X Sputum microscopy has low sensitivity in detecting tubercle bacteria, and classic tuberculosis culture methods give results as much as two months later. For early and sensitive identification of infectious TB and drug‑resistant TB, new technologies with rapid detection of tuberculosis bacteria and resistance patterns9 should be implemented as soon as possible. This is of particular importance in a setting where people are in close proximity, such as prison, because of the need for immediate separation of infected and drug‑resistant TB patients and for early treatment according to resistance pattern, in order to interrupt disease transmission effectively. High‑sensitivity detection methods for tubercle bacteria are also required because of the low sputum bacteria concentrations in HIV co‑infected infectious TB patients. X In view of the high rate of co‑infection with HIV and TB, and in accordance with the WHO policy on the dual epidemic,10 identifcation of HIV patients among identifed TB patients, and TB diagnostic in identifed HIV patients, must be intensifed. Owing to their long history with TB, many countries and prison systems have decentralised TB facilities, whereas HIV services are mostly centralised. In order to cope with a dual epidemic, it has been strongly suggested that staf of existing TB facilities in the community and in prison should receive training to provide education on HIV/Aids prevention and voluntary confdential counselling and testing for HIV of their TB patients and that those who test positive should start as soon as possible with cotrimoxazol prevention and be referred for antiretroviral (ARV) treatment. X Likewise, in identifed HIV patients, education in TB prevention, TB infection control and active TB case‑fnding needs to be intensifed. For those exposed to TB infection and/or with latent TB infection, preventive isoniazid (INH) treatment should be considered (provided there is no high prevalence of INH‑resistant TB bacteria). HIV patients with diagnosed TB disease must start immediate TB treatment in accordance with the result of their drug‑sensitivity testing. 9. Small P. M. and Pai M: “Tuberculosis diagnosis – time for a game change”. New England Journal of Medicine 363 (2010), 1070‑71; Boehme C. C., Nabeta P., Hillemann D. et al: “Rapid molecular detection of tuberculosis and rifampicin resistance”. New England Journal of Medicine 363 (2010), 1005‑15; WHO Global Tuberculosis Report 2012. 10. WHO policy on collaborative TB/HIV activities: guidelines for national programmes and other stakeholders (Geneva 2012). Prison health care and medical ethics Page 66