Tuberculosis behind bars in Latin America and Caribbean: A growing public health crisis

Abstract

To the Editor-Despite advances in recent years to end the tuberculosis (TB) epidemic and global efforts to reduce its prevalence, the disease remains a burden on public health in several countries. In Latin America and the Caribbean, the situation is no different. With incidence rates of 61.2 per 100,000 population in the Caribbean, 46.2 in South America, and 25.9 in Mexico and Central America, the region is at risk of falling short of the "End TB Strategy" goals. 1 TB transmission correlates with susceptible populations, which include the socioeconomically disadvantaged, migrants, ethnic minorities, individuals with comorbidities (eg, human immunodeficiency virus [HIV]), and persons deprived of their liberty (PDL). According to the World Health Organization (WHO), the incidence rate of TB is 100 times greater among inmates compared to the general population, and TB in PDL continues to increase because of gross neglect. 1 The disparity between prison and civilian TB control measures and the lack of policies to safeguard prison healthcare are the primary concerns. Overcrowding in prisons of Central and South America contributed to a 206% average increase in TB since 2000, higher than in any region. PDL TB in this region increased from 5% of the total reported cases in 2011 to 11.1% in 2017. 2 El Salvador, for example, had the greatest increase of 411% among TB PDL, with a corresponding increase in TB of 51.5%, in 2017. 3 In Brazil, the increase in the incarceration rate has led to more PDL than capacity in detention centers, with average occupancy at 161% of availability. A similar trend has been noted in other American countries. 4 Both the prison environment and host factors are responsible for TB surges. Globally, prisons have limited access to healthcare and medical facilities, lack of well-trained medical staff, an insufficient supply of newly updated quality medicine regimen, poor ventilation and sanitation, deficient new and upgraded diagnostic approach and laboratories, and malnutrition. These factors tend to be more conspicuous in Latin America. 5,6 Additionally, PDL are highly associated with low socioeconomic backgrounds, limited access to health care before incarceration, underprivileged ethnic groups, high tendency of substance misuse, smoking, and sexual

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