Prevalence of pulmonary tuberculosis among prison inmates: A cross-sectional survey at the Correctional and Detention Facility of Abidjan, Côte d'Ivoire.

Benjamin Séri,Thérèse N’Dri-Yoman,Christine Danel,Jean-Marie Masumbuko,Jeanne-D’Arc Assemien,Arnaud Laurent,Marie-Catherine Receveur,Marcel-Angora Blehoué,Serge K Domoua,Serge P Eholié,Eric Ouattara,Ange Koffi,Patrick Coffie,Timothée Ouassa,Xavier Anglaret,Nathalie Cartier,Gilles Raguin,Denis Malvy

doi:10.1371/journal.pone.0181995

Abstract

BackgroundIn Côte d’Ivoire, a TB prison program has been developed since 1999. This program includes offering TB screening to prisoners who show up with TB symptoms at the infirmary. Our objective was to estimate the prevalence of pulmonary TB among inmates at the Correctional and Detention Facility of Abidjan, the largest prison of Côte d’Ivoire, 16 years after this TB program was implemented.MethodsBetween March and September 2015, inmates, were screened for pulmonary TB using systematic direct smear microscopy, culture and chest X-ray. All participants were also proposed HIV testing. TB was defined as either confirmed (positive culture), probable (positive microscopy and/or chest X-ray findings suggestive of TB) or possible (signs or symptoms suggestive of TB, no X-Ray or microbiological evidence). Factors associated with confirmed tuberculosis were analysed using multivariable logistic regression.ResultsAmong the 943 inmates screened, 88 (9.3%) met the TB case definition, including 19 (2.0%) with confirmed TB, 40 (4.2%) with probable TB and 29 (3.1%) with possible TB. Of the 19 isolated TB strains, 10 (53%) were TB drug resistant, including 7 (37%) with multi-resistance. Of the 10 patients with TB resistant strain, only one had a past history of TB treatment. HIV prevalence was 3.1% overall, and 9.6%among TB cases. Factors associated with confirmed TB were age ≥30 years (Odds Ratio 3.8; 95% CI 1.1–13.3), prolonged cough (Odds Ratio 3.6; 95% CI 1.3–9.5) and fever (Odds Ratio 2.7; 95% CI 1.0–7.5).ConclusionIn the country largest prison, pulmonary TB is still 10 (confirmed) to 44 times (confirmed, probable or possible) as frequent as in the Côte d’Ivoire general population, despite a long-time running symptom-based program of TB detection. Decreasing TB prevalence and limiting the risk of MDR may require the implementation of annual in-cell TB screening campaigns that systematically target all prison inmates.

Highlights

The high burden of tuberculosis (TB) in African prisons is a challenging phenomenon [1,2,3]
Decreasing TB prevalence and limiting the risk of MDR may require the implementation of annual in-cell TB screening campaigns that systematically target all prison inmates
It has been related to several factors, including the fact that prisoners are mostly young men originating from disadvantaged neighbourhoods with a high TB incidence, dilapidated buildings with poor inside ventilation, overcrowding, malnutrition, and, in some areas, high prevalence of human immunodeficiency virus infection (HIV) [4]

Summary

Introduction

The high burden of tuberculosis (TB) in African prisons is a challenging phenomenon [1,2,3]. The difficulty in ensuring continued comprehensive TB care in prison leads to delay in TB diagnosis and to discontinuity in TB treatment. The latter favours the emergence of drug-resistant strains, which may further disseminate due to prison promiscuity and to the lack of facilities to perform cultures and drug sensitivity tests. After they are released, prisoners contribute to the spread of TB (including drug-resistant TB) in the communities into which they reintegrate [5,6]. Our objective was to estimate the prevalence of pulmonary TB among inmates at the Correctional and Detention Facility of Abidjan, the largest prison of Cote d’Ivoire, 16 years after this TB program was implemented

Objectives

Results

Conclusion