Abstract
BackgroundPrisoners are at high risk of developing tuberculosis (TB), causing morbidity and mortality. Prison facilities encounter many challenges in TB screening procedures and TB control. This review explores screening practices for detection of TB and describes limitations of TB control in prison facilities worldwide.MethodsA systematic search of online databases (e.g., PubMed and Embase) and conference abstracts was carried out. Research papers describing screening and diagnostic practices among prisoners were included. A total of 52 articles met the inclusion criteria. A meta-analysis of TB prevalence in prison facilities by screening and diagnostic tools was performed.ResultsThe most common screening tool was symptom questionnaires (63·5%), mostly reporting presence of cough. Microscopy of sputum with Ziehl-Neelsen staining and solid culture were the most frequently combined diagnostic methods (21·2%). Chest X-ray and tuberculin skin tests were used by 73·1% and 50%, respectively, as either a screening and/or diagnostic tool. Median TB prevalence among prisoners of all included studies was 1,913 cases of TB per 100,000 prisoners (interquartile range [IQR]: 332–3,517). The overall annual median TB incidence was 7·0 cases per 1000 person-years (IQR: 2·7–30·0). Major limitations for successful TB control were inaccuracy of diagnostic algorithms and the lack of adequate laboratory facilities reported by 61·5% of studies. The most frequent recommendation for improving TB control and case detection was to increase screening frequency (73·1%).DiscussionTB screening algorithms differ by income area and should be adapted to local contexts. In order to control TB, prison facilities must improve laboratory capacity and frequent use of effective screening and diagnostic tools. Sustainable political will and funding are critical to achieve this.
Highlights
An estimated 8–10 million people are incarcerated worldwide on any given day
TB prevalence and incidence was higher in facilities without entry screening as well as among inmates incarcerated for 10 months or longer, it is unclear to what extent these figures are attributable to confinement
It was beyond the scope of this review to address specific risk factors of TB prevalence and incidence
Summary
An estimated 8–10 million people are incarcerated worldwide on any given day. Many more are detained for short periods of time [1]. Screening procedures may be limited, e.g. by prison health staff who are unable to follow standard TB guidelines due to poor training and lack of funding [8]. Other limitations of successful screening practices in prison facilities include the finite available health staff combined with vast numbers of prisoners, slow symptom check-ups [8]. Laboratories inside prison facilities are often inadequate or nonexistent, delaying referral of prisoners to outside health services [8]. These limitations lead to high TB rates in prison facilities, likely contributing to transmission to wider communities [10]. This review explores screening practices for detection of TB and describes limitations of TB control in prison facilities worldwide
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