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

Abstract

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.

Association of Jail Decarceration and Anticontagion Policies With COVID-19 Case Growth Rates in US Counties

“…Our findings with respect to jail decarceration add to a growing body of literature on carceral-community epidemiology that documents the various ways in which the health and welfare of incarcerated people are intertwined with community health. 16 , 17 , 18 , 19 , 20 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 70 , 71 , 77 , 78 Carceral outbreaks during the COVID-19 pandemic underline these studies’ observations that it is in the immediate and long-term interest of US public health and safety to confront high rates of incarceration and poor carceral conditions. Our findings thus support existing consensus among public health experts that large-scale decarceration is needed not only to mitigate the spread of SARS-CoV-2 but also, in the longer-term, to assist in remedying US racial health inequities and to improve national public health, pandemic preparedness, and international biosecurity.…”

“…Carceral-community epidemiologic relationships, that is, connections between carceral conditions and disease spread in broader communities, have long been observed worldwide in relation to, for example, HIV, tuberculosis, influenza, and viral hepatitis. 16 , 17 , 18 , 19 , 26 , 27 , 28 , 29 , 30 , 31 , 32 To date, however, only 2 modeling studies, 20 , 33 2 peer-reviewed studies of empirical evidence limited to Illinois, 17 , 18 and 1 non–peer-reviewed empirical analysis 34 have specifically examined the association between carceral institutions and community spread of SARS-CoV-2. Although there is a growing body of empirical literature on the consequences of mass incarceration on community health, 17 , 18 , 31 , 35 , 36 to our knowledge, no study has yet evaluated the effects of decarceration on population-level community health outcomes, either in relation to COVID-19 or otherwise.…”

The Burden of Alcohol, Tobacco and Others Drugs Among Prisoners Diagnosed With Tuberculosis: Time Trends and Spatial Determinants in Southern Brazil

“…Therefore, a screening protocol should be implemented in the prison system to identify SP consumption and TB and invest and give priority to early diagnosis and interventions, providing appropriate treatment to avoid interruptions and relapses [30].…”

“…The prisons' social, spatial factors directly contribute to the maintenance of TB and other diseases considering many prisons are overcrowded, present high turnover of PDL, are poorly ventilated, and access to health services is restricted [30].…”

“…The community is also exposed to TB when contacting prison o cers, released prisoners, or families visiting prisoners. Hence, the prison environment promotes the incidence and maintenance of TB, and health actions are needed to break the transmission cycle and decrease the number of new cases and deaths [30].…”