Latent tuberculosis infection in a Malaysian prison: implications for a comprehensive integrated control program in...

Area of Science:

• Public Health
• Infectious Diseases
• Epidemiology

Background:

• Prisons are significant drivers of tuberculosis (TB) epidemics, especially where TB screening and prevention are limited.
• Malaysia has a high incarceration rate, yet lacks specific data on TB within its prison system.
• This study investigated the prevalence of latent tuberculosis infection (LTBI) in Malaysia's largest prison.

Purpose of the Study:

• To determine the prevalence of latent TB infection (LTBI) among prisoners in Malaysia.
• To identify factors associated with LTBI in a prison population.
• To inform the development of targeted TB control strategies in correctional settings.

Main Methods:

• A survey was conducted in Kajang prison from July to December 2010.
• Participants included HIV-infected and HIV-uninfected prisoners who provided informed consent.
• Tuberculin skin tests (TST) were administered, with results interpreted based on HIV status; logistic regression analyzed factors associated with TST positivity.

Main Results:

• Of 286 participants, 88.8% tested positive for LTBI (84.7% HIV-infected, 92.5% HIV-uninfected).
• LTBI prevalence was independently associated with being HIV-uninfected and having a history of frequent incarcerations.
• The majority of participants were male, under 40, Malaysian, previously incarcerated, and reported needle sharing.

Conclusions:

• The prevalence of LTBI in this Malaysian prison sample was exceptionally high, irrespective of age or HIV status.
• Further research is needed to assess TB in other congregate settings.
• An evidence-based TB control program integrating TB, HIV, and substance abuse services is crucial for Malaysian prisons.