Abstract
Design A cohort study using programmatic data was undertaken to assess TB diagnostic cascade in one of the study prisons for 2018. Treatment outcomes among male inmates with TB were assessed over a period of four years, in two study prisons. Results A total of 405 (11%) inmates with presumptive TB were identified, and 370 (91%) of these were evaluated for TB, mostly using rapid molecular testing of sputum specimens. Twenty-five inmates were diagnosed with TB resulting in a prevalence of 649/100,000 population. Of these, 16 (64%) were started on treatment. Nine (36%) were lost to follow-up before treatment initiation. From 2015 to 2018, 280 adult male inmates with TB were started on treatment. Of these, 212 (76%) had pulmonary disease that was bacteriologically confirmed. Almost all (276/280, 99%) had known HIV status, 65% were HIV-infected, and 80% of these were on antiretroviral treatment. The TB treatment success rate (cured or treatment completed) was recorded for 209 (75%) inmates, whilst 14 (5%) died and 11 (4%) were lost to follow-up. The frequency of unfavourable treatment outcomes (death, lost to follow-up, and not evaluated) was higher (54%) among inmates ≥ 60 years than those in the age group of 45-59 years (17%). Conclusion The findings revealed a threefold burden of TB in prisons, compared with what is reported by national survey. To decrease transmission of TB bacilli, it is essential to promote efforts that address missed opportunities in the TB diagnostic cascade, prompt treatment initiation, and ensure that tracking and documentation of treatment outcomes for all inmates are intensified.
Highlights
Worldwide prisons are recognised as major congregate institutions with an extraordinarily high burden of tuberculosis (TB), including multidrug-resistant TB, and inadequate resources for health and TB services [1]
There are forty-six established clinics and four prison hospitals staffed by nurses, doctors, and other health professionals
Ten people had Mycobacterium tuberculosis detected on XpertMTB/RIF, and one person was diagnosed through sputum microscopy resulting in a positivity rate of 3% (11/370) and a notification rate of 285 cases of bacteriologically confirmed pulmonary TB/100,000 population
Summary
Worldwide prisons are recognised as major congregate institutions with an extraordinarily high burden of tuberculosis (TB), including multidrug-resistant TB, and inadequate resources for health and TB services [1]. Prison populations may account for 25% of national TB burden [2]. Inadequate treatment, overcrowding, poor ventilation, and repeated prison transfers contribute to rampant transmission of TB bacilli. The Zimbabwe Prisons and Correctional Service (ZPCS) has a total of 46 established and 24 satellite prisons with an official holding capacity of approximately 17,000 inmates. The prisons are overcrowded, and some of them hold double the number of inmates compared to their recommended maximum holding capacity. TB diagnostic services are available at Chikurubi Maximum (Harare) and Khami Maximum (Bulawayo) Prison hospitals. All sputum smear microscopy examinations are done at the National Microbiology Reference Laboratory (NMRL)
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