Philippines: National TB Control Program conducts TB mass screening among persons deprived of liberty

TB does not respect prison walls. In 2009, a study by Philippine Tuberculosis Society Incorporated – funded by the Department of Health and Department of Science and Technology through the Philippine Center for Health Research and Development – showed that the prevalence of bacteriologically confirmed pulmonary TB in prisons was 4.5 times higher as compared to the general population. Jails and prisons act as a reservoir for TB, pumping the disease into the civilian community through staff, visitors and inadequately treated former PDLs.

In the first quarter of 2018, the Philippine Department of Health’s National TB Control Program through its Regional Office III and in collaboration with the Philippine Business for Social Progress-Global Fund Project (PBSP-GF) and Bureau of Jail and Penology and Management-Regional Office III (BJMP-RO III), conducted a series of TB mass screening among jails in different provinces of Region III (also known as Central Luzon Region), one of the biggest regions in the country.

All PDLs and personnel in Central Luzon jails underwent symptom screening or chest x-ray. People with abnormal signs in either of the two tests were subjected to Xpert MTB/RIF (Mycobacterium tuberculosis/Rifampicin) test. Based on estimates, 15%-30% among the screened population are presumed to have TB and 5%-20% among those, test positive.

For the first quarter, 4’760 people were covered through this screening approach: 3’996 were screened using chest x-rays out of which 299 had results suggestive of TB. Additionally, 1’493 were tested using Xpert MTB/RIF. A total of 214 people were diagnosed with TB – 51 had RIF-susceptible TB, 2 RIF-resistant TB and 161 were clinical diagnoses. All were initiated on treatment (212 DS-TB regimen and 2 RR-TB regimen).

Among the current problems that jails face are the absence of systematic chest x-ray screening upon entry, lack of isolation areas to avoid the spread of the disease and congestion rates that range from 500% to 3000%. Despite the high numbers of people with presumptive TB, these prisons do not have access to x-ray machines, TB laboratory testing or medical doctors.

In the next quarter, the National TB Control Program in the Philippines will continue to conduct more TB mass screenings in other jails and prisons in the region. There are also plans to improve infection control measures in jails and prisons and to establish a mechanism to make chest X-rays a primary screening tool upon jail/prison entry. Activities are and will be conducted in collaboration with Local Government Units and the Bureau of Jail Management and Penology, with support from the Global Fund.