Tuberculosis In Prisons Research Articles

Local and Travel-Associated Transmission of Tuberculosis at Central Western Border of Brazil, 2014-2017.

International migrants are at heightened risk for tuberculosis (TB) disease. Intensified incarceration at international borders may compound population-wide TB risk. However, few studies have investigated the contributions of migration, local transmission, or prisons in driving incident TB at international borders. We conducted prospective population-based genomic surveillance in 3 cities along Brazil’s central western border from 2014–2017. Although most isolates (89/132; 67%) fell within genomic transmission clusters, genetically unique isolates disproportionately occurred among participants with recent international travel (17/42; 40.5%), suggesting that both local transmission and migration contribute to incident TB. Isolates from 40 participants with and 76 without an incarceration history clustered together throughout a maximum-likelihood phylogeny, indicating the close interrelatedness of prison and community epidemics. Our findings highlight the need for ongoing surveillance to control continued introductions of TB and reduce the disproportionate burden of TB in prisons at Brazil’s international borders.

A systematic review of tuberculosis detection and prevention studies in prisons

ABSTRACT Many studies have demonstrated that prisons are hotspots of tuberculosis disease and transmission. Despite this, it remains unclear which interventions are most effective at controlling tuberculosis in prisons. The objective was to determine the study designs used to investigate tuberculosis control in prisons, and the efficacy of interventions undertaken. This systematic review included published studies which had the aim of reducing TB incidence or prevalence, or increasing the number of people screened for active pulmonary tuberculosis in incarcerated populations. 2,429 records were identified, 178 full-text articles were screened, and 17 studies included. The majority of reports were before/after or prospective non-comparative studies. The median study duration was 23 months (range 5-144). The most common intervention was the introduction of active case finding (10/17 studies) but the timing and methods varied. Comparable pre- and post intervention outcome values were infrequently reported; therefore, it was not possible to quantify the efficacy of interventions. Data from studies of tuberculosis control in prisons is limited by a lack of: controlled interventions, reporting of pre-intervention methods, and comparable pre- and post-intervention outcomes. Prospective comparative trials of adequate duration to determine trends in incidence are necessary to understand which interventions are effective in prisons.

Overview of the epidemic situation on tuberculosis in Russian prisons in 2019

Monitoring the epidemic situation of tuberculosis in pri- sons is of great importance in the Russian and internation- al system of monitoring tuberculosis. Objective of the study : to monitor the epidemic situation of tuberculosis in Russian prisons. Methods. We used information from official statistics. Extensive and intensive indicators were calculated, regression analysis was used. Results. The in- dicator “The proportion of people diagnosed with active tuberculosis diagnosed for the first time in their lives in penitentiary institutions in the total number of patients di- agnosed with active tuberculosis for the first time in their lives” is being successfully met. In 2019 it was 7.3% with a target of 7.8%. The notification rate of new cases of tuber- culosis is declining at a faster rate in correctional facilities (to 465.0 per 100,000) and at a lower rate in pre-trial de- tention centers (to 1251.0 per 100,000). The decline in the notification rate of new cases of tuberculosis in pre-trial de- tention centers may slow due to COVID-19. There is a fur- ther decrease in the prevalence of tuberculosis (to 2,677.3 per 100,000) and TB mortality (to 7.0 per 100,000). The inci- dence of TB/HIV among people living with HIV decreased to 2506.0 per 100,000, while ART coverage increased to 59.5%. A strong inverse correlation was found between the incidence of tuberculosis in people living with HIV and their coverage of ART (r=-0.99). The prevalence of MDR-TB has not changed over the past 3 years, amounting to 684.0 per 100,000 in 2019 with an increase in primary MDR to 32.8%. Conclusion: the TB epidemic situation continues to improve, mainly in correctional facilities, less in pre-trial detention centers. The improvement in the epidemic situa- tion of tuberculosis with HIV infection is associated with an increase in the coverage of people living with HIV with ART. Two multidirectional processes ensure the lack of MDR-TB dynamics: a decrease in the incidence of tuberculosis, on the one hand, and an increase in primary multidrug resis- tance of MBT, on the other.

Increased incarceration rates drive growing tuberculosis burden in prisons and jeopardize overall tuberculosis control in Paraguay

Incarcerated populations are at high-risk to develop tuberculosis (TB), however their impact on the population-level tuberculosis epidemic has been scarcely studied. We aimed to describe the burden and trends of TB among incarcerated populations over time in Paraguay, its clinical and epidemiological differences and the population attributable fraction. This is an observational, descriptive study including all TB cases notified to the National TB control Program in Paraguay during the period 2009–2018. We also used case registries of prisoners diagnosed with tuberculosis from the Minister of Justice. The population attributable fraction of TB in the community due to incarcerated cases was estimated through Levin’s formula. The characteristics of TB cases in and outside of prison were compared as well as the characteristics of TB in prisons were modified over time. During 2009–2018, 2764 (9.7%) of the 28,534 TB reported cases in Paraguay occurred in prisons. The number of prisoners in Paraguay increased from 6258 in 2009 to 14,627 in 2018 (incarceration rate, 101 to 207 per 100,000 persons) while the number of TB cases among prisoners increased by 250% (n = 192 in 2009 versus n = 480 in 2018). The annual TB notification rate among male prisoners was 3218 and 3459 per 100,000 inmates in 2009 and 2018, respectively. The percentage of all TB cases occurring among prisoners increased from 7.1% in 2009 to 14.5% in 2018. The relative risk of TB in prisons compared to community was 70.3 (95% CI, 67.7–73.1); the overall population attributable risk was 9.5%. Among the 16 penitentiary centers in the country, two of them—Tacumbú (39.0%) and Ciudad del Este (23.3%)—represent two thirds of all TB cases in prisons. TB among inmates is predominantly concentrated in those 20–34 years old (77.3% of all), twice the percentage of cases for the same age group outside of prison. Our findings show that the TB epidemic in prisons represents one of the most important challenges for TB control in Paraguay, especially in the country’s largest cities. Appropriate TB control measures among incarcerated populations are needed and may have substantial impact on the overall TB burden in the country.

Pre-test Assessment of SOSA Bottle Intervention’s Effectivity to Reduce Tuberculosis Spreading in Prisons

BACKGROUND: Tuberculosis (TB) is still a health problem in the world, especially in Indonesia, TB still causes serious transmission, including in prison. The Sorimuda-Syarifah (SOSA) bottle, a bottle containing lysol, has been tested in the community and has given satisfactory results. Prison inmates and TB patients in prison urgently need better treatment in an effort to prevent the spread of TB and support its treatment.
 AIM: This paper is the result of the pre-test, to assess the demographic profile and behavior of the respondents, before giving SOSA bottles.
 METHODS: The study was conducted using a questionnaire and was carried out on 27 prisoners in two separate locations in North Sumatra.
 RESULTS: The demographic profiles of respondents were not much different, both in the intervention group and in the non-intervention group. After statistical tests were carried out, only knowledge was statistically significant. There are still a lot of knowledge, attitudes, and practice of respondents that support the spread of TB in prison.
 CONCLUSION: The pre-test results indicate the need to implement the SOSA bottle in prisons.

Tuberculosis active case-finding interventions and approaches for prisoners in sub-Saharan Africa: a systematic scoping review

BackgroundIn sub-Saharan Africa (SSA), most prisons are overcrowded with poor ventilation and put prisoners disproportionally at risk of exposure to Mycobacterium tuberculosis (TB) and developing TB infection but are mostly missed due to poor access to healthcare. Active case-finding (ACF) of TB in prisons facilitates early diagnosis and treatment of inmates and prevent the spread. We explored literature and described evidence on TB ACF interventions and approaches for prisoners in SSA prisons.MethodsGuided by the Arksey and O’Malley framework, we searched PubMed, Google Scholar, SCOPUS, Academic search complete, CINAHL and MEDLINE with full text via EBSCOhost for articles on prisoners and ACF from 2000 to May 2019 with no language restriction. Two investigators independently screened the articles at the abstract and full-text stages in parallel guided by the eligibility criteria as well as performed the methodological quality appraisal of the included studies using the latest mixed-method appraisal tool. We extracted all relevant data, organized them into themes and sub-themes, and presented a narrative summary of the results.ResultsOf the 391 eligible articles found, 31 met the inclusion criteria. All 31 articles were published between 2006 and 2019 with the highest six (19.4%) in 2015. We found evidence in 11 countries. That is, Burkina Faso, Cameroon, Coˆte d’Ivoire, the Democratic Republic of the Congo, Ethiopia, Ghana, Malawi, Nigeria, South Africa, Uganda, and Zambia with most 41.9% (13/31) recorded in Ethiopia. These intervention studies were conducted in 134 prisons between 2001 and 2018 using either a single or combination of mass, facility-led, entry, peer educators for routine screening, and exit ACF approaches. The majority (74%) of the studies utilized only a mass screening approach. The most (68%) reported study outcome was smear-positive TB cases only (68%). We found no evidence in 16 SSA countries although they are classified among the three high-burden country lists for TB TB/HIV and Multidrug resistant-TB group.ConclusionOur review highlights a dearth of evidence on TB ACF interventions in most SSA countries prisons. Hence, there is the need to scaling-up ACF interventions in SSA prisons, particularly countries included in the three high-burden country lists for TB, TB/HIV, and MDR-TB.

Control of epidemics by jails: lessons for COVID-19 from HIV

Control of epidemics by jails: lessons for COVID-19 from HIV

Tuberculosis Case Finding Cascade and Treatment Outcomes among Male Inmates in Two Prisons in Zimbabwe.

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.

Ethical issues in tuberculosis screening and the use of new drugs for prisoners.

SETTING: Prisons are known to have extremely high tuberculosis (TB) and multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB prevalence and poor treatment outcomes.OBJECTIVE: To examine the screening and M/XDR-TB treatment with new TB drugs in prisons from the perspective of international ethical and legal requirements.DESIGN: WHO recommendations on TB screening in prisons and M/XDR-TB treatment as well as the international human rights law on prisoners were analysed.RESULTS: Prisoners have a human right to access at least the same level of TB care as in their communities. Screening for TB in prisons, which may run contrary to a given individual's choice to be tested, may be justified by the positive obligation to prevent other prisoners from contracting a possibly deadly disease. Introduction of new TB drugs in prisons is necessary, ethically sound and should start in parallel with introduction in a civilian sector in strict compliance with the WHO recommendations.CONCLUSION: Access to screening for TB, as well as effective treatment according to WHO recommendations, must be ensured by countries on the basis of international human rights conventions.

Health service provision for disease control among prisoners: a conceptual note

PurposeThe aim of present study was to integrate vital noncommunicable diseases (coronary artery disease, hypertension, diabetes mellitus and mental health disorders) into Prison-Based Active Health Services Provision (PAHSP).Design/methodology/approachOn Jan 1, 2018, there were 230,000 prisoners in Iran. Timely and systematic detection and diagnosis of chronic health conditions among this population are imperative. The collaboration between healthcare providers in prison and members of the multidisciplinary team of the healthcare community outside prison initiated an active health service provision approach for HIV and tuberculosis (TB). Guidelines for the control of HIV and TB in prison were piloted, and the finalized version was named “Prison-based Active Health Services Provision” (PAHSP), which has been scaled up in 16 of 260 Iranian prisons.FindingThe PAHSP approach emphasizes the importance of early identification of key symptoms and risk factors. This approach provides an opportunity for improved prevention and treatment, enabling prisoners identified at risk or those who have been diagnosed with a target disease to be followed up and receive the appropriate health care.Originality/valueInitiatives such as screening for chronic health conditions coupled with treatment will reduce the burden of chronic illness among prisoners and the broader community, thereby saving on healthcare costs and lives.

Prisons and custodial settings are part of a comprehensive response to COVID-19

Comment: Prisons are epicentres for infectious diseases because of the higher background prevalence of infection, the higher levels of risk factors for infection, the unavoidable close contact in often overcrowded, poorly ventilated, and unsanitary facilities, and the poor access to health-care services relative to that in community settings. Infections can be transmitted between prisoners, staff and visitors, between prisons through transfers and staff cross-deployment, and to and from the community. As such, prisons and other custodial settings are an integral part of the public health response to coronavirus disease 2019 (COVID-19).

Detecting Tuberculosis in Prisons: Switching Off the Disease at Its Source.

Detecting Tuberculosis in Prisons: Switching Off the Disease at Its Source.

Mahkumlar ve Genel Populasyondaki Akciğer Tüberkülozunun Karşılaştırılması

INTRODUCTION: Pulmonary tuberculosis in prisoners is higher than general population. The poor health care, poor nutrition, decreased physical activity and easy spread conditions increase the prevalence. In the study; it was aimed to compare pulmonary tuberculosis in prisoners with those in general population. METHODS: Totally 58 patients with pulmonary tuberculosis, 29 prisoners and 29 in general population diagnosed between 2010-2014 was included in the study. All of the records were got from software. Age, routine biochemical and hemogram values, smear test of the sputum and bronchial aspiration for asiodo resistant bacilli, culture, cytology, localization and sign (consolidation, nodule, cavitation) in chest radiography and treatments used were recorded. RESULTS: The mean age of the patients was 35.7 years. In comparison of the groups, serum protein level in general population was lower than the prisoners (p=0.007). The difference for creatinine levels was in borderline (p=0.05). When the signs of the pulmonary tuberculosis on chest radiography were compared; the presence of consolidation in prisoners and nodules in general population were in the foreground (p=0.018). In the assessment of treatments used; 22 prisoners and 21 in general population with pulmonary tuberculosis were given classical four drug regimen. Two prisoners and three in general population used isoniaside, rifampin, pyrazinamide, ethambutol and streptomycin. DISCUSSION AND CONCLUSION: There is no prominent difference for disease characteristics between prisoners and those in general population with pulmonary tuberculosis.

The development of the forecasting information system of HIV and tuberculosis coinfection’s outcome in inmates

The research describes the development of the forecasting information system that can predict the outcome of a disease in inmates with HIV-associated tuberculosis. The aim of the research is to develop an additional high-precision diagnostic criterion giving the possibility of the timely correction of diagnostic, treatment and organizational measures for patients with HIV and tuberculosis co-infection that helps to improve the quality of medical care. The research material is based on the data from clinical cases of patients with HIV and tuberculosis co-infection who were hospitalized in a tuberculosis hospital providing specialized medical care to inmates from 2012 to 2018. (367 people). The study methodology was developed in several stages with the use of the methods of system analysis and mathematical modeling (logical-statistical method of optimally reliable partitions, the method of analysis of hierarchies, artificial neural network, methods of statistical grouping). The result of a complex multi-stage research makes possible the development of the prognostic index forecasting outcome of HIV-associated tuberculosis in prisoners. For the automated calculation of the developed index a software package was created. Interpretation of the received data allows timely correcting of diagnostic and treatment tactics in order to improve the quality of medical care and reduce the hospital mortality rate. The developed information system does not require complex and expensive diagnostic measures, it is easy to use and can be suggested to use as a screening method.

Tuberculosis in prison and aspects associated with the diagnosis site.

Tuberculosis (TB) is highly endemic in prison environments, and requires special attention in the population deprived of liberty (PDL). Thus, we aimed to describe the epidemiological situation of TB among PDL in a large municipality of the Brazilian Legal Amazon, from 2012 to 2016, and to identify the factors associated with the site of TB cases notification. Both descriptive and cross-sectional studies were conducted. Sociodemographic, clinical, diagnostic and treatment data of PDL with TB were collected from the National Disease Notification System - SINAN. Data analysis included frequency distribution, Chi-square test, Fisher exact test and residue analysis, with a significance level of 95%. 256 cases of TB have been notified among PDL in the penitentiary complex situated in the municipality and 100 cases in local health services, such as Primary Health Care units or referral services. Notification in the penitentiary complex was associated with non-X-ray and more than ten contacts identified. An association was found between diagnosis in local health services and female sex, AIDS, alcoholism, illicit drug use, extrapulmonary clinical form, extrapulmonary pulmonary disease, suspected X-ray, sputum smear-negative for diagnosis, HIV positive, culture of sputum not performed/ in progress, DOT ignored/ blank, less than five contacts identified, transfer and others as closure situation. The results show that intricate TB cases were notified by the local health services. Strategies of surveillance and articulation with these health services seem to contribute to the identification of TB cases among PDL.

Epidemic Situation of Tuberculosis in Prisons in the Central Region of China.

We aimed to investigate the epidemic situation of tuberculosis (TB) in prisons in the central region of China. Tuberculosis screening was carried out in two prisons in middle China. A sum of 3,459 prisoners accepted chest X-ray examination; 40 of them were diagnosed as active TB patients. The active TB prevalence (1,156/105) was significantly higher than that of the province and China's general population (P < 0.01). As for gender, TB prevalence in men's prison (1,589/105) was higher than that in the women's prison (946/105). Nevertheless, the risk of having TB in women's prison was much higher than that in the men's prison when compared with the TB prevalence from the province (women: OR = 2.37, 95% CI: 1.34, 4.22; men: OR = 1.53, 95% CI: 0.90, 2.60) and the China's general population (women: OR = 3.30, 95% CI: 2.15, 5.09; men: OR = 2.06, 95% CI: 1.29, 3.30). In view of the severe epidemic situation of TB in prisons, integrating medical resources to establish a consummate and effective management system is necessary.

Evaluating strategies for control of tuberculosis in prisons and prevention of spillover into communities: An observational and modeling study from Brazil.

BackgroundIt has been hypothesized that prisons serve as amplifiers of general tuberculosis (TB) epidemics, but there is a paucity of data on this phenomenon and the potential population-level effects of prison-focused interventions. This study (1) quantifies the TB risk for prisoners as they traverse incarceration and release, (2) mathematically models the impact of prison-based interventions on TB burden in the general population, and (3) generalizes this model to a wide range of epidemiological contexts.Methods and findingsWe obtained individual-level incarceration data for all inmates (n = 42,925) and all reported TB cases (n = 5,643) in the Brazilian state of Mato Grosso do Sul from 2007 through 2013. We matched individuals between prisoner and TB databases and estimated the incidence of TB from the time of incarceration and the time of prison release using Cox proportional hazards models. We identified 130 new TB cases diagnosed during incarceration and 170 among individuals released from prison. During imprisonment, TB rates increased from 111 cases per 100,000 person-years at entry to a maximum of 1,303 per 100,000 person-years at 5.2 years. At release, TB incidence was 229 per 100,000 person-years, which declined to 42 per 100,000 person-years (the average TB incidence in Brazil) after 7 years. We used these data to populate a compartmental model of TB transmission and incarceration to evaluate the effects of various prison-based interventions on the incidence of TB among prisoners and the general population. Annual mass TB screening within Brazilian prisons would reduce TB incidence in prisons by 47.4% (95% Bayesian credible interval [BCI], 44.4%–52.5%) and in the general population by 19.4% (95% BCI 17.9%–24.2%). A generalized model demonstrates that prison-based interventions would have maximum effectiveness in reducing community incidence in populations with a high concentration of TB in prisons and greater degrees of mixing between ex-prisoners and community members. Study limitations include our focus on a single Brazilian state and our retrospective use of administrative databases.ConclusionsOur findings suggest that the prison environment, more so than the prison population itself, drives TB incidence, and targeted interventions within prisons could have a substantial effect on the broader TB epidemic.

Prevalence of tuberculosis in incarcerated populations: systematic review and meta-analysisPrevalencia de tuberculosis en la población privada de libertad: revisión sistemática y metanálisis

RESUMOObjetivoEstimar a prevalência de tuberculose entre a população privada de liberdade.MétodosRealizou-se uma revisão sistemática com metanálise. Foram selecionados estudos publicados de janeiro de 1997 a dezembro de 2016 nas bases de dados MEDLINE (via PubMed), SciELO e LILACS. O termos de busca foram (“tuberculosis”[MeSH] OR “tuberculosis”[TIAB]) AND (“prisons”[MeSH] OR “prisons”[TIAB]); ou (“tuberculose” [DeCS] OU “tuberculose” [palavras] E “prisões” [DeCS] OU “prisões” [palavras]). O desfecho primário foi a prevalência de tuberculose com intervalo de confiança de 95% (IC95%). Na metanálise, as variáveis associadas com as taxas de prevalência de tuberculose na população privada de liberdade na análise univariada (P ≤ 0,20) foram incluídas no modelo final multivariado.ResultadosCom base nos 29 estudos incluídos na metanálise, 2 163 presos foram identificados com tuberculose. A prevalência combinada de tuberculose entre os prisioneiros foi de 2% (IC95%: 0,02 a 0,02). A prevalência de tuberculose entre prisioneiros em países com prevalência de 0 a 24 por 100 mil habitantes na população geral ficou abaixo de 1% (IC95% = 0,00 a 0,00). Nos países com prevalência de tuberculose de 25 a 99/100 mil, a estimativa foi de 3% (IC95% = 0,02 a 0,04); e nos países com prevalência ≥ 300/100 mil, a estimativa foi de 8% (IC95% = 0,05 a 0,11).ConclusãoO presente estudo reafirma a alta magnitude da tuberculose entre a população privada de liberdade no contexto mundial. Os resultados mostram ainda uma ligação entre a prevalência de tuberculose na população geral e a prevalência da doença dentro dos presídios.

Coordinating the prevention, treatment, and care continuum for HIV-associated tuberculosis in prisons: a health systems strengthening approach.

To advance a re-conceptualized prevention, treatment, and care continuum (PTCC) for HIV-associated tuberculosis (TB) in prisons, and to make recommendations for strengthening prison health systems and reducing HIV-associated TB morbidity and mortality throughout the cycle of pretrial detention, incarceration, and release. Despite evidence of increased HIV-associated TB burden in prisons compared to the general population, prisoners face entrenched barriers to accessing anti-TB therapy, antiretroviral therapy, and evidence-based HIV and TB prevention. New approaches, suitable for the complexities of healthcare delivery in prisons, have emerged that may address these barriers, and include: novel TB diagnostics, universal test and treat for HIV, medication-assisted treatment for opioid dependence, comprehensive transitional case management, and peer navigation, among others. Realizing ambitious international HIV and TB targets in prisons will only be possible by first addressing the root causes of the TB/HIV syndemic, which are deeply intertwined with human rights violations and weaknesses in prison health systems, and, second, fundamentally re-organizing HIV and TB services around a coordinated PTCC. Taking these steps can help ensure universal access to comprehensive, good-quality, free and voluntary TB/HIV prevention, treatment, and care, and advance efforts to strengthen health resourcing, staffing, information management, and primary care access within prisons.

Clinical and Environmental Factors Associated with Pulmonary Tuberculosis in Prisoners in Northeastern Brazil

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