Post-release tuberculosis risk among formerly incarcerated populations in Lima Peru

People who experience incarceration face a markedly elevated risk of tuberculosis (TB), yet the extent to which this vulnerability persists after release remains incompletely characterized. We analyze data from a prospective cohort study conducted in Lima, Peru, including 3,658 adults with newly diagnosed pulmonary TB and 6,335 household contacts aged 15-60. Recent incarceration (within the preceding five years) is reported by 187 (5%) index patients and 112 household contacts (1.7%). Compared with those without incarceration history, formerly incarcerated individuals are more likely to present with more severe TB disease at diagnosis and experience a higher likelihood of adverse treatment outcomes. Among individuals with available incarceration timing data, TB diagnoses cluster after release, with nearly three-quarters occurring within two years. At the household level, TB infection prevalence at enrollment is higher among contacts with a history of incarceration and among those exposed to an index patient with prior incarceration, including among those with relatively short incarceration histories. These associations persist after adjustment for demographic, clinical, and socioeconomic factors. Together, these findings indicate that TB-related vulnerability extends beyond incarceration and into the post-release period, underscoring the importance of timely diagnosis and continuity of care post release.