Tuberculosis and HIV’s management: A health seeking behaviour Analysis of Incarcerated Patients

Abstract Madagascar has about 23.000 prisoners detained in 44 prisons. In prisons, tuberculosis (TB) prevalence is eight times higher than in the general population due to different conditions that make them vulnerable like overcrowded conditions. HIV prevalence may also be higher than in the general population due to risky practices that may expose prisoners to HIV infection, but no precise data are available. Though the national strategic plans for TB, HIV or TB-HIV co-infection' management mention prisoners as one of their target populations, any specific care are provided for these incarcerated patients. They then face many difficulties in their care specifically HIV carriers. An anthropological study dealing with the care pathway of TB and HIV patients in prison is on-going. The aim of our study is to analyse and understand the care seeking pathway of prisoners with TB and/or HIV'. Interviews are conducted at the main prisons of Antananarivo, Mahajanga and Manakara. A total of sixty interviews will be conducted with prisoners (with TB and/or HIV) and other persons such as nurses, reference doctors, prison officers. Focus groups were also conducted with prisoners in order to understand the care seeking pathway in prison and also detainees' perception of TB and HIV. Data collection is on-going and will be finished in May 2020. These preliminary findings revealed that there is an informal hierarchy to be respected for access to care. The power relations between detainees give unequal access to care. It is also conditioned by others circumstances like coinage or social status. It was also revealed that the level of detainees' knowledge of diseases TB and HIV remains limited to the modes of transmission. Interviews revealed any stigmatization of patients with TB or HIV. Data are being collected and recommendations will follow. Yet, we can already claim that the prevention of both TB and HIV needs to be strengthened. Key messages Our study will provide a better understanding of the detainees’ issues the management of TB and/or HIV. Our analysis would propose concrete recommendations to improve health care and cure in prisons.