The escalating tuberculosis crisis in central and South American prisons

Walter, Katharine S.; Martínez, Leonardo; Arakaki-Sanchéz, Denise; Sequera, Guillermo; Estigarribia, Gladys; Cohen, Ted; Ko, Albert I.; García‐Basteiro, Alberto L.; Rueda, Zulma Vanessa; López-Olarte, Rafael A; Espinal, Marcos; Croda, Júlio; Andrews, Jason R

doi:10.1016/s0140-6736(20)32578-2

Cited by 52 publications

(57 citation statements)

References 18 publications

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“…Tuberculosis notifications have been rising steeply in prisons in Latin America, largely driven by increasing rates of incarceration 3 . However, the impact of incarceration on tuberculosis treatment outcomes and risk factors for treatment failure within prisons have only begun to be identified.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of tuberculosis in Brazil has slowly declined over the last 20 years, although in the last three years there has been a modest increase 2 . This trend has been part of a troubling rise in tuberculosis cases across Central and South America in recent years 3 . The rate of incarceration in Central and South America has increased more than 206% since 2000 while tuberculosis cases among incarcerated individuals have increased by an even larger amount [3][4][5][6][7] .…”

Section: Introductionmentioning

confidence: 99%

“…This trend has been part of a troubling rise in tuberculosis cases across Central and South America in recent years 3 . The rate of incarceration in Central and South America has increased more than 206% since 2000 while tuberculosis cases among incarcerated individuals have increased by an even larger amount 3–7 . Incarcerated individuals represent a disproportionate and growing proportion of the total tuberculosis cases across Central and South America.…”

Section: Introductionmentioning

confidence: 99%

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The Effect of Incarceration on Tuberculosis Treatment Outcomes in Brazil: a Retrospective Cohort Study

O’Marr

Gonçalves

Arakaki-Sanchéz

et al. 2021

Preprint

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Background: Tuberculosis notifications in Latin American prisons have more than doubled over the past two decades; however, treatment outcomes and their determinants among incarcerated individuals in this region are not well understood. Methods: Newly diagnosed drug-susceptible tuberculosis cases reported to Brazils Sistema de Informação de Agravos de Notificação (SINAN) between January 2015 and December 2017 were included. Multivariate logistic regression was used to assess socioeconomic and clinical factors associated with treatment success among incarcerated individuals. Results: Incarcerated individuals (n=17,776) had greater treatment success than non-incarcerated individuals (n=160,728; 82.2% vs 75.1%, p<0.0001), including after adjusting for demographic and clinical risk factors (adjusted Odds Ratio [aOR]: 1.27; 95% CI: 1.19-1.34). These differences were partially mediated by increased use of directly observed therapy among incarcerated individuals (DOT) (61% vs 47%, p<0.001), which was associated with greater efficacy in the incarcerated population (aOR 2.56 vs aOR 2.17; p<0.001). DOT was associated with improved treatment success among incarcerated subpopulations at elevated risk of poor outcomes. Conclusion: Tuberculosis treatment success among incarcerated individuals in Brazil is higher than non-incarcerated individuals, but both fall below WHO targets. Expanding the use of DOT and services for socially and medically vulnerable individuals may improve outcomes in carceral settings.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Effect of Incarceration on Tuberculosis Treatment Outcomes in Brazil: a Retrospective Cohort Study

O’Marr

Gonçalves

Arakaki-Sanchéz

et al. 2021

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“…22.21259360 doi: medRxiv preprint 200% since 2000 and 11% percent of tuberculosis cases now occur among incarcerated people, who comprise <1% of the total population. (12) The full impact of increasing incarceration rates on the tuberculosis epidemic in the Americas and elsewhere has been difficult to quantify. Many people are infected in prison, but only diagnosed later.…”

Section: Introductionmentioning

confidence: 99%

The role of prisons in disseminating tuberculosis in Brazil: a genomic epidemiology study

Pcp

To³

et al. 2021

Preprint

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Prisons are high-incidence settings for tuberculosis around the world, yet the contribution of spillover from prisons in driving community epidemics has not been quantified. We whole genome sequenced 1,152 M. tuberculosis isolates from participants diagnosed with tuberculosis within prisons and in the community in Mato Grosso do Sul, Brazil from 2014 to 2019. By integrating timed phylogenies and detailed location data, we reconstructed probabilistic transmission histories. M. tuberculosis sequences from incarcerated and non-incarcerated people were closely phylogenetically related. We found that 57% of recent community-wide tuberculosis cases were attributable to transmission from individuals with an incarceration history, 2.6% of the population. Further, we find genomic evidence that the prison system disseminates M. tuberculosis genotypes through frequent transfers across the state. This population-wide genomic transmission reconstruction framework can be applied to identify key environments amplifying infectious disease transmission to prioritize public health interventions.

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“…These factors tend to be more conspicuous in Latin America. 5,6 Additionally, PDL are highly associated with low socioeconomic backgrounds, limited access to health care before incarceration, underprivileged ethnic groups, high tendency of substance misuse, smoking, and sexual…”

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confidence: 99%

Tuberculosis behind bars in Latin America and Caribbean: A growing public health crisis

Islam

Thada

Rahmat

et al. 2021

Infect. Control Hosp. Epidemiol.

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To the Editor-Despite advances in recent years to end the tuberculosis (TB) epidemic and global efforts to reduce its prevalence, the disease remains a burden on public health in several countries. In Latin America and the Caribbean, the situation is no different. With incidence rates of 61.2 per 100,000 population in the Caribbean, 46.2 in South America, and 25.9 in Mexico and Central America, the region is at risk of falling short of the "End TB Strategy" goals. 1 TB transmission correlates with susceptible populations, which include the socioeconomically disadvantaged, migrants, ethnic minorities, individuals with comorbidities (eg, human immunodeficiency virus [HIV]), and persons deprived of their liberty (PDL). According to the World Health Organization (WHO), the incidence rate of TB is 100 times greater among inmates compared to the general population, and TB in PDL continues to increase because of gross neglect. 1 The disparity between prison and civilian TB control measures and the lack of policies to safeguard prison healthcare are the primary concerns. Overcrowding in prisons of Central and South America contributed to a 206% average increase in TB since 2000, higher than in any region. PDL TB in this region increased from 5% of the total reported cases in 2011 to 11.1% in 2017. 2 El Salvador, for example, had the greatest increase of 411% among TB PDL, with a corresponding increase in TB of 51.5%, in 2017. 3 In Brazil, the increase in the incarceration rate has led to more PDL than capacity in detention centers, with average occupancy at 161% of availability. A similar trend has been noted in other American countries. 4 Both the prison environment and host factors are responsible for TB surges. Globally, prisons have limited access to healthcare and medical facilities, lack of well-trained medical staff, an insufficient supply of newly updated quality medicine regimen, poor ventilation and sanitation, deficient new and upgraded diagnostic approach and laboratories, and malnutrition. These factors tend to be more conspicuous in Latin America. 5,6 Additionally, PDL are highly associated with low socioeconomic backgrounds, limited access to health care before incarceration, underprivileged ethnic groups, high tendency of substance misuse, smoking, and sexual

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The escalating tuberculosis crisis in central and South American prisons

Cited by 52 publications

References 18 publications

The Effect of Incarceration on Tuberculosis Treatment Outcomes in Brazil: a Retrospective Cohort Study

The Effect of Incarceration on Tuberculosis Treatment Outcomes in Brazil: a Retrospective Cohort Study

The role of prisons in disseminating tuberculosis in Brazil: a genomic epidemiology study

Tuberculosis behind bars in Latin America and Caribbean: A growing public health crisis

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