1. 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

2. Washington D.C., USA, 22-27 July 2012www.aids2012.org Disclosure No conflicts of interest

3. 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%

4. 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

5. 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

6. Washington D.C., USA, 22-27 July 2012www.aids2012.org 6

7. Washington D.C., USA, 22-27 July 2012www.aids2012.org ChallengesResponses Requests for incentivesPromotion 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

8. 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

9. 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