Using chest X-ray to screen for Tuberculosis on arrival to prison: A service evaluation

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Radiology

Background:

• The World Health Organization recommends Chest X-ray (CXR) for tuberculosis (TB) screening in correctional facilities.
• Implementing effective TB screening in prisons is crucial due to higher transmission risks.

Purpose of the Study:

• To assess the acceptability and feasibility of offering CXR screening to new prison admissions.
• To inform TB epidemiology within the prison population.
• To evaluate the timeliness of CXR delivery and results.

Main Methods:

• A pilot, cross-sectional study offering CXR to new prison admissions between September 2023 and March 2024.
• Measured acceptance rates, completion rates, and time from admission to CXR completion.
• Assessed clinical and social TB risks for individuals accepting CXR.

Main Results:

• CXR screening was accepted by 61.0% of new admissions.
• 44.5% of all new arrivals received a CXR, with 72.9% of those accepting the offer completing it.
• Median time to CXR completion was 17 days; the 48-hour target was not met.
• No TB cases were identified, but 4.0% of CXRs showed other abnormalities.

Conclusions:

• Prisoner acceptance of CXR screening is high, but logistical challenges prevent timely delivery within 48 hours.
• CXR screening in prisons may serve as a valuable tool for detecting a broader range of respiratory conditions, not solely TB.