Global Prison Health Care Governance and Health Equity: A Critical Lack of Evidence.

The large and growing population of people who experience incarceration makes prison health an essential component of public health and a critical setting for reducing health inequities. People who experience incarceration have a high burden of physical and mental health care needs and have poor health outcomes. Addressing these health disparities requires effective governance and accountability for prison health care services, including delivery of quality care in custody and effective integration with community health services.Despite the importance of prison health care governance, little is known about how prison health services are structured and funded or the methods and processes by which they are held accountable. A number of national and subnational jurisdictions have moved prison health care services under their ministry of health, in alignment with recommendations by the World Health Organization and the United Nations Office on Drugs and Crime. However, there is a critical lack of evidence on current governance models and an urgent need for evaluation and research, particularly in low- and middle-income countries.Here we discuss why understanding and implementing effective prison health governance models is a critical component of addressing health inequities at the global level.

Determining the prevalence of high-risk human papillomavirus infection using a novel cervical precancer screening approach in incarcerated women at the Nsawam Medium Security Prison, Ghana.

BACKGROUND: Across Ghana, females comprise 1.2% of the entire prison population (n = 15,463). Cervical cancer screening services are however nonexistent and the prevalence of high-risk human papillomavirus (hr-HPV) and cervical precancer is undocumented. We aimed to screen and treat inmates for cervical precancer and determine the prevalence of hr-HPV using the novel AmpFire HPV detection system combined with colposcopy by trained nurses using a mobile colposcope (the Enhanced Visual Assessment (EVA) system). METHODS: A descriptive cross-sectional study design was employed, involving all incarcerated women at the Nsawam Medium Security Prison, Ghana. After counselling and informed consent, women underwent a structured questionnaire-based interview entered into a Microsoft Excel spreadsheet. Women were co-tested for cervical pre-cancer and hr-HPV by two trained nurses using dry brush cervical samples for 15 hr-HPV types (AmpFire HPV test) after which mobile colposcopy with the EVA system was performed. EVA images were reviewed by a gynaecologist. Frequencies and percentages were used to describe categorical data, while means, standard deviations, medians and interquartile ranges (IQRs) were used to describe continuous data. RESULTS: 75% of the women were convicts with a median sentence of 5 years (IQR: 2-10 years). Their mean age was 41.1 years (standard deviation: 15.5 years, range: 19-97 years). The self-reported prevalence rate of HIV was 13.1% (95% confidence interval (CI): 7.5%-21.9%), all of whom were receiving treatment. The hr-HPV prevalence rate was 47.6% (CI: 36.9%-58.3%) in the general population of imprisoned women and 63.6% (CI: 35.4%-84.8%) among HIV positive women. Six percent (6%) had lesions on the cervix, of which 3.6% were treated with thermal coagulation and 2.4% were treated with loop electrosurgical excision procedure. The average age of hr-HPV positive women was 37.8 years. CONCLUSIONS: There is a high prevalence of hr-HPV infection among women in custody at the Nsawam Medium Security Prison. These women will benefit from structured cervical cancer prevention services, including treatment for abnormalities that are picked up during such screening.