Tuberculosis Case Finding Cascade and Treatment Outcomes among Male Inmates in Two Prisons in Zimbabwe

Abstract

<jats:p><jats:italic>Setting</jats:italic>. Zimbabwe is a high tuberculosis (TB) burden country, with an estimated prevalence of 344/100,000 population. Though prisons are known high-prevalence sites for TB, the paucity of data affects the quantification of the disease and treatment outcomes in these settings. We measured the prevalence of TB disease and treatment outcomes among inmates at two major prisons in Harare, Zimbabwe. <jats:italic>Design</jats:italic>. A cohort study using programmatic data was undertaken to assess TB diagnostic cascade in one of the study prisons for 2018. Treatment outcomes among male inmates with TB were assessed over a period of four years, in two study prisons. <jats:italic>Results</jats:italic>. A total of 405 (11%) inmates with presumptive TB were identified, and 370 (91%) of these were evaluated for TB, mostly using rapid molecular testing of sputum specimens. Twenty-five inmates were diagnosed with TB resulting in a prevalence of 649/100,000 population. Of these, 16 (64%) were started on treatment. Nine (36%) were lost to follow-up before treatment initiation. From 2015 to 2018, 280 adult male inmates with TB were started on treatment. Of these, 212 (76%) had pulmonary disease that was bacteriologically confirmed. Almost all (276/280, 99%) had known HIV status, 65% were HIV-infected, and 80% of these were on antiretroviral treatment. The TB treatment success rate (cured or treatment completed) was recorded for 209 (75%) inmates, whilst 14 (5%) died and 11 (4%) were lost to follow-up. The frequency of unfavourable treatment outcomes (death, lost to follow-up, and not evaluated) was higher (54%) among <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M1"><mml:mtext>inmates</mml:mtext><mml:mo>≥</mml:mo><mml:mn>60</mml:mn></mml:math> years than those in the age group of 45-59 years (17%). <jats:italic>Conclusion</jats:italic>. The findings revealed a threefold burden of TB in prisons, compared with what is reported by national survey. To decrease transmission of TB bacilli, it is essential to promote efforts that address missed opportunities in the TB diagnostic cascade, prompt treatment initiation, and ensure that tracking and documentation of treatment outcomes for all inmates are intensified.</jats:p>

Factors associated with unfavorable outcome of tuberculosis treatment in people deprived of liberty: a systematic review

“…Among the sociodemographic characteristics, the risk of an unfavorable outcome of TB treatment in the prison system in relation to age group did not show a pattern in the articles studied. In two of them, the risk was higher in young adults (23,28) , while in another study it was higher in the older population (21) . However, when evaluated separately, treatment default was higher in people under 43 years old (27) , while death was higher in people aged ≥30 years old (27) .…”

“…The articles included in this review (20)(21)(22)(23)(24)(25)(26)(27)(28) were published in English (21,(23)(24)(25)(26)(27)(28) , Spanish (22) and one in two versions -Portuguese and English (20) . Five studies are from the African continent (21,(24)(25)(26)28) , three from South America (20,22,27) , and one from the Asian continent (23) . Regarding the year of publication, the articles were published in 2013 (27)(28) , 2014 (26) , 2018 (24,25) , 2019 (22)(23) , and 2020 (20)(21) .…”

“…Five studies are from the African continent (21,(24)(25)(26)28) , three from South America (20,22,27) , and one from the Asian continent (23) . Regarding the year of publication, the articles were published in 2013 (27)(28) , 2014 (26) , 2018 (24,25) , 2019 (22)(23) , and 2020 (20)(21) . The articles included worked with population, and no sample calculation was performed or presented.…”

“…As for the methodological quality of the productions, the main limitations of the studies were the collection of secondary data in all the articles included, whose exposure and outcome measures may not be reliable (20)(21)(22)(23)(24)(25)(26)(27)(28) , and the failure to identify confounding variables (21)(22)(23)(24)(25)(26)(27) and strategies to deal with them (21-23-28) . Two studies presented unreliable analysis, since it was not possible to identify the reference variable of some analyses (23,28) and some odds ratio values were not aligned with the confidence interval (28) .…”

“…Regarding the results of this systematic review, the articles presented different approaches to the object of interest, sometimes considering an unfavorable outcome such as death, loss to follow-up, and unidentified outcome all together (21) ; or evaluating treatment default, failure, and death together (22,24) ; or abandonment, treatment failure, and transfer together (23) ; failure, death, transfer, and unidentified outcome together (25) ; and sometimes failure, recurrence and death together (28) . In addition, three other studies assessed default (20,(26)(27) and death from TB (27) and from other causes (27) , separately.…”