Ethical issues in tuberculosis screening and the use of new drugs for prisoners

SETTING: Prisons are known to have extremely high tuberculosis (TB) and multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB prevalence and poor treatment outcomes. OBJECTIVE: To examine the screening and M/XDR-TB treatment with new TB drugs in prisons from the perspective of international ethical and legal requirements. DESIGN: WHO recommendations on TB screening in prisons and M/XDR-TB treatment as well as the international human rights law on prisoners were analysed. RESULTS: Prisoners have a human right to access at least the same level of TB care as in their communities. Screening for TB in prisons, which may run contrary to a given individual's choice to be tested, may be justified by the positive obligation to prevent other prisoners from contracting a possibly deadly disease. Introduction of new TB drugs in prisons is necessary, ethically sound and should start in parallel with introduction in a civilian sector in strict compliance with the WHO recommendations. CONCLUSION: Access to screening for TB, as well as effective treatment according to WHO recommendations, must be ensured by countries on the basis of international human rights conventions.