A situational analysis of latent tuberculosis infection among incarcerated population in Japan

Tuberculosis in prison: What about after release? The example of French Guiana

INTRODUCTION

Tuberculosis is a major cause of mortality worldwide. Prisoners in Guiana have multiple risk factors. The primary objective of this study was to describe tuberculosis occurring in prison and after release in French Guiana between 2008 and 2020. Secondary objectives were to identify tuberculosis risk factors and determine annual incidences.

METHODS

A retrospective cohort study of tuberculosis cases was carried out at the Guiana prison between 2008 and 2020. Data were collected from prison registers and cross-referenced with the list of tuberculosis notifications in French Guiana.

RESULTS

A total of 36 cases of tuberculosis were studied. Incidence was high, at 263/100,000 per year, higher than elsewhere in France and comparable to that in Brazil. Despite visibly effective screening on entry, with little evidence of intra-prison circulation of tuberculosis, 39% of patients were diagnosed within two years of leaving prison (76% were symptomatic). This could be explained by the high prevalence of latent forms (LTI).

DISCUSSION

Continued screening on entry, in combination with annual radiological and clinical screening, and reinforced follow-up on release seem indicated to improve patient management and the search for possible LTI.

Treatment of latent tuberculosis infection in incarcerated people: a systematic review

BACKGROUND

The estimated number of people deprived of liberty is increasing, with 11.55 million incarcerated globally in 2021. Transmission of Mycobacterium tuberculosis (MTB) strains is facilitated in over-crowded, poorly ventilated settings such as jails and penitentiaries. Moreover, inmates may show individual risk factors for the development of tuberculosis (TB) disease. Treatment regimens for latent tuberculosis infection (LTBI) may require up to 9 months of drug exposure and are characterized by adverse events (AEs) and low completion rates.

OBJECTIVES

to describe current scientific evidence on feasibility, acceptability and completion rate of LTBI treatment in prison/correctional institutes.

DATA SOURCES

Articles were retrieved from MEDLINE/PubMed, no time restriction was applied.

STUDY ELIGIBILITY CRITERIA

Human retrospective and prospective studies published on LTBI treatment in incarcerated populations were included.

ASSESSMENT OF RISK OF BIAS

Bias assessment plots and Egger weighted regression test were used to determine the risk of bias.

METHODS OF DATA SYNTHESIS

Absolute and relative frequencies were assessed for qualitative data. Pooled proportion of included study groups and 95% confidence interval estimates, weighted for sample sizes, were illustrated in forest plots. I² indicator association were used for true variability and overall variation. Fixed and random-effects models were chosen depending on the estimated between-study heterogeneity.

RESULTS

Of11 selected studies only 1 was conducted in a high TB incidence country. Overall, completion rates ranged from 26% to 100% across the included studies. Reason for discontinuation of treatment were transfer to other facilities, release, or loss to follow-up (LTFU) (range 0-74%), incidence of AEs (range 0-18%), and refusal or withdrawal from treatment (range 0-16%).

CONCLUSIONS

Implementation of short-course regimens in prisons should be considered given the low incidence of AEs observed; however, inmates consistently refused to complete LTBI treatment, thus underlining the need for improvement in retention in care.

Incidence and Risk Factors Associated with Latent Tuberculosis Infection and Pulmonary Tuberculosis among People Deprived of Liberty in Colombian Prisons

People deprived of liberty (PDL) are at high risk of acquiring Mycobacterium tuberculosis infection (latent tuberculosis infection [LTBI]) and progressing to active tuberculosis (TB). We sought to determine the incidence rates and factors associated with LTBI and active TB in Colombian prisons. Using information of four cohort studies, we included 240 PDL with two-step tuberculin skin test (TST) negative and followed them to evaluate TST conversion, as well as, 2,134 PDL that were investigated to rule out active TB (1,305 among people with lower respiratory symptoms of any duration, and 829 among people without respiratory symptoms and screened for LTBI). Latent tuberculosis infection incidence rate was 2,402.88 cases per 100,000 person-months (95% CI 1,364.62-4,231.10) in PDL with short incarceration at baseline, and 419.66 cases per 100,000 person-months (95% CI 225.80-779.95) in individuals with long incarceration at baseline (who were enrolled for the follow after at least 1 year of incarceration). The TB incidence rate among PDL with lower respiratory symptoms was 146.53 cases/100,000 person-months, and among PDL without respiratory symptoms screened for LTBI the incidence rate was 19.49 cases/100,000 person-months. History of Bacillus Calmette-Guerin vaccination decreased the risk of acquiring LTBI among PDL who were recently incarcerated. Female sex, smoked drugs, and current cigarette smoking were associated with an increased risk of developing active TB. This study shows that PDL have high risk for LTBI and active TB. It is important to perform LTBI testing at admission to prison, as well as regular follow-up to control TB in prisons.