Tuberculosis in prisons: an integrated prevention and care cascade for a persistent structural epidemic

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Correctional Healthcare

Background:

• Tuberculosis (TB) disproportionately affects prison populations worldwide due to factors like overcrowding and HIV co-infection.
• Weak integration between correctional health and national TB programs exacerbates the problem.

Purpose of the Study:

• To synthesize evidence on the prison TB prevention and care cascade.
• To identify gaps and effective strategies for TB control in correctional settings.

Main Methods:

• Structured narrative review using systematic review principles.
• Expert-led synthesis of direct prison-specific evidence and related fields.

Main Results:

• Symptom screening alone is insufficient; digital chest radiography with molecular testing improves detection.
• Rapid molecular tests (Xpert MTB/RIF or Ultra) are key for diagnosis and resistance detection.
• Shorter TB infection and MDR/RR-TB regimens show promise, but require more study in prisons.
• Ventilation, integrated TB/HIV services, and peer support aid transmission reduction.
• Post-release continuity of care is a significant implementation gap.

Conclusions:

• Sustainable prison TB control needs an integrated, measurable prison-community cascade.
• This includes improved screening, rapid diagnosis, effective treatment, environmental controls, and post-release linkage to care.