Prison populations are disproportionally affected by communicable diseases when compared with the general community because of a complex mix of socioeconomic determinants and environmental factors. Tailored and adequate health care provision in prisons has the potential to reach vulnerable and underserved groups and address their complex needs. We investigated the available evidence on modalities and effectiveness of active case-finding interventions in prisons by searching PubMed, Embase, and the Cochrane Library for records on prison and active case finding with no language limit. Conference abstracts and unpublished research reports also were retrieved. We analyzed the findings by testing modality, outcomes, and study quality. The included 90 records—63 peer-reviewed, 26 from gray literature, and 1 systematic review—reported variously on viral hepatitis, human immunodeficiency virus, sexually transmitted infections, and tuberculosis. No records were retrieved for other communicable diseases. Provider-initiated opt-in testing was the most frequently investigated modality. Testing at entry and provider-initiated testing were reported to result in comparatively higher uptake ranges. However, no comparative studies were identified that reported statistically significant differences between testing modalities. Positivity rates among tested inmates ranged broadly but were generally high for all diseases. The evidence on active case finding in correctional facilities is limited, heterogeneous, and of low quality, making it challenging to draw conclusions on the effect of different testing modalities. Scale-up of provider-initiated testing in European correctional facilities could substantially reduce the undiagnosed fraction and, hence, prevent additional disease transmission in both prison settings and the community at large.

中文翻译：

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监狱环境中传染病的积极病例发现：提高欧盟/欧洲经济区监狱人口的检测覆盖率和接受率

由于社会经济决定因素和环境因素的复杂组合，与一般社区相比，监狱人口受到传染病的影响尤为严重。监狱中量身定制的充足医疗保健服务有可能惠及弱势群体和服务不足的群体，并满足他们的复杂需求。我们通过在 PubMed、Embase 和 Cochrane 图书馆中搜索有关监狱和无语言限制的主动案件发现的记录，调查了有关监狱主动案件发现干预措施的方式和有效性的现有证据。还检索了会议摘要和未发表的研究报告。我们通过测试方式、结果和研究质量来分析研究结果。其中包括 90 条记录，其中 63 条经过同行评审，26 条来自灰色文献，以及 1 条系统评价，分别报告了病毒性肝炎、人类免疫缺陷病毒、性传播感染和结核病。没有检索到其他传染病的记录。提供商发起的选择加入测试是最常调查的方式。据报告，进入测试和提供商发起的测试导致了相对较高的采用范围。然而，没有发现比较研究报告测试方式之间存在统计显着差异。接受测试的囚犯的阳性率范围广泛，但所有疾病的阳性率普遍较高。惩教机构中积极发现病例的证据有限、异构且质量低下，因此很难就不同检测方式的效果得出结论。在欧洲惩教设施中扩大提供者发起的检测可以大大减少未确诊的比例，从而防止监狱环境和整个社区的额外疾病传播。