Background Previous studies have shown gender differences in tuberculosis (TB) incidence, however, gender disparity has not been well documented across granular categorizations of anatomic sites affected by TB and in the presence of HIV coinfection, largely due to small sample size for less common TB clinical presentations and lack of detailed clinical data. Methods The study population included TB cases aged ≥15 years (n = 41, 266) diagnosed in Harare, Zimbabwe. This cross-sectional study estimated male-to-female ratio (M:F ratio) for: i) age-specific TB incidence, ii) age-specific HIV prevalence among incident TB cases, and iii) nine types of TB defined by affected anatomic site. Results Males were at a 53% higher risk of TB compared to females (Risk Ratio (RR) = 1.53,95% CI: 1.12, 2.09). Based on multinomial logistic regression model, adjusted odds ratios for abdominal TB (aOR = 0.51,95% CI: 0.39, 0.68), TB bones/joints/spine (aOR = 0.63,95% CI: 0.45, 0.90) and ‘other’ extra-pulmonary TB sites (aOR = 0.69,95% CI = 0.59,0.81) vs pulmonary TB were lower among males compared to females. The risk of TB-HIV coinfection among males was 17% (RR = 0.83, 95% CI: 0.74, 0.93) and 8% (RR = 0.92, 95% CI: 0.88,0.95) lower in the 15-24 year and 25-44 year age groups respectively. Conclusions This study revealed a nuanced role of gender across finer categorizations of TB, indicating the need for future research to delineate underlying mechanisms driving gender disparities in TB. The finding that women had a greater likelihood of severe forms of TB and TB-HIV coinfection compared to men has important implications for women’s health in TB-HIV high burden settings.

Background Despite incarcerated population being at an increased risk of tuberculosis (TB) and serving as a potential source of TB transmission for the general population, prison TB remains understudied. Given its adverse impact on progress towards TB elimination, World Health Organization (WHO) has identified prison TB research as a top priority to guide TB treatment/control interventions. Methods We retrospectively analyzed 921 notified TB cases that were diagnosed at Kality Federal Prison, Ethiopia during 2009–2017. To assess trends of microbiologically confirmed pulmonary TB (PTB), extra-pulmonary TB (EPTB), and TB-HIV co-infection, an ecological analysis of aggregated cases was used to report trends over time. Additionally, we used multivariable log binomial regression to identify patient characteristics associated with microbiologically confirmed PTB, EPTB, and TB-HIV co-infection. Results Microbiologically confirmed PTB proportion increased over time. Young age was identified as an important risk factor for EPTB (adjusted prevalence ratio [aPR] = 1.74, 95% CI 0.97, 3.13) while HIV coinfection was negatively associated with EPTB (aPR = 0.73, 95% CI 0.55, 0.97). While previous TB history was associated with a lower likelihood of EPTB (aPR = 0.42, 95% CI 0.25, 0.70), it was associated with an increased risk of TB-HIV coinfection (aPR = 1.37, 95% CI 1.10, 1.71). Clinically diagnosed PTB patients were more likely to have TB-HIV coinfection compared to microbiologically confirmed PTB patients (aPR = 1.32, 95% CI 1.02, 1.72). Conclusions Increasing proportion of microbiologically confirmed PTB may suggest delayed access to treatment, severe disease and increased risk of intramural transmission. Associations with clinical/demographic factors varied for different types of TB and were not always consistent with what has been previously reported for the general population, necessitating the need to refocus prison TB control/treatment strategies based on context specific epidemiological factors.

Background: Despite incarcerated population being at an increased risk of tuberculosis (TB) and serving as a potential source of TB transmission for the general population, prison TB remains understudied. Given its adverse impact on progress towards TB elimination, World Health Organization (WHO) has identified prison TB research as a top priority to guide TB treatment/control interventions. Methods: We retrospectively analyzed 921 notified TB cases that were diagnosed at Kality Federal Prison, Ethiopia during 2009-2017. To assess trends of microbiologically confirmed pulmonary TB (PTB), extra-pulmonary TB (EPTB), and TB-HIV co-infection, an ecological analysis of aggregated cases was used to report trends over time. Additionally, we used multivariable log binomial regression to identify patient characteristics associated with microbiologically confirmed PTB, extra-pulmonary TB (EPTB), and TB-HIV co-infection. Results: Microbiologically confirmed PTB proportion increased over time. Young age was identified as an important risk factor for EPTB (aPR=1.74, 95%CI: 0.97, 3.13) while HIV coinfection was negatively associated with EPTB (aPR=0.73, 95%CI: 0.55, 0.97). While previous TB history was associated with a lower likelihood of EPTB (aPR=0.42, 95%CI:0.25, 0.70), it was associated with an increased risk of TB-HIV coinfection (aPR=1.37, 95%CI:1.10, 1.71). Clinically diagnosed PTB patients were more likely to have TB-HIV coinfection compared to microbiologically confirmed PTB patients (aPR= 1.32, 95%CI: 1.02, 1.72).Conclusions: Increasing proportion of microbiologically confirmed PTB may suggest delayed access to treatment, severe disease and increased risk of intramural transmission. Associations with clinical/demographic factors varied for different types of TB and were not always consistent with what has been previously reported for the general population, necessitating the need to refocus prison TB control/treatment strategies based on context specific epidemiological factors.