND: Prisons often serve as high-risk environments for drug use, and incarcerated people are at a high risk for substance use-related mental and physical harms. This study aimed to determine the prevalence of non-injection drug use inside the prison and its related factors among incarcerated people in Iran. METHODS: We utilized data from three national bio-behavioral surveillance surveys conducted among incarcerated people in Iran in 2009, 2013, and 2017. Eligibility criteria were being ≥ 18 years old, providing informed consent, and being incarcerated for over a week. Overall, 17,228 participants across all surveys were recruited through a multi-stage random sampling approach. Each participant underwent a face-to-face interview and HIV test. The primary objective of the study was to assess self-reported non-injection drug use within the prison environment within the last month. A multivariable logistic regression model was built to determine associated covariates with drug use inside prison and an adjusted odds ratio (aOR) with 95% confidence intervals (CI) were reported. RESULT: The prevalence of non-injection drug use inside the prison was 24.1% (95% CI 23.5, 24.7) with a significant decreasing trend (39.7% in 2009, 17.8% in 2013, 14.0% in 2017; p-value < 0.001). Overall, 44.0% of those who used drugs were also receiving opioid agonist therapy (OAT) and we noted that in 2017, 75.1% of those on OAT used stimulants. In the multivariable logistic regression model, the year of interview (2013: aOR = 1.43 and 2009: aOR = 5.60), younger age (19-29: aOR = 1.14 and 30-40: aOR = 1.37), male sex (aOR = 3.35), < high school education (aOR = 1.31), having a history of previous incarceration (aOR = 1.26), and having a history of lifetime HIV testing (aOR = 1.76) were significantly and positively associated with recent non-injection drug use inside the prison. CONCLUSIONS: Approximately one in four incarcerated people in Iran reported drug use within the last month inside prisons. While a declining trend in non-injection drug use was noted, substantial gaps persist in harm reduction programs within Iranian prisons. In particular, there is a pressing need for improvements in drug treatment programs, focusing on the integration of initiatives specifically designed for people who use stimulants.

An exploration of nursing students' lived experience of clinical placement in adult male prisons: A phenomenological study.

AIM: To explore nursing students' lived experience of a clinical placement within healthcare in a prison, to gain an insight into the support provided prior to and during this unique clinical placement. DESIGN: An inductive phenomenological study. METHODS: Participants included 14 nursing students from three undergraduate nursing programmes in England, Adult (n = 4), Learning Disability (n = 3) and Mental Health (n = 7). Following a clinical placement in a prison, each participant completed a semistructured audio-recorded interview on MS Teams between October and December 2021. Audio recordings were transcribed verbatim and thematic analysis was completed. RESULTS: Two overarching themes were identified, 'shock' due to the (a) reality of prison; (b) overwhelming emotional impact and (c) frequency and severity of self-harm and 'surprise' due to (a) the need to work with prison officers; (b) recognizing and addressing preconceptions of people in prison and (c) the development of clinical knowledge, skills and becoming a nurse. CONCLUSIONS: The need remains for a comprehensive strategy of preparation and orientation for nursing students before commencing a clinical placement in prison, which includes the development of knowledge and clinical skills to support the complex health and social care needs of people in prison. IMPACT: Our research identified the support provided to nursing students prior to clinical placement in prison varies considerably. The development of a preparation and orientation programme has the potential to reduce pre-placement anxiety, emotional burden and support nursing students in addressing their preconceptions of people in prison. This approach is essential to support future nursing students to embrace the unique opportunity of a clinical placement within a prison, enhance their clinical knowledge and skills, and develop as a nurse. REPORTING METHOD: Our paper adheres to the consolidated criteria for reporting qualitative research (COREQ). PATIENT OR PUBLIC CONTRIBUTION TO THE DEVELOPMENT OF THIS STUDY: None.

Reframing reentry: Understanding how reentry programming affects the well-being and quality of life of returning citizens.

This study examined the experiences returning citizens (RCs) have in participating in different reentry programs and how these experiences may lead to improved well-being and quality of life (QOL). We conducted 14 semi-structured interviews with RCs participating in employment-oriented reentry programs. The interviews focused on participants' reentry programming experience and areas affecting their well-being (e.g., housing, education, financial stability). QOL was enhanced for RCs when they were able to access stable housing, develop supportive relationships, have a job that permitted them the resources needed to live independently, and increase their perceptions of self-efficacy and social capital. While reentry programs maintain a focus on employment for RCs, housing, healthy relationships, and opportunities for increasing self-efficacy and social capital are tied to well-being and QOL among RCs. Reentry programs have the potential to influence a variety of factors at multiple levels that shape well-being and QOL, and in turn employment and recidivism, among RCs.

[Prevalence of mental disorders in French prisons: A systematic review]. / Prévalence des troubles psychiatriques en population carcérale française : une revue systématique de la littérature.

INTRODUCTION: The prevalence of psychiatric disorders among prisoners remains a major public health issue worldwide. In France, despite the increasing number of persons who are incarcerated (+30% between 1992 and 2002 with a 120% prison overcrowding), and a historical concern about the mental health of persons in detention and its management, no systematic review has been published on this subject. The aim of this article is to present the results of a systematic review of the literature on the prevalence of psychiatric disorders in French prisons. METHOD: The reporting of this systematic review conforms to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) checklist. We searched the PubMed and Web of Science databases. We used combinations of keywords relating to prison (prison*, jail*, inmate*), to psychiatry ("mental health", psychiatr*), and to France (France, French). This work was completed with a search through the digital libraries of the École des Hautes Études en Santé Publique (EHESP) and of the Système Universitaire de Documentation (Sudoc) to obtain data from academic works and the gray literature. References cited in studies included in this review were also examined. All references published up to September 2022, written in English or French, presenting the results of original quantitative studies on the prevalence of psychiatric disorders in correctional settings were included. Two researchers independently extracted data from included references according to a pre-established protocol. RESULTS: Among 501 records identified, a total of 35 papers based on 24 epidemiological studies met the eligibility criteria for inclusion in this review: 16 were cross-sectional, 7 retrospective and 1 both cross-sectional and retrospective. All papers were published between 1999 and 2022. We found one European study, 5 international studies, 18 regional or local studies. Of these, 21 studies had all-male or mixed gender samples (but when the sample was mixed gender, it was always at least 92% male). Almost half of the studies (n=11) involved a small sample of fewer than 500 persons. Half of the studies involved a sample of recently incarcerated persons: 6 involved a random sample of persons in detention, and 1 involved a sample of people incarcerated for more than 5 years. The last 5 studies focused on persons aged over 50 years and incarcerated for more than one year (n=1), incarcerated for sexual offences (n=2), placed in disciplinary cells (n=1) or in a special wing for radicalized or suspected radicalized individuals (n=1). Nine studies used standardized and validated diagnostic tools. According to the 4 studies involving representative samples and using standardized and validated diagnostic tools, the prevalence of the following psychiatric disorders was: 29.4-44.4% for anxiety disorders, 5-14.2% for PTSD, 28-31.2% for mood disorders, 6.9-17% for psychotic disorders, 32% for personality disorders and 11% for ADHD. CONCLUSION: This systematic review of the literature highlights the high prevalence of psychiatric disorders in French prisons. The data collected are in line with international studies. The great methodological heterogeneity of the papers included in this review calls for further rigorous research to better understand the rates of mental disorders in French prisons and to explore their determinants.

The Labyrinthine Journey: Unveiling Obstacles in addressing Mental Health Challenges in Prisons and its Confluence with Medico-Legal and Pharmacological Perspectives.

This paper delves into the intricate realm of mental health issues within prisons including other correctional facilities, the intersectionality with legal and medical aspects, and the potential of pharmacology as a viable treatment modality. The prevalence and diverse array of mental disorders among incarcerated individuals are thoroughly examined, underscoring the imperative for all-encompassing interventions. The legal structure, hurdles encountered in delivering mental healthcare, and the indispensability of interdisciplinary cooperation are scrutinized. Furthermore, the effectiveness and moral implications of pharmaceutical interventions in correctional environments are deliberated upon. Conclusive suggestions are put forth to enhance mental healthcare provisions in prisons. The research paper endeavors to penetrate the labyrinthine complexities of mental health predicaments within correctional institutions, with a specific emphasis on the convergence of medico-legal facets and the plausible impact of pharmacological interventions. The study strives to elucidate the intricate nature of mental health challenges among incarcerated populations, considering the intricate interplay of socio-cultural, environmental, and psychological factors that contribute to their pervasiveness. By delving into these interconnected dimensions, the research aims to unlock prospective remedies capable of efficaciously meeting the mental health requisites of incarcerated individuals.

Resident interactions when affirming and correcting peers in a therapeutic community for women.

Purpose ­: While recent years have seen a number of studies of social networks in therapeutic communities (TCs) and other residential settings, these have primarily focused on male residents. This paper aims to conduct a longitudinal social network analysis of interpersonal interactions in a TC for women. Design/methodology/approach ­: The data consists of a longitudinal directed social network of instances of feedback between 56 residents of a 16 bed TC for women over a period of 611 days. Mean age of the participants was 33.1 years, mean length of stay was 133.9 days and 91% of the participants were female. Feedback consisted of written affirmations for prosocial behavior and written corrections for contravening TC norms. Data was analyzed using a latent factor longitudinal social network model. Findings ­: Residents react to peer intervention in complex ways. Residents reciprocated affirmations (B = 0.14, 95% confidence interval = 0.10, 0.18) and corrections (B = 0.20, 95% CI = 0.13, 0.25). Controlling for reciprocity, participants who received affirmations were more likely to affirm and correct peers (B = 0.10, 95% CI = 0.06, 0.15; B = 0.17, 95% CI = 0.10, 0.23), suggesting that the encouragement offered by affirmations leads to increased activity. Homophily by admission time occurred in both affirmations and corrections (B = 0.23, 95% CI = 0.10, 0.37; B = 0.51, 95% CI = 0.29, 0.74). Originality/value ­: While affirmations and corrections serve as vehicles for behavioral reinforcement and social learning, they also allow residents to interact in ways that strengthen social bonds.