Clinical mentorship and TB detection in prison health facilities

TB incidence in prison populations exceeds surrounding communities by factors of up to 100. Early case detection in correctional systems is constrained by gaps in health care worker training and inconsistent application of diagnostic algorithms. Structured clinical mentorship may strengthen diagnostic performance, although evidence from Kenyan correctional settings remains limited.

We conducted a retrospective evaluation across 20 prison health facilities in Kenya, comparing TB indicators during 4-month pre- and post-intervention periods following a 3-month clinical mentorship programme. Facility-level outcomes included TB screening coverage, testing coverage, diagnostic modality use, and TB detection among presumptive cases. Analyses were stratified by baseline facility TB detection capacity (≥1 vs. 0 confirmed cases pre-intervention).

Among inmates, TB diagnostic yield was higher in the post-intervention period than in the pre-intervention period (2.6% vs. 5.4%; risk ratio [RR] 2.05, 95% confidence interval: 1.33-3.17), and screening coverage also increased (58.5% vs. 70.3%; RR 1.20; P < 0.001). Diagnostic practices shifted toward WHO-recommended modalities. These changes were concentrated in facilities with baseline detection capacity.

Clinical mentorship was associated with higher TB diagnostic yield, greater screening coverage, and increased use of WHO-recommended diagnostics during the post-intervention period. Gains were concentrated in facilities with baseline detection capacity.