The recommendations for congregate settings are less specific than those for healthcare facilities, because congregate settings are so diverse. They include a mix of settings that range from correctional facilities and military barracks, to homeless shelters, refugee camps, dormitories and nursing homes. Each facility differs in the type of population it contains and the duration of stay; in turn, this affects the dynamics of TB transmission. Congregate settings are often divided into two categories — long-term (e.g. prisons) and short-term (e.g. jails and homeless shelters) — to reflect the different duration of stay of the inhabitants.

Managerial activities in congregate settings

The full set of national and sub-national managerial activities already described should also apply to congregate settings. This level of activity may involve other ministries besides the Federal Ministry of Health, such as the Ministry of Justice, plus a range of other stakeholders. In any congregate setting, overcrowding should be avoided because it can lead to non-infected individuals being exposed to TB. Any information, education and communication (IEC) material needs to include a specific focus on congregate settings, including the monitoring and evaluation of TB infection control measures at this level.

Administrative controls in congregate settings

The administrative controls used in healthcare facilities were introduced earlier in this study session and they are also equally important in congregate settings. Cough manners and respiratory hygiene should be implemented, as should early identification of TB suspects and cases, followed by separation and proper treatment of infectious cases.

In long-term residential facilities and similar long-stay congregate settings, occupants should be screened for TB before entry. All staff should be given appropriate information and encouraged to undergo TB diagnostic investigation if they have signs and symptoms suggestive of TB. People suspected of having TB should be diagnosed as quickly as possible. In short-term residential congregate settings, such as jails and homeless shelters, a referral system for proper case management should be established.

In congregate settings with a high prevalence of HIV (particularly in correctional services), patients living with HIV and other forms of immunosuppression should be separated from those with suspected or confirmed infectious TB. All staff and persons residing in the setting should be given information and encouraged to undergo HIV testing and counselling. In congregate settings with patients having, or suspected of having drug-resistant TB, such patients should be separated from other patients (including other TB patients), and referral for proper treatment should be established.

Environmental controls in congregate settings

Buildings in congregate settings should fulfil national norms and regulations for ventilation in public buildings, and the specific norms and regulations for prisons, where these exist. In congregate settings in which there is a high risk of TB transmission and where adequate ventilation cannot be achieved, other (mechanical) ways of maintaining ventilation should be adopted.