Screening in Jail and Prison Populations

Few public institutions are more important to the surveillance and treatment of communicable disease and mental health disorders than jails, prisons, and other detention centers. Due to the concentration and high turnover of high-risk individuals otherwise out of contact with other public and community health systems, correctional institutions are uniquely situated to implement testing, treatment and referrals for chronic diseases, STDs, HIV, and tuberculosis via cost-effective means (Lee, Vlahov, & Freudenberg, 2006). Proper TB control mandates prompt and uniform screening at facility admission. Finally, adequate screening for suicidality and drug and alcohol withdrawal syndromes helps ensure these two leading causes of preventable death among the incarcerated are greatly minimized. Intake and general screening recommendation are summarized in Tables 14.1 and 14.2.

Communicable Disease Active Tuberculosis Infection

The need to screen for TB on admission to a correctional facility is uncontroversial and based on multiple studies demonstrating higher incidences of active TB in correctional environments and evidence of outbreaks in the setting of poor TB controls (MacNeil et al., 2005; "Prevention and control of tuberculosis in correctional and detention facilities," 2006). Despite this, recommended screening protocols in jails and prisons are not uniformly applied, with only 55% (11 of 20) of large jail systems instituting routine tuberculosis skin testing (TST) at admission in a 1998 survey (Roberts et al., 2006).

Table 14.1 Recommended correctional screening for adults: intake.

Condition

Recommended procedure

Tuberculosis, active infection

Symptom questionnaire and one or more

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