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Inmate peer educators are essential to prison-based HIV testing and TB screening in Zambia

Inmate peer educators are essential to prison-based HIV testing and TB screening in Zambia. K Maggard, S Hatwiinda W Phiri, J Morse, E Turnbull, S Topp, S Roberts, G Samungole , N Kapata , C Chileshe, J Harris, S Reid, G Henostroza. German Henostroza, MD University of Alabama at Birmingham

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Inmate peer educators are essential to prison-based HIV testing and TB screening in Zambia

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  1. Inmate peer educators are essential to prison-based HIV testing and TB screening in Zambia K Maggard, S Hatwiinda W Phiri, J Morse, E Turnbull, S Topp, S Roberts, G Samungole, N Kapata, C Chileshe, J Harris, S Reid, G Henostroza German Henostroza, MD University of Alabama at Birmingham Centre for Infectious Disease Research in Zambia

  2. Disclosure • No conflicts of interest

  3. TB REACH: TB-HIV Screening Program in Zambian Prisons • Establish prison-based TB and HIV screening systems and infrastructure in 6 Zambian prisons • Performed one-time intensive mass screening with CIDRZ staff and assistance from inmate peer educators • Set up sustainable entry screening programs using only prison officers and inmate peer educators • Nov 2010-Sept 2011: screened 6,516 inmates (avg. 33/day during mass screening ) • Overall TB prevalence: 8%; HIV prevalence: 23%

  4. Why Peer Educators? • Supplemental workforce • Knowledge of prison culture and inmate hierarchy • Improved inmate buy-in • Increased scope of previous HIV peer educator training 74 inmate peer educators received 5-day training and assisted with implementation activities

  5. Inmate Peer Educator Responsibilities • Mass screening: • Identify, assemble, and guide inmates through screening • Collect sputum • Conduct group pre-test HIV counseling • Assist with TB screening questionnaire and form completion • Facilitate access to TB-HIV care and treatment • Outreach to inmates • Ongoing routine entry TB screening • 1,532 inmates screened from September 2011 to March 2012 • In addition to above, assess TB symptoms, history, & risk exposure • Peer-to-peer mentorship to maintain active inmate peer educators • Uninterrupted and sustainable

  6. Conclusions • Peers were enthusiastic and committed • Smoothly transitioned roles from mass to entry screening • Under current prison staffing conditions, sustained entry screening would not be feasible without peers • Cadre with potential role in other prison-based health programs “ Before the CIDRZ program there was always a call for the cell chairman (“Boss”) every day , I have not heard anyone calling the “Boss” in several months” Lusaka Central Prison Inmate

  7. Acknowledgements • Participating inmates, peer educators, and prison officers • TB REACH • PEPFAR/CDC/EGPAF • Ministry of Health • Ministry of Home Affairs • Zambia Prisons Service • ZAMBART Project • CIDRZ

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