Perceived Enablers and Barriers to HIV Testing Service Uptake Among Adolescent Girls and Young Women in Kilimanjaro, Tanzania: A Contextual Analysis.

Incarcerated persons have the right to healthcare services of the same quality as those available outside detention settings (Abbing, ). Despite the brief duration of police custody, detained individuals may face serious health risks if essential care is delayed or withheld. Police custody detainees often experience poor physical and mental health conditions and may be at elevated risk of acute drug and alcohol intoxication or withdrawal (Zinger et al., ; McKinnon et al., ; Rekrut-Lapa & Lapa, ; Sondhi & Williams, ). One of the distinctive features of healthcare in police custody is that consultations must be requested through custody officers, a procedural step that can delay timely access to care (Pont et al., ). Ensuring good quality healthcare is therefore essential to prevent health deterioration and to safeguard compliance with healthcare standards (Pont et al., ). Performance measurement is a cornerstone of quality improvement and accountability in healthcare (WHO, ; Foley & Vale, ). Routinely monitoring through quality indicators provides essential information to identify priority areas, guide corrective actions, and track progress over time (Forster & van Walraven, ; Stelfox & Straus, ). Data collected from practice can be analyzed to support learning in health systems by providing feedback to healthcare providers; driving improvement in patient outcomes, resource allocation, and staff performance (Enticott et al., ; WHO, ; Foley & Vale, ; Foley & Vale, ). In longer-term prison settings, structured performance assessment has been supported by initiatives such as the guide and toolkit co-developed by the International Committee of the Red Cross (ICRC, ), and the Health In Prisons European Database (HIPED), which collects data guided by the World Health Organization (WHO) Prison Health Framework (Alves da Costa et al., ). Despite these developments, important gaps in prison health quality measurement remain. A previous study has noted inconsistent rigor in indicator development, limited involvement of detained persons, and a lack of structure and outcome indicators. Moreover, it showed that scientific literature on quality indicator development for primary healthcare in prison settings appears largely limited to the United States (Bellass et al., ). The healthcare needs of police custody detainees differ from those in prisons, because of the short-term nature of detention and the requirement to provide healthcare only when delaying treatment would harm the detainee’s health (Thoonen, ).