REPUBLIC OF SOUTH AFRICA COMBINED SECOND PERIODIC REPORT UNDER THE AFRICAN CHARTER ON HUMAN AND PEOPLE`S RIGHTS and INITIAL REPORT UNDER THE PROTOCOL TO THE AFRICAN CHARTER ON THE RIGHTS OF WOMEN IN AFRICA • TB treatment: Smear- or culture-positive and GeneXpert® MTB/RIF-positive, rifampicinsensitive patients must be treated according to the National Tuberculosis Management Guidelines, the latter patients further need a second specimen sent for microscopy. GeneXpert® MTB/RIF-positive, rifampicin-resistant patients need to be referred to a multidrug-resistant TB unit for further management. Inmates with pulmonary TB must be admitted in the health facility and isolated for two weeks. Hospitalisation must be considered for diabetes, liver disease, respiratory insufficiency, haemoptysis, serious adverse events of therapy and severe extra pulmonary disease. • HIV-positive inmates who are not on ART require repeat CD4 testing every 6 months, TB symptom and STI screening during every encounter with a health care provider. These inmates must receive cotrimoxazole, TB prophylaxis and ART as per eligibility criteria. If inmates have TB, ART must be started immediately. They must be screened for cryptococcal disease if CD4<100cells/mm3. • STIs treatment must be initiated immediately in all inmates with a confirmed diagnosis.The syndromic management flow charts for management of symptomatic STIs outlined in the DoH guidelines must be followed. In addition, HCT must be offered (if not recently tested), condom promotion, adherence counselling and education about the importance of partner notification and treatment must be shared with the inmate. All patients must be reviewed on completion of treatment and referred if not responding to treatment. • Adherence support must consist of information on the regimen and the reason for longterm treatment including side effects of therapy. Education must emphasise the importance of taking treatment exactly as prescribed. Support provided by nurses, care workers, treatment buddies and support groups must be complemented by pill counts. • Inmates and correctional centre staff must be informed about TB, HIV and STIs including prevention in their increased risk environment. Peer education as an effective means involves dissemination of correct information by both centre staff and inmates. • TB prevention: Isoniazid preventive therapy (IPT) must be given to all HIV-infected adults who are not on TB treatment; are asymptomatic for TB; have no active liver disease and no history of alcohol abuse, psychosis, convulsions or neuropathy. Isoniazid 300 mg plus Vitamin B6 25 mg daily must be given for the duration of incarceration. Inmates must be monitored for side effects and indications for interruption of IPT. Special considerations apply for infants. • TB infection control consists of environmental and administrative controls and personal protection. These involve an Infection Prevention and Control Committee and Plan, risk assessments, education of staff and inmates, regular screening, isolation of TB patients, coughing etiquette, face masks, safe environments for sputum provision, natural ventilation where possible and ultraviolet germicidal radiation. 27