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Purpose: The sexual health of the male prison population is often among the poorest in a country. This paper aims to identify the wider health impacts and social value of a sexual health self-sampling programme offered to male prisoners in an open prison setting in Wales., Design/methodology/approach: This study applied a unique pilot approach of using Health Impact Assessment and Social Return on Investment Frameworks in tandem. Key stakeholder groups affected by the intervention were identified, and engaged with through workshops, interviews and questionnaires to identify and quantify the health impacts and wider outcomes. Outcomes were then valued using proxy financial values to present the overall estimated social value of the self-sampling service., Findings: Based on a small sample, results indicate that for every £1 spent on the self-sampling service in the prison, a potential value of £4.14 was created. This resulted in a ratio of £4.14:£1. Approximately one-third of the value created (£1,517.95) was categorised as monetarily returnable, whereas the remaining value (£3,260.40) was purely illustrative social value, for example improved mental well-being., Originality/value: This unique pilot study demonstrates the health impacts and wider social value of providing a self-sampling sexual health service to prisoners within an open prison setting. By innovatively testing the feasibility of using a Health Impact Assessment process alongside Social Return on Investment analyses, this paper has outlined how the frameworks can be used in synergy to illustrate not just direct return on investment but also the social value of providing such a service., (© Kathryn Ashton, Aimee Challenger, Christie Craddock, Timo Clemens, Jordan Williams, Oliver Kempton, Mariana Dyakova and Liz Green.)

To evaluate the impact of the CD4 count on ESAT6-CFP10 (EC) skin test, QuantiFERON-TB Gold In-tube test (QFT) and tuberculin skin test (TST) in a large prison and communities in Jiangsu Province among people living with HIV (PLHIV). Participants in communities were tested with the QFT and EC skin test and in prison were tested with the QFT, TST and EC skin test. A 4-knotted restricted cubic spline fitted for Logistic models was used to explore the cutoff point of CD4 count and the associations between changes in CD4 count and Mycobacterium tuberculosis (M.tb) infection. Among 1,815 PLHIV included, 19.3% (350) were from prisons and 80.7% (1465) were identified through community screenings. M.tb infection rates were 12.2% and 8.3% through QFT and EC tests, respectively. Odd Ratios (ORs) for infection increased with CD4 counts, peaking at 618 cells/mm 3 for EC, 392 cells/mm 3 for QFT, then plateaued. However, the pattern differed for EC between prison and screening scenarios. In prison settings, M.tb infection increased with CD4 count from 0 to 350 cells/mm3, plateaued until 500 cells/mm 3 , and then persistently increased. Conversely, for community, ORs decreased until 300 cells/mm 3 , followed by an increase between 300 and 729 cells/mm 3 , after which they continued to rise persistently. Our cross-sectional study among PLHIV revealed a higher rate of M.tb infection in prison compared to the community. The relationship between CD4 count and infection became negative after a certain threshold. This pivotal point differed with detection methods, with QFT showing lower CD4 thresholds than EC., (© 2024. The Author(s).)

Preventing in-prison violence and maintaining a safe environment is an important goal within prison settings. Screening for violence risk may provide a valuable addition to reach this goal. Within the Dutch prison system, the Risk Screener Violence (RS-V) has become an important new element in overall risk management. Prior research shows that RS-V scores are a sound predictor of institutional violence and aggression of incarcerated persons. Whereas previous studies predominantly analyzed retrospective file-based data, the present study includes RS-Vs rated by prison employees in real-life prison practice shortly after implementation. The RS-Vs of 956 detained individuals from 25 Dutch prisons were analyzed. Disciplinary reports were consulted to measure violent and aggressive incidents during 4 months after the screening. In addition, detention duration (length of stay in prison before the screening) was included as an additional variable. Results of the present prison practice study show good predictive values of the RS-V ratings for violent and aggressive incidents during prison stay. The predictive validity was similar for prisoner-to-prisoner assault as well as prisoner-to-staff assault. In addition, the predictive validity of the RS-V scores did not differ between individuals with a longer detention duration versus individuals with a shorter detention duration. This multisite prison practice study is an important step in the further validation of the RS-V and shows that the RS-V is a valuable tool in determining who is more likely to show institutional violence. Nonetheless, it remains important to continually monitor the implementation and correct application of the RS-V in prison practice. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objectives: Prisoners face inequalities relating to health and social care and educational needs. Peer support (prisoners providing support to other prisoners) is used in addition to professional support to address needs. It is not clear how effective or cost-effective peer-support services are, how they are implemented or experienced, or how best to evaluate such schemes. This review aimed to evaluate the following: 1. Outcomes and economic outcomes that have been studied for prison peer support, and data sources used. 2. Effectiveness and cost of prison peer support. 3. Implementation and experiences with prison peer support., Study Design: A rapid systematic scoping review (registered on International Prospective Register of Systematic Reviews: CRD42022351592) that focussed on peer support within adult prisons., Methods: The search included six databases, grey literature databases, handsearching journals, and reviewing reference lists (June 2022). Studies were screened, and data were extracted. Narrative synthesis was used to analyse findings., Results: Seventy papers were included (qualitative: 30, quantitative: 21, and mixed-methods: 19). No studies measured cost/cost-effectiveness. A range of methods were used to measure effectiveness (e.g., surveys, routinely collected data), implementation, and experience (e.g. interviews, surveys, observation). There was evidence of some positive effects (e.g., disease detection, mental health). Factors influencing peer support in prisons included individual, service, and organisational factors. Benefits (for prisons/prisoners/staff) and challenges (e.g., burden, exploitation) were identified., Conclusion: Prison peer support services are internationally used to address public health. Future research could robustly evaluate effectiveness and cost effectiveness. Attention should be given to potential risks and barriers affecting implementation., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

It is critical to address hepatitis C virus (HCV) in carceral settings to achieve worldwide elimination of the virus. We describe New Mexico's (NM) experience expanding HCV treatment in state prisons, supplemented with Project ECHO (ECHO; virtual mentorship through guided practice) and the NM Peer Education Program (NMPEP). We describe how using these programs may be a model for expanding treatment in prisons globally. ECHO, NM Corrections Department (NMCD) and Wexford Health Services (WHS) collaborate to treat HCV in state prisons and increase HCV knowledge among incarcerated persons using NMPEP. Each person arriving in prison is tested for HCV and those with active infection receive baseline labs, which are reviewed. Patients not meeting criteria for simplified treatment are presented to ECHO for expert guidance. Otherwise, patients are treated by WHS without consultation. NMPEP provides patient-to-patient education in prisons, addressing HCV myths and exploring treatment refusals. From December 2020 to June 2023, 3603 people had HCV viremia. In this study, 1685 people started treatment: 1280 were treated using the simplified algorithm and 405 were presented to ECHO. Of the 988 people who completed treatment and had sustained virologic response (SVR) labs drawn, 89.2% achieved SVR (i.e., cure). Most of the 107 people who did not achieve SVR had presumed reinfection. NMPEP trained 148 peer educators who educated 3832 peers about HCV prevention and treatment. HCV treatment in prisons can be expanded by implementing simplified treatment algorithms, use of the ECHO model for patients with advanced disease and peer education., (© 2024 The Author(s). Journal of Viral Hepatitis published by John Wiley & Sons Ltd.)

This review aimed at evaluating the state of availability, accessibility and model of delivery of oral health services in prisons, globally. Five databases of peer-reviewed literature and potential sources of grey literature were systematically searched. Inclusion criteria encompassed oral health papers related to prisons globally, with exclusion of certain article types. Selection involved independent evaluations by two researchers, followed by quality assessment. Data on the availability of oral health interventions in prisons came from 18 countries, while information on the model of delivery of the services is scarce. In addition, two sets of individual and organizational barriers toward oral health service uptake in prisons were revealed and discussed in the text. Lack of oral health services in prisons affects people living in prisons and jeopardizes their reintegration. Urgent and concrete international actions are required to ensure the availability, accessibility, and quality of oral health services among people living in prisons., (© 2023 The Authors. Journal of Community Psychology published by Wiley Periodicals LLC.)

This article explores the factors contributing to drug-related deaths in English and Welsh prisons between 2015 and 2020. Based on content analysis of all Prison and Probation Ombudsman 'other non-natural' fatal incident investigation reports, descriptive statistics were generated. Qualitative analysis explored the circumstances surrounding deaths and key risk factors. Most deaths were of men, whose mean age was 39 years. Drug toxicity was the main factor in causing death, exacerbated by underlying physical health conditions and risk-taking behaviours. A variety of substances were involved. New psychoactive substances became more important over time. A high proportion had recorded histories of substance use and mental illness. During this period, the prison system was under considerable stress creating dangerous environments for drug-related harm. This study highlights the process of complex interaction between substances used, individual characteristics, situational features and the wider environment in explaining drug-related deaths in prisons. Implications for policy and practice are discussed., (© 2023 The Authors. Journal of Community Psychology published by Wiley Periodicals LLC.)

Mandatory drug testing is commonly used in Australian prisons to detect and deter drug use. In this commentary, we review the limited evidence for mandatory drug testing programs, highlight potential harms associated with their implementation and provide recommendations for drug surveillance in prisons concordant with a harm minimisation framework., (© 2024 Australasian Professional Society on Alcohol and other Drugs.)

The objective of this study is to examine interventions implemented to increase vaccine uptake among people who live and work in prisons around the world. Peer-reviewed and gray literature databases were searched systematically to identify relevant information published from 2012 to 2022. Publications were evaluated by two researchers independently and underwent quality assessment through established tools. Of the 11,281 publications identified through peer-reviewed (2607) and gray literature (8674) search, 17 met the inclusion criteria. In light of limited data, the identified interventions were categorized into two categories of educational and organizational interventions, and are discussed in the text. The lack of availability of vaccination services and interventions to increase vaccine uptake among people who live and work in prisons, worldwide, is a serious public health concern. These interventions reported in this review can be adapted and adopted to mitigate the burden of infectious diseases among people who live and work in prisons., (© 2023 The Authors. Journal of Community Psychology published by Wiley Periodicals LLC.)

Introduction: Correctional officers (COs) are exposed to emotional and physical harm by the nature of their work. Operational stress can lead to burnout and influence absences and COs work performance., Objectives: This study aimed to evaluate the association between work-related stress and burnout adjusted by potential confounding variables (age, sex, correctional facility, type of correctional facility, distance to work, and absenteeism)., Methods: The sample of this cross-sectional study was made up of 799 prison officials. The self-administered questionnaire consisted of four instruments: demographic data, Health and Job Performance Questionnaire, Police Operational Stress Questionnaire, and Maslach Burnout Inventory. The questionnaires were completed online and in person., Results: A high proportion of COs reported high operational stress and burnout levels. Fatigue was the highest mean value from all stressors, with 5.89. COs reported high levels of emotional exhaustion and depersonalization. They also reported low levels of personal accomplishment. Furthermore, COs with high stress levels are approximately eight times more likely to experience burnout., Conclusion: These findings suggest that COs in Puerto Rico exposed to stress are more vulnerable to present burnout. The findings suggest that evidence-based interventions and programs should be implemented to help prevent and reduce operational stress and burnout among COs., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Laureano-Morales et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Purpose: During the COVID-19 pandemic, prisons faced a unique challenge of preventing and managing outbreaks with minimal adverse impact. This study aims to describe the epidemiology of COVID-19 in prisons, identify lessons learnt and make recommendations., Design/methodology/approach: The authors used the PubMed advanced search function using MeSH terms; (coronavirus, sars) AND (prisons) AND (disease outbreaks). The authors included original research reporting COVID-19 outbreaks in prisons. All other types and non-English publications were excluded. The authors used a structured data abstraction template to extract data systematically, and a second author independently abstracted data from 10% of the papers for quality assurance., Findings: The search yielded 96 hits. The authors included 15 studies meeting the inclusion criteria. These studies were from four countries. Seven studies reported individual outbreaks. The mean and median number of inmates and staff were 1,765, 1,126 and 575, 510. The mean and median number of cases among inmates and staff were 584, 464, and 72, 77. The number of reported deaths varied from 0 to 11. The authors present the prison-specific hazards grouped under human factors, healthcare factors and environmental factors. The authors also summarise interventions deployed as either primary prevention interventions, such as vaccinations, or secondary prevention interventions, including screening and contact tracing., Originality/value: This narrative review summarises the prison-specific hazards, which include movement of people in and out of the person, moving in new prisoners from other prisons, mixing of prisoners when transporting to courts, limited medical and isolation resources, crowded dormitories, shared lavatories, small communal facilities, poor ventilation and overcrowding. The interventions included limiting non-medical transfers into and out of the persons, assigning staff members to specific areas, encouraging face coverings among prisoners and staff and social isolation measures within the constraints of the prison setting. The interventions were adopted by prison authorities to contain and manage the outbreaks. Public Health and prison authorities need to be aware of the risk of further outbreaks of COVID-19 and other infectious diseases in these settings and implement key measures identified in this review to minimise adverse outcomes., (© Emerald Publishing Limited.)

Purpose: Smoke-free prison policies have been introduced in some countries, in part to address very high levels of tobacco use in people in prison. However, relapse rates post-release remain high. This papers aims to improve understanding of post-release smoking and/or vaping behaviour is necessary to inform support for a priority population., Design/methodology/approach: The authors searched health, social science and criminal justice databases for studies about smoking/vaping behaviours among people released from smoke-free prisons. Studies were included if they reported primary data and were published between January 2017 and March 2024 in English; the population was adults/young people (16 yr+) imprisoned or formerly imprisoned, in prisons with comprehensive smoke-free policies; and at least one of the following was reported: pre-release intention to smoke, vape or remain abstinent post-release; smoking/vaping behaviour post-release and factors influencing smoking/vaping behaviour; attempts to quit again following post-release smoking/vaping relapse., Findings: Nine studies met our criteria. The evidence base is small and mainly from the USA or Australia. Evidence continues to suggest that most people resume smoking after leaving a smoke-free prison. No new interventions have been successful in reducing relapse rates. No studies report on vaping post-release, although two studies report on perceived factors affecting smoking relapse post-release from prisons allowing vaping., Research Limitations/implications: Given very high rates of relapse, there remains a significant need to better understand what approaches are feasible and acceptable for reducing return to smoking post-release., Originality/value: This review updates the limited evidence on smoking behaviours after leaving a smoke-free prison., (© Ashley Brown, Clair Woods-Brown, Kathryn Angus, Nicola McMeekin, Kate Hunt and Evangelia Demou.)

Background: A barrier to hepatitis C virus (HCV) cure is conventional testing. The aim of this study was to evaluate the effect of HCV antibody and RNA point-of-care testing (POCT) on testing rates, linkage to care, treatment, and acceptability of testing in 3 priority settings in Australia., Methods: Participants were enrolled in an interventional cohort study at a reception prison, inpatient mental health service, and inpatient alcohol and other drug unit, between October 2020 and December 2021. HCV POCT was performed using SD Bioline HCV antibody fingerstick test and a reflexive Xpert HCV Viral Load Fingerstick test using capillary blood samples. A retrospective audit of HCV testing and treatment data was performed at each site for the preceding 12-month period to generate a historical control., Results: A total of 1549 participants received a HCV antibody test with 17% (264 of 1549) receiving a positive result, of whom 21% (55 of 264) tested HCV RNA positive. Across all settings the rate of testing per year significantly increased between the historical controls and the study intervention period by 2.57 fold (rate ratio, 2.57 [95% confidence interval, 2.32-2.85]) for HCV antibody testing and 1.62 (rate ratio, 1.62 [95% confidence interval, 1.31-2.01]) for RNA testing. Treatment uptake was higher during the POCT intervention (86% [47 of 55]; P = .01) compared to the historical controls (61% [27 of 44])., Conclusions: This study demonstrated across 3 settings that the use of HCV antibody and RNA POCT increased testing rates, treatment uptake, and linkage to care. The testing model was highly acceptable for most participants., Clinical Trials Registration: ACTRN-12621001578897., Competing Interests: Potential conflicts of interest. E. M. M. reports grants paid to Royal Adelaide Hospital from the Gilead Research Fellowship. J. R. reports payments from AbbVie for education. A. W. reports Medical Research Future Fund grants for 2021–2022. V. C. reports an National Health & Medical Research Council grant partnership, serving as principal investigator for the National Australian HCV Point-of-Care Testing Program, and participation as a member of the Clinical Advisory Group for the Kirby National Australian HCV Point-of-Care Testing. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Equal access to health initiatives and services under the principles of universal and comprehensive care remains a challenge in Brazil. The realization of public health policies is further intricate when one examines the health situation of people deprived of liberty. This study showcases the "Prison System: Beyond the Walls" educational pathway, available on the Virtual Learning Environment of the Brazilian National Health System (AVASUS). The action research methodological strategy guided the pathway development, emphasizing dialogic learning. The goal was to address the need for massive training on the topic of prison health, with the model focusing on engagement through spontaneous, non-mandatory participation in the pathway courses. The pathway comprised four modules, whose educational offerings were based on the self-learning model. Students were free to choose which courses to take and in what order, as there was no prerequisite for participating in modules. Hence, students could either take all the courses or only those with which they identify their learning needs, regardless of work demands or personal interests. Structuring the pathway through action research facilitated a massive, cohesive, and continuous training process. This approach expanded knowledge and established meaningful relationships among the related topics and the key players involved: health professionals, prison officers, and people deprived of liberty. Notably, the pathway courses have surpassed the 50,000-enrollment mark, spanning all five regions of Brazil. In this context, this article presents and discusses the development of the "Prison System: Beyond the Walls" pathway, emphasizing the massive improvement of health within Brazil's prison system and highlighting the results achieved.

Morisenuola Ladele, Chief Nurse Fellow, Birmingham Community Healthcare NHS Foundation Trust (Morisenuola.ladele1@nhs.net), was the Gold Award winner in the Nurse of the Year category in the BJN Awards 2024.

Prisons, due to various risk factors, are environments that are conducive to infectious disease transmission, with significantly higher prevalence of infectious diseases within prisons compared to the general population. This underscores the importance of preventive measures, particularly vaccination. As part of the international project "Reaching the hard-to-reach: Increasing access and vaccine uptake among the prison population in Europe" (RISE-Vac), this study aimed to map the availability and delivery framework of vaccination services in prisons across Europe and beyond. A questionnaire designed to collect data on the availability and delivery model of vaccination services in prisons was validated and uploaded in SurveyMonkey in July 2023. Then, it was submitted to potential participants, with at least one representative from each European country. Potential participants emailed an invitation letter by the RISE-Vac partners and by the European Organization of Prison and Correctional Services (EUROPRIS). Twenty European countries responded. Vaccines are available in European countries, although their availability differs by country and type of vaccine. The first dose is offered to people living in prisons (PLP), mostly within one month, COVID-19 is the most widely offered vaccine. In all countries, vaccines are actively offered by healthcare workers; in most countries, there is no evaluation of vaccination status among people who work in prison. The survey shows variance in vaccine availability for PLP and staff across countries and vaccine types. Quality healthcare in prisons is not only a matter of the right to health but also a critical public health investment: enhancing vaccine uptake consistently among PLP and staff should be prioritized., (© 2024. The Author(s).)

The nutritional content of food in carceral institutions is important because it influences weight gain and health during incarceration. This systematic review assessed the available quantitative data and nutritional analyses of food in carceral institutions. Methodology is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement with four phases (identification, screening, eligibility, and inclusion). Nine articles were selected. Most carceral institutions provided adequate nutrition for micronutrients, except for vitamin D (inadequate) and sodium (excessive). Most menus followed recommendations for macronutrients. Food from the commissary stores is high in calories, sugar, fat, and sodium. Most menus are adequate according to Dietary Reference Intakes. Changing menus drastically to meet nutritional targets may lead to consuming more food from commissary, potentially leading to poorer eating. For some menus, minor adjustments could bring the nutritional content closer to recommendations.

Nutrition-related health disparities plague prisons in the United States. Unregulated and inadequate prison menus may contribute to noncommunicable chronic health conditions in this vulnerable population. The purpose of this research was to assess nutrition offerings provided by prison menus. Researchers requested the most current version of all master menus and associated nutrition analyses for gendered and age-centric (pediatric vs geriatric) menus. Menu and nutrient data were extracted and entered into a spreadsheet for analysis. Prisons serve gendered or nongendered menus to the general population, and 52.9% of prisons offer nongendered menus where males and females receive the same meals. This approach provides excess calories and saturated fat to females. Sodium was served in excess to both males and females. Fruit and vegetable servings on all gendered menus fell short of recommendations. The average prison menu inappropriately offers calories, sodium, and fruit and vegetable servings in a one-size-fits-all menu development method without considering gender, age, and physical activity. Interpretation and application of Dietary Guidelines for Americans are inconsistent. Nutrition guidelines recommending appropriate nutrients and food groups should be developed and available to corrections systems and dietitians. Current prison menu development practices yield inappropriate nutrition for prison populations.

People in prison often experience risk factors that can lead to poor sexual health which is compounded by social deprivation. In response, the British Association for Sexual Health and HIV (BASHH) has published the first national standards in the management of UK prisons, providing recommendations for commissioners, service providers, health care providers and people in prison. Nine standards have been devised which cover aspects of sexual health diagnosis and management, public health measures, and some reproductive health issues. The aim of these standards is to drive improvements in sexual health provision in prisons to ensure access to high quality care that is equitable to that which is provided to the general population., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: As the number of people ageing in prison with complex healthcare needs continues to increase, so does the need for palliative care in the restrictive prison context. Palliative care for people in prison is facilitated by correctional officers, and prison- and hospital-based clinicians. A collective analysis of existing research to identify common experiences of these stakeholders globally has not been completed., Aim: To explore the perceptions and experiences of correctional officers and prison- and hospital-based clinicians who facilitate palliative care for people in prison., Design: A systematic review and meta-synthesis., Data Sources: Keywords and subject headings related to palliative care and prisons were used to search seven databases with no time limitations. Peer-reviewed research in English, containing qualitative data from stakeholders facilitating palliative care for people in prison were included, and appraised using the CASP tool., Results: Two analytical themes emerged: (i) a prison lens on a palliative approach and (ii) coping complexities. Palliative care is 'translated' into the prison setting according to security and environmental constraints. Stakeholders experienced ethical, personal and professional difficulties, because prison-based palliative care did not align with community norms. Ambiguous policy and expectations regarding prioritising care needs and balancing custodial rules led to role stress., Conclusions: Providing palliative care for people in prison is complex and impacts stakeholders and people in prison with palliative care needs. Supporting person-centred care through a multi-service approach, stakeholder education and standards will improve the quality and accessibility of care., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Background: Scholarship on how fentanyl affects the complexities of correctional settings is limited in Canada, as scholars have focused on the prevalence of opioid use and overdose in prisons, as well as community treatment and access following release. Fentanyl constitutes a continuing challenge both in prisons and broader society., Results: The current qualitative, interview-based empirical study examines how fentanyl is interpreted by correctional officers (COs, n = 99) across federal prisons in Canada, some of whom have worked in institutions with a high presence of fentanyl, while others have less exposure to the drug. We found that while many COs had responded to an overdose during their first or second year on the job, most COs who had did not perceive the event to be psychologically traumatic nor were concerned about the presence and availability fentanyl in their work environment, or they were indifferent. Yet this finding competes with the 41.4% of officers who did express concern about the presence of fentanyl - suggesting both a "normalization" of fentanyl as a workplace hazard as well as an underpinning social concern., Conclusions: We discuss the implications of these complicated findings in relation to reducing workplace stressors and countering misinformation that, in addition to other potential occupational factors, may be responsible for the concerns of COs tied to the presence of fentanyl., (© 2024. The Author(s).)

The global incidence of tuberculosis (TB) in prison is 5 to 70 times greater than that in the general population. The systematic screening and treatment of TB in prison benefit TB control and treatment outcomes. However, no study has supported this in Thailand. Here, we evaluated the effectiveness of long-term, continuous, systematic screening for TB control. We conducted a retrospective study in Suratthani Central Prison, Thailand, using annual TB screening from 2016 to 2020. A positive TB screening was defined as having any TB symptoms or chest radiography abnormality. We collected sputum smear and Xpert® Mycobacterium tuberculosis/rifampicin (MTB/RIF) results from those inmates with positive screening results. Bacteriologically confirmed TB was defined as a positive sputum smear or M. tuberculosis detected by Xpert assay. Inmates with clinically diagnosed TB were also eligible for this study. Those inmates diagnosed with active TB were sent to an isolation zone in prison and received anti-TB medicine using directly observed therapy and were monitored by pulmonologists during the treatment course via telemedicine. Of 18,965 TB screening events, 175 patients were diagnosed with TB. The 5-year prevalence was 922 per 100,000 inmates. The relative reduction in TB prevalence was 60.5% from 2016 to 2020. Overall, 94.3% of TB patients were successfully treated (sum of patients cured and treatment completed). Three TB patients died during the 5-year study period. All occurred in 2016. The systematic screening and treatment of TB in inmates effectively reduced the prevalence and mortality in Suratthani Central Prison. The success rate of treatment in this prison has been consistently high.

Objective: Individuals with psychiatric disorders are incarcerated at disproportionately high rates and often have low educational attainment. Access to psychiatric and education services within prisons has been described as inadequate, but recent data are lacking. The authors sought to assess the association of psychiatric disorders with both educational attainment before incarceration and access to psychiatric and education services during incarceration., Methods: Data were from the 2016 Survey of Prison Inmates, a national survey of adults incarcerated in U.S. state and federal prisons (N=24,848). Multinomial regression was used to identify associations of educational attainment before incarceration with psychiatric disorders and sociodemographic factors. Multivariable logistic regression models were used to assess associations of psychiatric disorders with access to psychiatric and education services during incarceration and with sociodemographic factors., Results: Before incarceration, 57.3% of survey respondents had less than a high school diploma. Across four education and psychiatric services, only 8.4%-44.8% of respondents reported participating in these services during incarceration, despite 57.3% reporting a psychiatric or learning disorder. Psychiatric disorders were associated with lower educational attainment before incarceration and lower access to education services during incarceration. Psychiatric disorders were associated with higher odds of access to psychiatric services during incarceration. Men had lower educational attainment before incarceration and lower odds of accessing psychiatric and education services during incarceration., Conclusions: Incarcerated people had a high need for psychiatric and education services. Individuals with psychiatric disorders had lower odds of participating in education services during incarceration, highlighting the need for policies and services that increase participation., Competing Interests: The authors report no financial relationships with commercial interests.

Background: Prison needle exchange programs (PNEPs) are a critical component for harm reduction in prisons. Little is known about the PNEP access barriers for people who are incarcerated, but the low uptake in the Canadian program highlights these constraints. We aimed to identify the barriers and potential solutions for increasing PNEP coverage in the nine Canadian federal prisons where they operate., Methods: Eighteen focus groups were conducted in nine prisons using nominal group technique (NGT) with two stakeholders: peer advocates and people who use or identified as potential users of the PNEP. NGT uses a round-robin technique followed by generating a list of barriers to PNEP enrolment within their prison. Participants then allocated votes to rank the highest priority barriers, followed by an identical process to generate solutions to address the top three barriers. Interview transcripts describing participant narratives during this process were de-identified and coded to generated themes. Barriers and solutions receiving >10 % of votes within respective participant groups, alongside associated narratives, are discussed more fully., Results: Fear of repercussions due to drug use, lack of confidentiality, and fear of being targeted and sanctioned by correctional authorities were perceived by both stakeholder groups as the top barriers inhibiting PNEP enrolment. Stigma (peer advocates) and the application process for the program (PNEP users) were also ranked as a priority. Proposed solutions included education and external oversight of PNEP (i.e., not via correctional officers) by both groups. Peer advocates regarded improving participant confidentiality and a supervised/safe injection site as potential enablers for program participation, while PNEP users identified wrap-around services as likely to improve access., Conclusion: Barriers to increasing PNEP coverage in Canadian federal prisons proposed by participants highlight the importance of trust and perceived repercussions surrounding program participation. These barriers and proposed solutions highlight a need for changes in implementation to PNEP delivery if the potential health benefits of PNEPs are to be realised., Competing Interests: Declaration of competing interest F.L., B.H., and F.L.A. have no disclosures of interest to report. L.L. has received speaker fees from AbbVie Pty Ltd unrelated to this work. M.S. has received investigator-initiated research funding from Gilead Sciences and AbbVie and consultant fees from Gilead Sciences for activities unrelated to this work. A.R.L. has received investigator-initiated research support from Gilead and AbbVie. N.K. has received research funding from ViiV Healthcare and Abbvie, advisory fees from Gilead Sciences, ViiV Healthcare, Merck, and Abbvie, and speaker fees from Gilead Sciences, Abbvie, and Merck, all outside this work., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Carceral conditions in the United States may serve as a proxy for crises within justice and health systems. This study seeks to consider and measure prison climate from the perspective of incarcerated people. By examining within-facility differences in carceral experiences, results shed light on the complex nexus between the carceral context, health, and justice. We administered the Prison Climate Questionnaire (PCQ) to the complete population of incarcerated men in a correctional facility located in the Eastern United States. In this facility, housing units hold distinct populations, fulfill different functions, and can offer unique programming. We regress select items from the PCQ on a set of dummies corresponding to different residential units within the facility. Responses indicate low but relatively uniform perceptions of overall personal health, as well as access to, and satisfaction with, medical care. Between-unit differences emerge regarding staff relationships, experiences of discrimination, and levels of isolation. The perspectives of incarcerated people can, and should, play a role in understanding and conceptualizing the nature of the prison environment. Policy responses, especially those that impact the health and well-being of currently and formerly incarcerated people, can be informed by these perspectives., (© 2024. The Author(s).)

Prison has been described as the ultimate form of time-punishment - a place where time is no longer a commodity for individuals to spend, but is ordered by a system which symbolises its power through the control of segments of people's lives. As such, a prison sentence epitomises the experience of waiting. Yet anticipating release is not the only form of waiting within carceral life; waiting for healthcare in its various forms also shapes people's temporal experience. Drawing on interviews with 21 people who have lived in prison, this article describes how experiences of waiting for healthcare are mediated by expectation or hope, perceptions of the relationship between behaviour and healthcare access, and the consequences of waiting for care. Constraints on the autonomy of people in prison mean that waiting for healthcare differs in important ways from waiting for healthcare in the community, and can be perceived as an additional form of punishment. The experience of waiting for prison healthcare can affect physical and psychological well-being, and can in itself be understood as a pain of imprisonment., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The correctional training program (CTP), composed of three stages, includes a 14 week in-person component that Correctional Officer Recruits (CORs) must complete prior to their employment as a federal Correctional Officer (CO) for Correctional Service Canada (CSC). The CTP prepares recruits for a plethora of CO responsibilities, some dependent on physical fitness, such as responding to codes being called, physical altercations, or violent situations. Unlike other public safety positions (e.g. policing, border services, or coast guard) CSC does not require occupational fitness testing. In the current article, we use data from a multiyear longitudinal study of federal COs from across Canada to unpack how CORs manage physical fitness expectations at CTP; CSCs' expectations of COR physical fitness; and outline what types of physical fitness (e.g. weightlifting, cardiovascular, self-defence) are taught, thus valued most, during CTP. We situate the voices of CORs regarding physical fitness within the broader "body" literature and discuss policy recommendations tied to physical fitness, specifically COs' interest in reinstating pre-employment physical fitness screening.

Purpose: The correctional system continues to face challenges with responding to and managing methamphetamine use among incarcerated individuals. This study aims to uncover what resources and policies could better help correctional workers deal with these challenges. The authors also examined methamphetamine's impact on correctional work and staff well-being., Design/methodology/approach: An online survey was distributed to correctional workers ( n = 269) in Manitoba, Canada, featuring questions about their experiences related to methamphetamine use in populations under their care, what supports are needed to adequately address the concern, and the potential effects on self and their occupational responsibilities. Using NVivo software, survey responses were analysed using an emergent theme approach., Findings: Correctional workers believed policies and protocols for managing methamphetamine use and withdrawal are currently inadequate. Correctional workers reported having monthly contact with incarcerated individuals experiencing methamphetamine withdrawal, posing safety concerns to them and other incarcerated individuals. Respondents proposed more education and training on managing incarcerated people withdrawing from methamphetamines, related to the symptoms of use and withdrawal and how to support persons detoxing. Increased human and material resources were reported as being needed (e.g. more nurses onsite and better screening devices). Respondents also desired more medical intervention, safe living spaces for methamphetamine users and programming to support addiction., Originality/value: The current study unpacks correctional workers' perspectives, support desires and their experiences managing methamphetamine use amongst incarcerated people. The authors discuss the required knowledge to respond to gaps in prison living, re-entry and related policy needs., (© Emerald Publishing Limited.)

Purpose: Around the world, prison complexes have always been fundamentally taxing environments. The strained atmosphere within these prisons often contributes to the deterioration of mental health, mostly those who may already be psychologically vulnerable. This paper aims to understand whether there exists a relationship between the built environment of prisons, particularly the central prisons of India and its effects on the mental health of inmates., Design/methodology/approach: By means of literature reviews, the study parameters were found to be connectivity to nature, lighting, acoustics, colour, air quality and thermal comfort. The data collected through interviews and email correspondences with identified experts were analysed thematically using a deductive approach to derive a set of practical recommendations, which could be implemented in Indian prisons., Findings: The built environment of prisons impacts the prison population by further contributing to depressive symptoms. The effects of the built space persist regardless of social factors. A well-designed environment is healthy for its occupants and would yield positive changes. However, it is not the sole contributor to depression; social interactions, prison management, societal acceptance and meaningful activities are equally relevant factors. The sole focus of this paper is the relationship between the built environment and the mental health of inmates., Originality/value: There is a paucity of research into the intersection between prison architecture and the mental health of inmates in the Indian subcontinent. This paper that addresses the gap may have significant consequences on how criminal reform is perceived, and also encourage further research in this field., (© Emerald Publishing Limited.)

Background: Tuberculosis (TB) remains a significant public health concern, particularly within prison settings, where the confluence of adverse health factors and high-risk behaviors contribute to a heightened risk of transmission. This study delves into the perspectives of medical doctors, regarding the implementation of the 2014 TB protocol in Portugal., Methods: The study has a qualitative, descriptive design. Individual semi-structured interviews with medical doctors from TB outpatient centers in Porto and Lisbon were used for data collection. For the analysis thematic analysis method was used., Results: The study population comprised 21 medical doctors with the majority being female (61.9%) and 57.1% specializing in pulmonology. The results indicate varied perceptions of the protocol's usefulness, with positive impacts on coordination reported by some participants. Improved communication and evolving collaboration between TB outpatient centers and prisons were highlighted, although challenges in contact tracing and resource constraints were acknowledged. The study also sheds light on the role of nurses in patient education., Conclusion: Despite overall positive perceptions, challenges such as sustaining therapy post-symptomatic improvement and delays in diagnostic methods were identified. The findings underscore the importance of continuous collaboration between prisons and TB control programs to address challenges, improve disease control and prevent TB transmission., (© The Author(s) 2024. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Enforcing strict protocols that prevent transmission of airborne infections in prisons is challenging. We examine a large severe acute respiratory syndrome coronavirus 2 outbreak in a Catalan penitentiary center in February-April 2021, prior to vaccination deployment. The aim was to describe the evolution of the outbreak using classical and genomic epidemiology and the containment strategy applied. The outbreak was initially detected in 1 module but spread to 4, infecting 7 staff members and 140 incarcerated individuals, 6 of whom were hospitalized (4.4%). Genomic analysis confirmed a single origin (B.1.1.7). Contact tracing identified transmission vectors between modules and prevented further viral spread. In future similar scenarios, the control strategy described here may help limit transmission of airborne infections in correctional settings., Competing Interests: Potential conflicts of interest. The authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Although prison facilities are not fully isolated from the communities in which they are located, most of the population is confined and requires high levels of health vigilance and protection. This study aimed to examine the dynamic relationship between facility-level wastewater viral concentrations and the probability of at least one positive COVID-19 case within the facility. The study period was from January 11, 2021 to May 8, 2023. Wastewater samples were collected and analyzed for SARS-CoV-2 (N1) and pepper mild mottle virus (PMMoV) three times weekly across 14 prison facilities in Kentucky (USA). Positive clinical case reports were also provided. A hierarchical Bayesian facility-level temporal model with a latent lagged process was developed. We modeled facility-specific SARS-CoV-2 (N1) normalized by the PMMoV wastewater concentration ratio threshold associated with at least one COVID-19 clinical case at an 80 % probability. The threshold differed among facilities. Across the 14 facilities, our model demonstrates a mean capture rate of 94.95 % via the N1/PMMoV ratio threshold with p ts ≥0.5. However, as the p ts threshold was set higher, such as at ≥0.9, the mean capture rate of the model was reduced to 60 %. This robust performance underscores the effectiveness of the model for accurately detecting the presence of positive COVID-19 cases among incarcerated people. The findings of this study provide a facility-specific threshold model for public health response based on frequent wastewater surveillance., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Penitentiary systems serve as breeding grounds for all kinds of diseases. Drawing upon new archival materials, this article examines the history of the management and reporting of epidemics in the Russian prison system from the late Imperial period to the present day. We use the case studies of cholera (1892-1893), typhus (1932-1933), and pulmonary tuberculosis (the 1990s) to examine how the general political and social conjuncture at different times affected the response of prison authorities to epidemics to show that, notwithstanding major shifts in society and polity, there was continuity in the management of epidemics by prison authorities in the long twentieth century. However, there were fundamental discrepancies in the way late Imperial, Soviet, and post-Soviet Russia reported epidemiological emergencies in prisons. We argue that Russia's tumultuous past has reinforced the tendency among the Russian penal administration towards a lack of transparency that has persisted to the present day, in relation to the latest, COVID-19, epidemic., (© The Author(s) 2023. Published by Oxford University Press.)

Competing Interests: I declare no competing interests.

Drug use is prevalent in prisons with drugs associated with depressant effects found to be more prevalent than stimulants. Synthetic cathinones (SCats; often sold as "bath salts", "ecstasy", "molly", and "monkey dust") are the second largest category of new psychoactive substances (NPS) currently monitored by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) and are commonly used as substitutes for regulated stimulants, such as amphetamine, cocaine, and MDMA. N,N-dimethylpentylone (also known as dimethylpentylone, dipentylone, and bk-DMBDP) was detected for the first time in the Scottish prisons in seven powder samples seized between January and July 2023. Samples were analyzed using gas chromatography-mass spectrometry (GC-MS), ultra-high performance liquid chromatography-quadrupole time of flight mass spectrometry (UPLC-QToF-MS), and nuclear magnetic resonance imaging (NMR). Dimethylpentylone was detected alongside other drugs in four samples, including the novel benzodiazepine desalkylgidazepam (bromonordiazepam) and the synthetic cannabinoid receptor agonists (SCRAs) MDMB-INACA and MDMB-4en-PINACA., Competing Interests: Declaration of Competing Interest None, (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Hepatitis C virus (HCV) is a significant concern within prison populations. Provision of HCV testing and treatment for people in prison is expanding and a key component of global elimination efforts. Despite growing service availability, several challenges remain in HCV testing and treatment engagement during incarceration. The PIVOT study demonstrated that a 'one-stop-shop' intervention (point-of-care HCV RNA testing, Fibroscan®, nurse-led clinical assessment, and fast-tracked direct-acting antiviral prescription) enhanced HCV testing and treatment at a reception prison in Australia. Utilising Squier et al's Health Literacy Skills Framework, this analysis aimed to understand HCV health literacy and educational needs among people at a reception prison in Australia., Methods: Semi-structured interviews were conducted with twenty-four male PIVOT study participants. Purposive sampling ensured comparable representation of those with: 1) prior HCV testing history (standard pathology / no prior testing), and 2) injecting drug use history (IDU; ever / never)., Results: Varied HCV health literacy levels and educational needs were evident amongst people in prison. Whilst those with multiple incarceration episodes and IDU history (prior knowledge) appeared to have stronger HCV health literacy than those without, substantial gaps in HCV health literacy were evident. Knowledge of HCV transmission risks in prison was high, and most understood the importance of HCV testing and treatment in prison (comprehension), but ability to engage with HCV testing and treatment services, participation in safe injecting behaviours (health-related behaviours), and knowledge of re-infection and re-treatment, within the context of the prison environment, were suboptimal. There was a general desire for increased HCV education in prison., Conclusion: Gaps in HCV health literacy among people in prison were evident, indicating opportunities for improvement. A targeted HCV education program for people in prison, addressing the gaps identified in this analysis, may enhance HCV testing, treatment, and prevention by fostering stronger HCV health literacy among people in prison., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: YS has nothing to disclose. AC and LL have received speaker fees from AbbVie Pty Ltd. CT has received speaker fees from Gilead Sciences. JG is supported by an NHMRC Investigator Grant (1176131), and is a consultant/advisor and has received research grants from AbbVie, Cepheid, Gilead Sciences, Hologic, Indivior, and Merck/MSD. ARL is supported by an NHMRC Practitioner Fellowship (1137587) and has received investigator-initiated research grants from Gilead Sciences and AbbVie Pty Ltd. The contents of the published material are solely the responsibility of the individual authors and do not reflect the views of NHMRC. The Kirby Institute and the Centre for Social Research in Health are funded by the Commonwealth Department of Health and Ageing. The views expressed in this publication do not necessarily represent the position of the Australian Government., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Introduction: The prevalence of psychiatric disorders among prisoners remains a major public health issue worldwide. In France, despite the increasing number of persons who are incarcerated (+30% between 1992 and 2002 with a 120% prison overcrowding), and a historical concern about the mental health of persons in detention and its management, no systematic review has been published on this subject. The aim of this article is to present the results of a systematic review of the literature on the prevalence of psychiatric disorders in French prisons., Method: The reporting of this systematic review conforms to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) checklist. We searched the PubMed and Web of Science databases. We used combinations of keywords relating to prison (prison*, jail*, inmate*), to psychiatry ("mental health", psychiatr*), and to France (France, French). This work was completed with a search through the digital libraries of the École des Hautes Études en Santé Publique (EHESP) and of the Système Universitaire de Documentation (Sudoc) to obtain data from academic works and the gray literature. References cited in studies included in this review were also examined. All references published up to September 2022, written in English or French, presenting the results of original quantitative studies on the prevalence of psychiatric disorders in correctional settings were included. Two researchers independently extracted data from included references according to a pre-established protocol., Results: Among 501 records identified, a total of 35 papers based on 24 epidemiological studies met the eligibility criteria for inclusion in this review: 16 were cross-sectional, 7 retrospective and 1 both cross-sectional and retrospective. All papers were published between 1999 and 2022. We found one European study, 5 international studies, 18 regional or local studies. Of these, 21 studies had all-male or mixed gender samples (but when the sample was mixed gender, it was always at least 92% male). Almost half of the studies (n=11) involved a small sample of fewer than 500 persons. Half of the studies involved a sample of recently incarcerated persons: 6 involved a random sample of persons in detention, and 1 involved a sample of people incarcerated for more than 5 years. The last 5 studies focused on persons aged over 50 years and incarcerated for more than one year (n=1), incarcerated for sexual offences (n=2), placed in disciplinary cells (n=1) or in a special wing for radicalized or suspected radicalized individuals (n=1). Nine studies used standardized and validated diagnostic tools. According to the 4 studies involving representative samples and using standardized and validated diagnostic tools, the prevalence of the following psychiatric disorders was: 29.4-44.4% for anxiety disorders, 5-14.2% for PTSD, 28-31.2% for mood disorders, 6.9-17% for psychotic disorders, 32% for personality disorders and 11% for ADHD., Conclusion: This systematic review of the literature highlights the high prevalence of psychiatric disorders in French prisons. The data collected are in line with international studies. The great methodological heterogeneity of the papers included in this review calls for further rigorous research to better understand the rates of mental disorders in French prisons and to explore their determinants., (Copyright © 2024 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Worldwide, there is a lack of systematically collected health data on people who are incarcerated. Our objective in this paper was to describe a process model of formative work for a project to strengthen health surveillance for people incarcerated under a Canadian prison authority. We have developed project structures and processes, and we are evaluating project partnerships. To inform prison health surveillance foci, we are conducting a review of literature on best practices, a qualitative study to understand stakeholders' needs and priorities, and mapping work to understand available prison health-related data. Developing and implementing prison health surveillance is gradual and developmental, necessitating time to build relationships and obtain approvals. The needs and interests of knowledge users should be prioritized, but there may be challenges to achieving a coherent vision due to feasibility and differing needs and objectives of various stakeholders. Developing collaborative relationships could help bridge this gap., Competing Interests: The authors declare that they do not have any conflicts of interest., (Copyright © 2024 Gaber, Sanya, Lawson, Grenada and Kouyoumdjian.)

Background: Elimination of bloodborne viruses including HIV and hepatitis C virus from prisons requires high coverage of evidence-based interventions that prevent bloodborne virus transmission, including needle and syringe programs. Canada launched a Prison Needle Exchange Program (PNEP) in nine federal prisons in 2018; however, uptake among people who inject drugs in prison remains low. We aimed to explore barriers and facilitators to improving PNEP uptake identified by correctional officers and healthcare workers., Methods: Participants from nine federal prisons with PNEP completed focus groups using nominal group technique, a rapid mixed-method consensus strategy. Responses were generated, rank-ordered, and prioritized by each stakeholder group. We identified the highest-ranking responses (≥10 % of the overall votes) to questions about barriers and facilitators to PNEP uptake., Results: Between September 2023 and February 2024, 16 focus groups were conducted with 118 participants (n = 51 correctional officers; n = 67 healthcare workers). Among correctional officers, the top perceived barriers were bullying from peers (22 %), fear of being targeted by correctional officers (14 %), and fear of repercussions due to drug use (13 %). The top facilitators were safe injection sites (30 %), provision of wrap-around services (16 %), and education of correctional officers (10 %). Among healthcare workers, the top perceived barriers were lack of confidentiality (16 %), fear of being targeted by correctional officers (12 %), and a long and complex application process (11 %). The top facilitators were education of correctional officers (29 %), delivery of PNEP by an external provider (15 %), automatic approval for participation in the PNEP (13 %), and safe injection sites (12 %)., Conclusion: Multiple modifiable barriers and solutions to improving PNEP uptake in Canadian federal prisons were identified by correctional employees. Both participant groups identified the potential for safe injection sites and education to correctional officers as enabling PNEP uptake. These data will inform Canadian efforts to improve engagement and to expand PNEP coverage., Competing Interests: Declaration of competing interest FL, BH, and FLA report no competing interest. NK has received research funding from ViiV Healthcare, Abbvie, and Gilead, advisory fees from Gilead Sciences, ViiV Healthcare, Merck, and Abbvie, and speaker fees from Gilead Sciences, Abbvie, and Merck, all outside this work. LL has received speaker fees from AbbVie Pty Ltd unrelated to this work. FL has no disclosure. MS has received investigator-initiated research funding from Gilead Sciences and AbbVie and consultant fees from Gilead Sciences for activities unrelated to this work. ARL has received investigator-initiated research support from Gilead and AbbVie, outside this work., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

The case fatality rate (CFR) is an important metric in the correctional setting because it permits assessment of the lethality of an infectious agent independent of its underlying variations in transmissibility and incidence. Several studies have reported that incarceration is associated with both increased COVID-19 incidence and mortality. CFR, sometimes referred to as infection fatality rate for COVID-19, was used to compare mortality in a population at two points in time. A retrospective cohort study design was used to assess age-adjusted mortality among people diagnosed with COVID-19 in the Texas prison system and the Texas nonincarcerated population from January 1, 2020, through December 31, 2021. For each 6-month period under study, the Texas prison population had a substantially lower age-adjusted CFR compared with the Texas nonincarcerated population. However, in the absence of information on underlying COVID-19 severity, comorbidities, and other potential confounding factors in these two populations, it is difficult to make strong inferences based on a comparison of their CFRs. Future research, with careful attention to bias and confounding, should examine the specific health system factors that may be used to reduce morbidity and mortality associated with infectious disease outbreaks in prisons.

Introduction: The prison-based Therapeutic Community (TC) is widely used within correctional institutions to address substance use disorders (SUDs). While most evaluations of the prison-based TC find the program to be effective, recent mixed evidence and the continued surge of the opioid crisis call for deeper investigation into program operations, barriers to engagement, and sources of treatment effect heterogeneity. Notably lacking from prior evaluations, and critical to our understanding of variable program engagement, is first-hand experiences and perceptions from program participants., Methods: To assess prison-based TC resident perceptions of the program and their recommendations for improvement, we utilize data from the Therapeutic Community Prison Inmate Network Study (TC-PINS), a longitudinal data collection effort conducted in one prison-based TC unit within a Pennsylvania state prison. Specifically, we assess resident responses to the open-ended item "What can the TC do better?" Analyzing 470 responses to this question by 177 residents, two independent coders identified seven substantive categories of recommended changes or improvements to their TC program., Results: Residents provided tangible recommendations for improvement of their prison-based TC program based on their experiences and perceptions. Importantly, a number of their recommendations directly counter the intended model of the TC, which highlights imperative issues underlying the translation of the TC model within the prison environment. Resident suggestions include enhanced structure, increased individualization, expanded curriculum, stricter enforcement of rules, and improved or more experienced staff. Additionally, many question the coercive nature of TC program participation within this prison system., Conclusions: Resident recommendations for program improvement unveil important sources of treatment effect heterogeneity and highlight tangible program changes that can be implemented to reduce barriers to treatment engagement. We provide suggested changes to this prison-based TC based on resident perceptions and discuss both the importance and relative ease of eliciting this critical participant feedback., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

During COVID and lockdown, many prisoners have not only been affected by infection transmission in crowded and ill-equipped institutions, they have also been separated from a range of supports, including loss of family and professional supports and support for prisoners with addiction and/or mental health problems has been disrupted. This paper reports on evidence of how peer-based recovery organizations have attempted to mitigate these adverse effects, based on a case study of one prison in the North-West of England, using a range of routine reporting data and original research data. The paper shows how prison-based peer recovery support has not only continued through lockdown but grown both in the prison and in continuing care on release. The key conclusion is that Lived Experience Recovery Organizations (LEROs) have a vital role to play in offering continuing care to prison populations both to support early recovery and to sustain change around release back into the community, in COVID but also more generally., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.