Study: Inmates nine times more likely to contract TB than general population

The risk of inmates contracting tuberculosis is nine times higher than for the rest of society, with Africa registering the highest incidence rate among the various global regions. 

This is according to a study published in The Lancet Public Health journal.

The study team consisted of researchers from across the world,  analysing data from 193 countries from 2000 to 2019.

They found that about 125,105 of the 11-million people incarcerated globally developed TB in 2019 — a rate of 1,148 cases per 100,000 people per year. This was significantly higher than the global incidence rate among all people — 127 cases per 100,000 people per year.

However, the case detection rate was just 53% of all TB cases in prisons globally. Furthermore, the researchers found a strong relationship between country-level tuberculosis incidence rates and overcrowding in prisons.

The study also found that the increased risk of TB among inmates exceeds that of alcohol use disorders, diabetes, smoking and undernourishment.

Former inmate Karabo Rafube explained how he contracted TB at a South African prison.

He shared his personal experience and why it is important to support inmates in a similar position.

“There was no screening when you entered and we were crowded into small spaces, so it was no surprise that I caught TB. I was very sick, but it took a long time to find out that I had TB. I took treatment for six months and luckily fully recovered. Some people would sell their medicines to other inmates.

“After recovering I was appointed as a TB teacher in the prison. Ever since I left, I’ve been supporting others with TB in prison. It is important to break the silence of TB. Prisoners have the right to be screened and have access to medicines, but they are often neglected. We can’t end TB without treating everyone — that includes prisoners.”

Honing in on the regions outlined by the World Health Organisation (WHO), researchers also found that TB prison rates greatly differed in the different regions in 2019, with the greatest incidence rate being in the African region: 2,242 cases 100,000 people per year — almost double the global estimate for this population.

“The Americas region, largely driven by Central and South America, meanwhile, had the largest estimated absolute number of TB cases among incarcerated people, clocking in at 30,509.”

Further regional prison differences:

• Incidence decreased in several regions (for example, European, African and South-East Asian regions) and increased in the Americas region.
• Trends in Europe were largely influenced by prisons in Russia which, after targeted interventions in prisons and reductions in incarceration over the past decade, have successfully reduced TB incidence in prisons.
• Reasons for the increases in TB burden in the Americas may be multifactorial. Mass incarceration has risen dramatically in the Americas, likely leading to increased crowding.
• The strong association found between crowding and TB incidence suggests this may be an important driver of the rising TB incidence in prisons from the Americas, especially in Central and South America.
• While estimated incidence rates were high across WHO regions, there were differences within regions as well. For example, in the Americas, incidence in South and Central American countries (both more than 1,200 cases per 100,000 people per year) was considerably higher than those in North America (less than 50 incident cases per 100,000 people per year). Similarly, Eastern Europe had a substantially higher incidence than Western Europe.

Lead researcher in the study, Leonardo Martinez from the school of public health at Boston University, US, said: “This connection between TB and overcrowding suggests that efforts to limit the number of people who are detained may be one potential public health tool to combat the TB epidemic in prisons.

“The high incidence rate globally and across regions, low case detection rates, and consistency over time indicate that this population represents an important, under-prioritised group. Continued failure to detect, treat, and prevent tuberculosis in prisons will result in the unnecessary disease and deaths of many incarcerated people.

“And, of course, when incarcerated people are released from prison, they can take this infectious disease back into the communities in which they live, further contributing to the spread of tuberculosis globally. Greater focus and resources for addressing the tuberculosis epidemic in prisons are needed to protect the health of incarcerated people and their communities.”

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