Aim: To evaluate the feasibility of the revised “Clinical Guideline for HIV
and TB” in the Great Tehran Prison during October 2013 to June 2014.
Methods: The guideline includes all aspects of HIV/TB diagnosis based on active
case finding (ACF), treatment and care services. Before the implementation, a focus
group discussion was conducted, and attended by experts on prison health. The objective
was to identify defects and limitations of the guideline. After the discussion,
the guideline was revised.
The Great Tehran Prison contains three separate units; all prisoners are taken first to
“reception and identification unit (quarantine)” and then send to two housing units
according to their legal status.
An HIV ACF strategy was employed in the quarantine, and two units through a voluntary
provider-initiated HIV testing. Three staff of the triangular clinic trained the
prisoners about common routes of HIV transmission and the symptoms of TB in the
units. In the quarantine, all prisoners were examined for all HIV-risk factors, HIV
testing and symptoms of TB. In unit one, healthcare staff continued the ACF process,
while in unit two, the peers of prisoners were assigned as the healthcare communicators
to proceed with the strategy. At this caring process, when the test result was positive,
then the process of care, treatment and follow ups was initiated. Moreover, the
use of directly observed therapy (DOT) for antiretroviral therapy (ART) and TB was
applied to the sick prisoners. There was also a follow-up caring for released prisoner
to refer them to care and treatment services outside the prison.
Results: The guideline was implemented in the prison successfully.
Conclusion: Regarding feasibility of the guideline, the investigators of this study
suggest that the guideline should be implemented in other prisons across the country.