Washington D.C., USA, 22-27 July 2012www.aids2012.org
Inmate peer educators are essential to prison-based HIV testing and TB screening in Zambia
German Henostroza, MD
University of Alabama at Birmingham
Centre for Infectious Disease Research 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
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Disclosure
• No conflicts of interest
Washington D.C., USA, 22-27 July 2012www.aids2012.org
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%
Washington D.C., USA, 22-27 July 2012www.aids2012.org
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
Washington D.C., USA, 22-27 July 2012www.aids2012.org
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
Washington D.C., USA, 22-27 July 2012www.aids2012.org6
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Challenges Responses
Requests for incentives Promotion of peers within the inmate hierarchy (“Super Peer”)
Concerns over TB exposure during screening
Use of open, sunny screening areas and provision of N95 masks
Maintaining adequate numbers of peers despite release or transfer
Additional training to increase numbers and establish peer-to-peer mentorship
Confidentiality of HIV status
Identification of one inmate peer educator (“health chairman”) to assist with enrollment into HIV care and treatment
Washington D.C., USA, 22-27 July 2012www.aids2012.org
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
Washington D.C., USA, 22-27 July 2012www.aids2012.org
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