Is mass screening enough to control tuberculosis in Ecuador's prisons?

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Prison Health

Background:

• Tuberculosis (TB) remains a significant global health challenge, particularly in congregate settings like prisons.
• Ecuadorian prisons face unique challenges in controlling infectious diseases due to population density and healthcare access.

Purpose of the Study:

• To assess the effectiveness of mass screening campaigns for tuberculosis (TB) among inmates in Ecuadorian prisons.
• To determine the prevalence and identify risk factors associated with TB in this population.

Main Methods:

• A cross-sectional study involving 12,365 inmates entering two Ecuadorian prisons from January to December 2016.
• Analysis of chronic cough (CC) prevalence, TB positivity rates, and time distribution of cases.
• Logistic regression used to identify factors influencing TB positivity.

Main Results:

• A high prevalence of TB was found, with 1,332 chronic coughers identified and a TB positivity rate of 17.3%.
• The overall TB prevalence was 1.9%, with significant variation in detection and diagnosis over time.
• Higher prison density was associated with increased TB positivity (adjusted OR 3.8).

Conclusions:

• Mass TB screening alone is insufficient to control tuberculosis in Ecuadorian prisons.
• The high incidence necessitates strengthening diagnostic processes to interrupt transmission chains.
• Targeted interventions considering prison density are crucial for effective TB control.