Increase in Tuberculosis Cases among Prisoners, Brazil, 2009–20141

Bourdillon, Paul M; Gonçalves, Crhistinne Cavalheiro Maymone; Pelissari, Daniele Maria; Arakaki-Sanchéz, Denise; Ko, Albert I.; Croda, Júlio; Andrews, Jason R

doi:10.3201/eid2303.161006

Cited by 38 publications

(25 citation statements)

References 13 publications

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“…These data suggest that a significant portion of the prison population may leave the state following release, and so TB incidence among ex-prisoners may be considerably higher than we have calculated. We assumed that the TB epidemic in the community and prisons is at steady state, and population-level incidence has changed by <5% in the past 15 years; if TB incidence disparities are growing, as some evidence suggests [17], our model would underestimate the benefits of interventions targeted in the prisons. Our model is a simplification of a complex process; we deliberately chose a parsimonious model structure that builds directly upon widely used models in the TB literature.…”

Section: Discussionmentioning

confidence: 99%

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Evaluating strategies for control of tuberculosis in prisons and prevention of spillover into communities: An observational and modeling study from Brazil

Mabud

Alves²,

et al. 2019

PLoS Med

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BackgroundIt has been hypothesized that prisons serve as amplifiers of general tuberculosis (TB) epidemics, but there is a paucity of data on this phenomenon and the potential population-level effects of prison-focused interventions. This study (1) quantifies the TB risk for prisoners as they traverse incarceration and release, (2) mathematically models the impact of prison-based interventions on TB burden in the general population, and (3) generalizes this model to a wide range of epidemiological contexts.Methods and findingsWe obtained individual-level incarceration data for all inmates (n = 42,925) and all reported TB cases (n = 5,643) in the Brazilian state of Mato Grosso do Sul from 2007 through 2013. We matched individuals between prisoner and TB databases and estimated the incidence of TB from the time of incarceration and the time of prison release using Cox proportional hazards models. We identified 130 new TB cases diagnosed during incarceration and 170 among individuals released from prison. During imprisonment, TB rates increased from 111 cases per 100,000 person-years at entry to a maximum of 1,303 per 100,000 person-years at 5.2 years. At release, TB incidence was 229 per 100,000 person-years, which declined to 42 per 100,000 person-years (the average TB incidence in Brazil) after 7 years. We used these data to populate a compartmental model of TB transmission and incarceration to evaluate the effects of various prison-based interventions on the incidence of TB among prisoners and the general population. Annual mass TB screening within Brazilian prisons would reduce TB incidence in prisons by 47.4% (95% Bayesian credible interval [BCI], 44.4%–52.5%) and in the general population by 19.4% (95% BCI 17.9%–24.2%). A generalized model demonstrates that prison-based interventions would have maximum effectiveness in reducing community incidence in populations with a high concentration of TB in prisons and greater degrees of mixing between ex-prisoners and community members. Study limitations include our focus on a single Brazilian state and our retrospective use of administrative databases.ConclusionsOur findings suggest that the prison environment, more so than the prison population itself, drives TB incidence, and targeted interventions within prisons could have a substantial effect on the broader TB epidemic.

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Section: Discussionmentioning

confidence: 99%

“…With a population of 2.6 million, the state of Mato Grosso do Sul lies in central-west Brazil, adjoining Paraguay and Bolivia. The state has the highest incarceration rate in Brazil (475 prisoners per 100,000 individuals), driven primarily by drug trafficking across country borders [17].…”

Section: Methodsmentioning

confidence: 99%

Evaluating strategies for control of tuberculosis in prisons and prevention of spillover into communities: An observational and modeling study from Brazil

Mabud

Alves²,

et al. 2019

PLoS Med

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“…Despite being a minority, the research showed a higher proportion of treatment failure in women (71.4%) than in men (26.3%). A study assessing TB in the Brazilian PPL from 2009 to 2014 11 showed that women deprived of liberty had HIV co-infection rates (24.1%) higher than men (15.2%). In this study, co-infection appeared in 28.6% of women and 5.5% of men, and may contribute significantly to the observed failure scenario, though associated with other characteristics.…”

Section: Discussionmentioning

confidence: 99%

Fatores associados à tuberculose na população privada de liberdade no Espírito Santo

Macedo¹,

Maciel²,

Struchiner³

2020

Rev. saúde pública

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OBJETIVOS: Calcular a taxa de casos diagnosticados com tuberculose por unidades prisionais do Espírito Santo, apresentar as características individuais, clínicas e institucionais dos casos na população privada de liberdade (PPL) do ES e analisar a associação entre essas características e o encerramento do tratamento da tuberculose nessa população. MÉTODOS: A população de estudo foram os casos de tuberculose na PPL do ES de 2014 a 2016. Realizou-se o cálculo de taxa, a análise descritiva e a regressão logística hierarquizada considerando os níveis individual, clínico e institucional. RESULTADOS: A taxa de casos diagnosticados por unidade prisional no estado variou de 0 a 17,3 casos por 1.000 presos. Do total de casos notificados, 218 (72,6%) se curaram, 21 (7,0%) abandonaram o tratamento, 1 (0,3%) morreu por tuberculose, 2 (0,7%) morreram por outras causas, 56 (18,7%) transferiram o local de tratamento e 2 (0,7%) desenvolveram tuberculose drogarresistente. A análise ajustada mostrou que o tratamento supervisionado é um fator protetor para o insucesso (RC = 0,29; IC95% 0,01–0,76). CONCLUSÕES: O estudo apontou a importância do conhecimento do desfecho do tratamento da TB na PPL visando à implementação de ações para a redução do insucesso, bem como a contribuição do tratamento supervisionado nesse processo. DESCRITORES: Prisioneiros. Tuberculose, epidemiologia. Tuberculose Resistente a Múltiplos Medicamentos, epidemiologia.

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“…12 In a survey carried out for the national notification database, in 2009-2014, TB cases among prisoners increased by 28.8%. 21 Corroborating these data, in the 12 prisons in the central-west region, a prevalence of 0.7% was found at baseline and 1.8% 1 year later. 14 At the regional level, there is little data on São Paulo state.…”

Section: Discussionmentioning

confidence: 82%

Prevalence and epidemiological characteristics of inmates diagnosed with infectious diseases living in a region with a high number of prisons in São Paulo state, Brazil

et al. 2020

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ObjectiveTo determine the prevalence and epidemiological characteristics of inmates diagnosed with infectious diseases living in a region with a high number of prisons, São Paulo, Brazil.DesignThis is a retrospective and descriptive study conducted from November 2017 to October 2018.SettingPrisons located in the western and northwestern regions of São Paulo, Brazil.MethodsWe conducted a retrospective analysis on infectious diseases and coinfections (HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), syphilis and tuberculosis (TB)) of inmates from 28 prisons. Inmates were previously diagnosed following the protocol for control and surveillance of infectious diseases, through laboratory or imaging methods. A questionnaire was completed by the healthcare staff. Prevalence was obtained by dividing the number of individuals with positive results by the number of inmates in each prison. Locations of prisons were obtained and maps were constructed using geographic information systems.ResultsA total of 741 of 37 497 inmates (1.97%) were diagnosed with HIV, HBV, HCV, syphilis or TB. HIV was the most prevalent infectious disease (0.68%), followed by TB (0.66%), syphilis (0.2%), HCV (0.2%) and HBV (0.04%). For all of these diseases, prevalence rates varied from very low to high (3.11% and 2.45%) for TB and HIV, respectively, in the five prisons where they were most prevalent. HIV-syphilis was the most associated coinfection (OR, 63.7; 95% CI 41.4 to 96.7). Three of those diagnosed with the infection were female and the ratio of female to men was 0.004:1.ConclusionsOur findings demonstrate that the number of cases of infectious disease among inmates in the northwestern and western region of São Paulo is probably underestimated, with lower rates of HCV, HBV and syphilis. This represents a challenge to prisoners’ health. Improvements in diagnosis, mainly to reduce viral hepatitis, are crucial with benefits for inmates and the general population.

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Increase in Tuberculosis Cases among Prisoners, Brazil, 2009–20141

Abstract: During 2009–2014, incarceration rates in Brazil rose 34%, and tuberculosis (TB) cases among prisoners rose 28.8%. The proportion of national TB cases that occurred among prisoners increased from 6.2% to 8.4% overall and from 19.3% to 25.6% among men 20–29 years of age.

Cited by 38 publications

References 13 publications

Evaluating strategies for control of tuberculosis in prisons and prevention of spillover into communities: An observational and modeling study from Brazil

Evaluating strategies for control of tuberculosis in prisons and prevention of spillover into communities: An observational and modeling study from Brazil

Fatores associados à tuberculose na população privada de liberdade no Espírito Santo

Prevalence and epidemiological characteristics of inmates diagnosed with infectious diseases living in a region with a high number of prisons in São Paulo state, Brazil

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