Tuberculosis in prisons

Tuberculosis (TB) remains disproportionately concentrated in prison populations worldwide, driven by overcrowding, poor ventilation, HIV co-infection, delayed diagnosis, treatment interruption, social vulnerability, and weak integration between correctional health services and national TB programs. This structured narrative review synthesizes current evidence across the prison TB prevention and care cascade, including screening, diagnosis, treatment, transmission reduction, TB/HIV integration, surveillance, and continuity after release. We conducted an expert-led narrative synthesis informed by systematic-review principles, distinguishing direct prison-specific evidence from mathematical modeling, policy guidance, systematic reviews, and indirect evidence from adjacent fields such as HIV care and TB infection treatment. Symptom screening alone has limited sensitivity in high-burden prisons. Digital chest radiography with computer-aided detection can improve case detection when linked to confirmatory molecular testing and treatment capacity. Xpert MTB/RIF or Ultra are central to rapid confirmation and rifampicin-resistance detection. Shorter rifamycin-based regimens for TB infection generally achieve higher completion than longer isoniazid-based regimens, while shorter all-oral MDR/RR-TB regimens may offer programmatic advantages but remain insufficiently studied in correctional settings. Ventilation improvement, safer spaces, peer-supported case detection, and integrated TB/HIV services are important components of transmission reduction. Decongestion may have substantial population-level impact, but this conclusion is supported mainly by mathematical modeling and should be interpreted as a projected effect rather than direct prison-specific causal evidence. Post-release continuity remains a major implementation gap, with limited direct evidence for active TB interventions. Sustainable prison TB control requires moving from isolated activities to an integrated, measurable prison–community cascade linking risk-adapted screening, rapid diagnosis, effective treatment, environmental controls, data systems, and confirmed linkage to community care after release

Health care · Infection control · Multidisciplinary approach · Prison · SAFER · Tuberculosis · Criminal Justice and Corrections Analysis · Infectious Diseases and Tuberculosis · Tuberculosis Research and Epidemiology

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  Open Access•Yordanos Sisay Asgedom, Gizachew Ambaw Kassie et al.•Frontiers in Public Health•2023

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• Pooling sputum for Xpert MTB/RIF and Xpert Ultra testing during the Covid-19 pandemic in Lao People’s Democratic Republic

  Open Access•Vibol Iem, Phonenaly Chittamany et al.•PLOS Global Public Health•2022

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• New admissions and asymptomatic TB cases seem to fuel TB epidemic in prisons, a cross sectional survey in Tanzania

  Open Access•Chacha David Mangu, Petra Clowes et al.•PLOS Global Public Health•2024

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• A Scoping Review of Qualitative Research Methods Used With People in Prison

  Open Access•Penelope Abbott, Michelle Digiacomo et al.•International Journal of…•2018

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• Tuberculosis in prison

  Open Access•Moise Niaux, Mathilde Boutrou et al.•Global Public Health•2024

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• Jail-Based Case Management Improves Retention in HIV Care 12 Months Post Release

  Open Access•Ann Avery, Rachel Ciomica et al.•AIDS and Behavior•2018

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• Continuity of opioid substitution treatment between prison and community in Southeast Asia

  Open Access•Debbie Ann Loh, Emma Plugge et al.•International Journal of Drug…•2023

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• Tuberculosis Outbreaks in State Prisons, United States, 2011–2019

  Rebekah J Stewart, Kala M Raz et al.•American Journal of Public Health•2022

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