Burden and determinants of MDR-TB among prisoners in sub-Saharan Africa: Systematic review and meta-analysis protocol

Tuberculosis (TB) is one of the leading causes of death globally because of a single infectious pathogen. The rise in prevalence of multi-drug-resistant tuberculosis (MDR-TB) puts an increased burden on the health system in terms of cost and longer treatment duration. People living in correctional facilities are more likely to develop TB and have poor TB treatment outcomes than the general population, making them a vulnerable group to develop MDR-TB. However, the burden of MDR-TB and associated treatment outcomes among prisoners in sub-Saharan Africa (SSA) is poorly documented.

The study aims to investigate the burden and associated factors of MDR-TB treatment among prisoners in SSA.

The review will include studies of MDR-TB done in prisons and detention centers involving prisoners and inmates in sub Saharan Africa.

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PROSPERO), we will conduct a systematic review and meta-analysis. We will review studies examining MDR-TB patient treatment outcomes among prisoners reported in published literature in SSA from 2000 to 31 December 2024. A search on studies reporting MDR-TB treatment outcomes from the databases such as 'Medline, Embase, CINAHL (EBSCOhost), Scopus and Web of Science' will be conducted. We will analyse continuous outcomes as mean differences for studies using the same scales with standard deviation reported and binary outcome data as odds ratios or risk ratios, all presented with their 95% confidence intervals. Additionally, the pooled proportions will be used to determine the prevalence or incidence of specific MDR-TB treatment outcomes. Heterogeneity will be assessed using the I ² statistic, and where significant heterogeneity is detected, a random-effects model meta-analysis will be performed; otherwise, a fixed-effect model meta-analysis will be carried out. Risk factors will be determined using the meta-regression analysis technique.

After analysis of pooled data, prevalence of MDT-TB in prisons will be presented as proportions. Meta-analysis outcome will be presented as forest plots, showing odd ratios and co-responding 95% confidence intervals. Narrative synthesis of included studies will be presented in a table format.

This proposed systematic review and meta-analysis will help consolidate evidence to support the development of public health guidelines to enhance the reduction of MDT-TB factors among prisoners in the SSA region.

This review will provide evidence to support guideline development on screening, diagnosis, and clinical management of MDR-TB patients in prisons.