Tuberculosis (TB) rates in South Africa's prisons could be cut by up to 94 percent if the country reduced overcrowded conditions in cells and implemented active TB case finding, according to research presented at the recent South African TB Conference.
Overcrowding and poor living conditions have driven TB in prisons for centuries, but a recent court case has finally given South African researchers at the Desmond Tutu HIV Centre at the University of Cape Town enough information on conditions in one of the country's prisons to mathematically model TB transmission risks.
Using witness testimonies to deduce TB risk factors for inmates, researchers found that overcrowding - more so than poor ventilation or a lack of access to outside yards - was the main driver of TB in a prison environment.
Reducing overcrowding by conforming to South Africa's own national guidelines would lower the risk of TB infection for inmates by almost a third, and bringing the country's prisons in line with international standards would halve the risk. However, researchers found that implementing international standards as well as active case finding could bring down the risk by 94 percent.
"Having communal cells with more than 20 prisoners per cell in a country like ours is a total disaster," said Prof Robin Wood of the Desmond Tutu HIV Centre, who called prison conditions a human rights abuse.
South Africa is ranked at 17 among the 22 countries that account for 80 percent of all TB cases globally, according to the World Health Organization (WHO). South Africa diagnoses about 400,000 cases annually.
Although many people carry TB, only 10 percent will ever develop the active disease. But people with compromised immune systems, such as those living with HIV, are up to 37 times more likely to develop active TB.
In 2011 a former inmate of Cape Town's Pollsmoor prison, Dudley Lee, took the Department of Correctional Services to court, arguing that the conditions he was forced to live in for almost five years as an awaiting-trial prisoner caused him to develop active TB.
Pollsmoor was built to house 1,800 inmates but now has about 4,200, Wood said. South Africa's 240 correctional facilities hold about 160,000 prisoners, about a third more than the facilities were built to accommodate, according to the Institute for Security Studies, a South African think-tank.
Lee's legal team argued that although the Department of Correctional Service was aware of the elevated TB risk associated with overcrowding and poor ventilation, it failed to respond to prisoner requests for adequate TB prevention and treatment. The department could also have reduced the risk by segregating prisoners with active TB during the period they were infectious.
A judge initially ruled in favour of Lee, who sought about US$46,600 in compensation from the state, but the ruling was later overturned.