Controlling tuberculosis in prisons could drastically reduce the diseases indexes, says researcher

The most effective measure to control tuberculosis among inmates is to revert the growing imprisonment rate, as well as greater equity regarding access to diagnostic

Prioritizing tuberculosis control in prisons – where the diseases index is 28 times greater than among the general population – is not only essential to reduce the incidence among inmates, but also in the entire community. This is the belief of the infectious disease expert Julio Croda, member of the Tuberculosis technic advisory committee at the Health Ministry (CTA-TB/MS).

A recent study published by our research group showed that 54% of the strains identified in Dourados city were related to strains from prisons. If we take Mato Grosso do Sul State as an example, we can estimate that at least 30% of all TB cases are related to the diseases transmission inside prisons, explains the researcher.

Interviewed by the Brazilian Society of Tropical Medicine (BSTM), Doctor Julio explains the causes of the high incidence of the disease within Brazilian prisons and the main actions to control the disease.

Find, below, the full interview:

BSTM: Which are the main causes for the high tuberculosis incidence in Brazilian prisons?

Dr. Julio Croda: The main cause is overpopulation. During the past 24 years the Countrys inmate population grew by 595%. Prisons present ideal conditions to transmit the disease. The proportion of new cases related to inmates increased from 4.1% to 8.2% of all reported cases if compared to the years 2007 and 2014. Mato Grosso do Sul State holds the highest rate: 15.6% of the new tuberculosis cases reported to the National Disease Notification System (SINAN) are related to inmates. Currently there is a deficit of 231,062 positions, resulting in an occupancy of 161%. Today, Brazil has the fourth greatest inmate population in the world, following the USA, China and Russia. Between 2008 and 2014, the USA reduced their inmate population by 8%, China by 9% and Russia by 25%. In contrast, Brazil increased its inmate population by 33%.

Besides overcrowding, we can quote the lack of implementation, in most prisons, of the Health Ministry Authority’s and World Health Organizations recommendations, conducting annual and at-admission sorting with chest X-ray, skin smear and culture and Xpert. Currently, only 32% of the diagnosed cases had a chest X-ray. This way, the lack of opportune diagnostic favors the diseases transmission, keeping its transmission and incidence in high levels among these populations.

BSTM: What could be done to control tuberculosis circulation in prisons?

Dr. Julio Croda: The most effective measure to control TB among inmates is to revert the growing imprisonment rate trend. Besides this, there must be greater equity regarding access to diagnostic. Also, greater access to chest X-ray, skin smear and culture and Xpert are fundamental. With an incidence 28 times greater we should make available at least one Xpert in every prison with over 2,000 inmates.

Prioritizing this population is essential not only to reduce the incidence in the prison, but also in the community. A recent study published by our research group showed that 54% of the strains identified in Dourados City were related to strains from prisons. If we take Mato Grosso do Sul State as an example, we can estimate that at least 30% of all tuberculosis cases are related to the diseases transmission inside prisons, explains the researcher. The States population is 2.5 million people and 13 thousand inmates. Prioritizing prisoners, we could reduce the number of cases of the disease drastically in a short period of time. We must prioritize this population, in Brazil, in order to meet our strategy goals with the WHO.

BSTM: How could the scientific community contribute to improve this situation?

Dr. Julio Croda: Investigating more effective individual and group screening methods. Besides this, in these environments we need more studies able to identify the role of chemoprophylaxis among these populations. Currently, after the Health Ministry added Rifapentine+isoniazid as an option to treat latent TB, several possibilities can now be studied especially due to the convenience of weekly dosage of this new scheme.

BSTM: Are there data about the incidence in prisons? Which?

Dr. Julio Croda: Yes. Currently the incidence among inmates is 1,195 cases per 100,000. It is a detection rate 28 times greater than among the general population. Definitely, besides a health issue, it is a matter of social justice. As a society we must join efforts to reduce this high incidence rate. Our research group, recently through a cohort study accompanied 1,422 inmates for a year in 12 prisons in Mato Grosso State. We evidenced an incidence of active TB of 1,940 per 100,000 and a latent infection rate of 26% after a year of follow-up. It is urgent that new control approaches for this disease are implemented in these environments.…