Participatory communication for tuberculosis control in prisons in Bolivia, Ecuador, and Paraguay.

OBJECTIVES To assess the challenges in reducing tuberculosis (TB) in prisons in Bolivia, Ecuador, and Paraguay and propose ways to address them through communication interventions. METHODS Challenges to two central goals of TB control--early diagnosis of positive cases and successful application of the directly observed treatment, short course (DOTS) strategy--were examined. Data were gathered (through in-depth, structured interviews) and focus groups were conducted in the prisons that housed the largest number of male inmates in each country. Interviewees and focus group participants included program directors, administrative personnel, correctional health and security staff, and incarcerated people who were or had been under treatment for TB and had participated as 'peers' in health services. RESULTS The findings showed a range of entrenched obstacles for adequate TB control. Stigmatizing attitudes and low knowledge about TB among inmates and key prison personnel discouraged people living in prisons from seeking diagnosis and treatment. Systemic problems in prison health services, along with squalid living conditions, lack of coordination between national TB programs and prison health systems, and insufficient allocation of resources to health prevented the provision of adequate TB prevention and care. CONCLUSION In addressing the barriers to effective TB control in prison systems in Bolivia, Ecuador, and Paraguay, a participatory approach to communication is necessary.