Infectious Diseases Prevention and Control in Canadian Federal Penitentiaries 2000-01

Publications

Infectious Diseases
Prevention and Control
in Canadian Federal
Penitentiaries 2000-01

METHODS

Surveillance data reporting

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The Correctional Service of Canada (CSC) institutional Health Services units submit to their respective Regional Headquarters a monthly surveillance report, which provides non-identifying (also called non-nominal) case counts of inmates who test positive for HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV), and selected STDs (genital chlamydia, gonorrhea, syphilis). Additionally, non-nominal information on HIV and HCV testing and treatment are collected. It should be noted that currently the CSC Infectious Diseases Surveillance System (CSC-IDSS) does not permit differentiation between acute and chronic HCV and HBV infections, nor does it allow case-based reporting of infections. The case reporting activity is over and above the existing provincial and territorial requirements of surveillance.

Reporting sites may abstract data from multiple sources including patient charts and lab requisitions to ensure completeness of reported information. Health Services staff at each of five CSC Regional Headquarters collate, verify and transmit regional surveillance data to CSC-NHQ Health Services Branch where the information is entered into the CSC-IDSS database. Quality assurance procedures are in place at all reporting and receiving sites to identify errors in reported data. Any discrepancies arising from the verification process are reviewed with institutional surveillance personnel and corrected prior to analysis.

Surveillance period

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This report presents surveillance data collected in Canadian federal correctional penitentiaries during the 2000 and 2001 calendar years.

Definitions (see also Glossary of terms)

Actual cases of disease in a population are referred to as prevalence and incidence of disease. Because not all infected persons come forward for testing, a proportion of prevalent infections remains undiagnosed and is, therefore, not included in surveillance data. In this report, the term positive disease test reports has been used to represent laboratory confirmed cases of infection and serves as an estimate of the burden of disease in CSC penitentiaries. While new diagnoses are called new positive test reports, the total number of identified disease cases at year-end is referred to as total positive disease test reports.

The testing uptake rate refers to the proportion of inmates who underwent voluntarily testing for infection. For inmates who were tested, test positivity refers to the proportion of those with a positive disease test report.

For the purpose of surveillance, newly admitted offenders (including recidivist offenders) are categorized as new admissions for a period of up to 6 weeks following entry into the CSC system. New admissions include all new warrants of committal, transfers from international prisons, transfers from provincial prisons, exchanges of service, other admissions and revocations. All inmates housed for a period longer than 6 weeks in CSC facilities are classified as general population inmates.

In this report, the term women offenders refers to female inmates housed in institutions for women; it does not include women incarcerated in institutions with both men and women offender populations. Because surveillance reports from institutions housing both men and women offenders do not differentiate data by gender, offender data from such institutions have been aggregated with tabulations for men.

Surveillance data analysis

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Surveillance data was collected by CSC Health Services staff and quality controlled and analyzed by technical support from Health Canada. Data were examined across CSC regions for crude rates (i.e., number of disease cases per inmate population at year-end) of new positive test reports, total positive test reports, testing uptake and treatment uptake. Whenever appropriate, the absolute number of disease cases is also presented. Test positivity rates were calculated by using the number of positive disease test reports as the numerator and the number of inmates who completed testing for the disease as the denominator.

Wherever possible, data have been distinctly identified for new admissions and general population inmates in order to discern rates of infection and testing between these two groups. A similar approach was applied for comparisons between men and women offender data.