X ray screening at entry and systematic screening for the control of tuberculosis in a highly endemic prison

Abstract

BackgroundTuberculosis (TB) is a major issue in prisons of low and middle income countries where TB incidence rates are much higher in prison populations as compared with the general population. In the Rio de Janeiro (RJ) State prison system, the TB control program is limited to passive case-finding and supervised short duration treatment. The aim of this study was to measure the impact of X-ray screening at entry associated with systematic screening on the prevalence and incidence of active TB.MethodsWe followed up for 2 years a RJ State prison for adult males (1429 inmates at the beginning of the study) and performed, in addition to passive case-finding, 1) two “cross-sectional” X-ray systematic screenings: the first at the beginning of the study period and the second 13 months later; 2) X-ray screening of inmates entering the prison during the 2 year study period. Bacteriological examinations were performed in inmates presenting any pulmonary, pleural or mediastinal X-ray abnormality or spontaneously attending the prison clinic for symptoms suggestive of TB.ResultsOverall, 4326 X-rays were performed and 246 TB cases were identified. Prevalence among entering inmates remained similar during 1st and the 2nd year of the study: 2.8% (21/754) and 2.9% (28/954) respectively, whereas prevalence decreased from 6.0% (83/1374) to 2.8% (35/1244) between 1st and 2nd systematic screenings (p < 0.0001). Incidence rates of cases identified by passive case-finding decreased from 42 to 19 per 1000 person-years between the 1st and the 2nd year (p < 0.0001). Cases identified by screenings were less likely to be bacteriologically confirmed as compared with cases identified by passive-case finding.ConclusionsThe strategy investigated, which seems highly effective, should be considered in highly endemic confined settings such as prisons.

Tuberculosis in prison and aspects associated with the diagnosis site

“…Regarding the PDL profile, several studies report the presence of TB in penitentiary complexes as being predominantly related to males, economically active, low schooling, and brown skin-color individuals [10,11] which is in agreement with the findings of this study. However, higher number of notifications of female patients in other services implies structurerelated gaps and poor organization of health care in female prisons, such as the need for laboratory support and a lower number of health teams compared to male prisons, as well as weaknesses in health care access.…”

“…This reveals weaknesses in the availability of the equipment and the network for TB screening, which can be caused by the limited financial and human resources present in most penitentiary complexes [10,16]. These results reveal the need to acquire radiological equipment, fixed or mobile, since some studies demonstrate that annual radiological screening, other than symptom-based one, has been used to identify suspected cases of TB and played an important role in the reduction of the disease incidence and prevalence in prisons [11,17].…”

Tuberculosis: health care and surveillance in prisons

“…TB is a persistent disease in prison systems, mainly due to the late diagnosis, high prevalence of antimicrobial-resistant bacteria, improper treatment, use of illicit drugs, overcrowding of prison systems, poor infrastructure conditions, high prisoner turnover and low socioeconomic power (6)(7)(8) . The TB is a second penalty for the detainees and the high risk of developing the disease is shared with security and health professionals, visitors, and the general public (9)(10) .…”

The Impact of Ventilation and Early Diagnosis on Tuberculosis Transmission in Brazilian Prisons

“…Nearly all studies have focused on early diagnosis of active TB through radiography or rapid diagnostics. [4][5][6][7] Such interventions do not address the fundamental conditions favoring the transmission of TB, which may be critical for making a durable impact on epidemics in prisons. To do so, a better understanding of the role of underlying environmental epidemiology of prisons on TB transmission is needed.…”