Using chest X-ray to screen for Tuberculosis on arrival to prison: A service evaluation

Objectives

Chest X-ray (CXR) is recommended by the World Health Organization as a TB screening tool on admission to prison. We piloted the offer of CXR on admission to prison to understand if it was acceptable to residents, feasible to deliver within 48 hours of admission, and to inform TB epidemiology.

Study Design

Cross-sectional

Method

Between 1 September 2023 and 31 March 2024, CXRs were offered to new prison admissions. We measured the numbers accepting, numbers completed and the results. For each person accepting the CXR we undertook an assessment of clinical and social TB risks. We measured the time taken to deliver the CXR and receive results.

Results

CXR was acceptable to those in prison with 61% (n=310) of new admissions accepting the offer. Of those accepting the offer, 226 (73%) went on to receive a CXR, equating to 44% of all new arrivals within the pilot period. A quarter of those accepting the CXR offer did not attend their first appointment and needed further appointment offers. We observed that as the number of rearranged appointments increased the number of men attending decreased. The total median number of days from arrival at the prison to completion of CXR was 17 [IQR 13-20 days]. We did not identify any respiratory TB, however nine (4%) CXRs were abnormal..

Conclusion

CXR screening was acceptable to prison residents but we could not achieve delivery within 48 hours of arrival to prison. We identified other respiratory abnormalities suggesting CXR screening could be used as a wider respiratory health screen of which TB would be included.

What this study adds

• CXR screening for TB on admission to prison is recommended despite a low certainty of evidence for this approach. Our findings contribute to the evidence and demonstrate the complexity of implementing this in practice

• The offer of CXR on admission to prison was acceptable to new arrivals although delivery within 48 hours of arrival to prison could not be achieved within the existing service model

• Whilst we did not identify any TB, we identified other respiratory abnormalities suggesting CXR screening on arrival could be used as a wider respiratory health screen.

Implications for policy and practice

• To achieve CXR within 48 hours of admission to prison would require a bespoke service model in addition to existing prison radiography provision

• Policies should consider CXR TB screening as part of a wider respiratory health screen, offering the opportunity to address multiple health issues at the same time

• The frequent movement of people through the criminal justice system presents a challenge to continuity of care and should be considered when designing interventions