Table 1. Criminal justice reforms to reduce incarceration rates.

The following criminal justice reforms can help reduce prison overcrowding and, with it, the risk of HIV-associated TB in carceral settings.

Reform/Action	Definition and Evidence	Target Stakeholders
Legislation and criminal law reform	Evidence supports decriminalization of behaviors associated with HIV transmission and unjust imprisonment, such as for drug-related offenses. In Portugal, de-criminalization of drug possession and use was associated with reduced HIV transmission[2,40,41]	Federal and state or provincial legislators and parliamentarians.
Eliminating arbitrary pre-trial detention	Pre-trial detention is common and may be extensive in under-resourced criminal justice systems. Eliminating this practice can reduce the number of people detained without a conviction, and can support efforts to mitigate prison overcrowding. Limited evidence suggests that this may be a cost-effective intervention to reduce inmate exposure to HIV and TB risk brought about by incarceration[42,43].	Federal and state or provincial legislators and parliamentarians; Judges and courts at all levels of the criminal justice system; Public defendants
Release on personal recognizance, and non-custodial sentencing	These criminal justice interventions can also alleviate prison overcrowding and have been implemented in a number of countries globally[2,41,44,45].	Federal and state or provincial legislators and parliamentarians; Judges and courts at all levels of the criminal justice system; Public defendants
Substance use disorder treatment for drug offenders outside carceral settings	Focusing on providing substance use treatment to non-violent drug offenders in medical settings would offload already burdened criminal justice systems, and more effectively, sustainably, and humanely address many of the root social and physiologic factors contributing to HIV transmission among people who use drugs[39,41,46].	Judges and courts at all levels of the criminal justice system; Public defendants; Prison and Community Health System Administrators; Substance Use Treatment Program Managers