The objective of this report is to systematically review the evidence on active case finding in prison settings, with a focus on the European Union (EU) and the European Economic Area (EEA) region. The communicable diseases targeted by this review were not selected a priori, but identified through the retrieved evidence.
A systematic literature review was performed in PubMed and Embase.com from 1990 onwards and in Cochrane Library from 1980 onwards. No language or geographical limits were applied. In addition, the following sources were searched through a pre-defined website list search and a call for papers from experts: conference abstracts (from 2010), unpublished research reports, protocols and guidelines (from 2005).
From the peer-reviewed literature, 63 primary articles and one systematic review were included. Furthermore, 24 conference abstracts/unpublished research reports, two other documents and 19 guidelines were included. The search of the literature revealed that most of the existing evidence on active case finding in prison settings is concentrated on just a few communicable diseases, such as hepatitis (A, B and C), human immunodeficiency virus (HIV), sexually transmitted infections (STIs; chlamydia, gonorrhoea, syphilis and trichomoniasis) and tuberculosis (TB). These findings may be consistent with the general notion that these diseases are on one hand casing a sizeable burden of infectious disease in the prison population, and on the other are at higher risk of transmission within prison settings. Against this background of infectious disease burden and transmission risk, people in prison are entitled to a medical assessment upon entry, which offers the opportunity to conduct active case finding for a number of relevant conditions, and not limited to communicable diseases
The body of evidence retrieved through this systematic review was largely composed of studies conducted in non-EU/EEA countries, and primarily in the United States (US). A large part of the literature covering active case finding in EU/EEA prisons was retrieved from grey sources, thus revealing a substantial publication bias. In addition, very few studies, and even less EU/EEA ones, investigated interventions to increase the effectiveness of active case finding in prison settings; and even among those, statistical significance was hardly ever reported.