Global, regional, and national estimates of tuberculosis incidence and case detection among incarcerated individuals from 2000 to 2019: a systematic analysis.

People who are incarcerated are at high risk of developing tuberculosis. We aimed to estimate the annual global, regional, and national incidence of tuberculosis among incarcerated populations from 2000 to 2019. We collected and aggregated data for tuberculosis incidence and prevalence estimates among incarcerated individuals in published and unpublished literature, annual tuberculosis notifications among incarcerated individuals at the country level, and the annual number of incarcerated individuals at the country level. We developed a joint hierarchical Bayesian meta-regression framework to simultaneously model tuberculosis incidence, notifications, and prevalence from 2000 to 2019. Using this model, we estimated trends in absolute tuberculosis incidence and notifications, the incidence and notification rates, and the case detection ratio by year, country, region, and globally. In 2019, we estimated a total of 125 105 (95% credible interval [CrI] 93 736-165 318) incident tuberculosis cases among incarcerated individuals globally. The estimated incidence rate per 100 000 person-years overall was 1148 (95% CrI 860-1517) but varied greatly by WHO region, from 793 (95% CrI 430-1342) in the Eastern Mediterranean region to 2242 (1515-3216) in the African region. Global incidence per 100 000 person-years between 2000 and 2012 among incarcerated individuals decreased from 1884 (95% CrI 1394-2616) to 1205 (910-1615); however, from 2013 onwards, tuberculosis incidence per 100 000 person-years was stable, from 1183 (95% CrI 876-1596) in 2013 to 1148 (860-1517) in 2019. In 2019, the global case detection ratio was estimated to be 53% (95% CrI 42-64), the lowest over the study period. Our estimates suggest a high tuberculosis incidence rate among incarcerated individuals globally with large gaps in tuberculosis case detection. Tuberculosis in incarcerated populations must be addressed with interventions specifically tailored to improve diagnoses and prevent transmission as a part of the broader global tuberculosis control effort. National Institutes of Health. [Abstract copyright: This is an Open Access article published under the CC BY 3.0 IGO license which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any use of this article, there should be no suggestion that WHO endorses any specific organisation, products or services. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.

A situational analysis of latent tuberculosis infection among incarcerated population in Japan.

BACKGROUND:The World Health Organization recommends that systematic testing and screening of latent tuberculosis infection (LTBI) among the incarcerated population "should be considered", though based on evidence of either low or very low quality. However, in Japan, a TB middle-burden country, systematic screening for LTBI in correctional facilities is currently not conducted. As part of a larger study to determine the cost-effectiveness of LTBI screening in correctional facilities in Japan, this study was conducted to determine the situation of LTBI, including treatment outcome, among the incarcerated population in Japan, and provide the essential data for cost-effectiveness analysis. METHOD:A cross-sectional study was conducted between 2017 and 2018 with public health centers which have one or more correctional facilities under their jurisdiction. Questionnaire surveys were sent to collect information on their policy of managing LTBI patients notified from correctional facilities, including whether or not there was a standardized procedure for initiating LTBI treatment, and also to collect sociodemographic information and treatment outcome of LTBI patients who were notified from the respective correctional facilities in 2015 and 2016. RESULTS:The survey was sent to a total of 163 public health centers, out of which 133 (81.6%) responded. 8 of the 133 public health centers actively guided the correctional facilities regarding LTBI treatment initiation through a standardized procedure, while 115 either had not established such procedure or were unaware of how LTBI treatment was being initiated in the correctional facilities. A total of 91 LTBI patients were notified from the correctional facilities in 2015 and 2016, and the information of 89 were available for analysis. 82 were males, and 83 were Japan-born. Treatment outcome was known for 88 patients, of which 70 had completed treatment. Of the 18 who did not complete the treatment, 15 had been lost to follow-up upon release from the facilities. Among those who had been released whilst on treatment, the proportion of those who completed the treatment was higher in those patients who received pre-release visit by a public health nurse, than those who did not. CONCLUSIONS:LTBI treatment was often being initiated without consideration for the patients' prison term. The treatment completion rate within jail was high, indicating the possibility that incarcerated population can benefit for LTBI treatment. On the other hand, the completion rate decreased significantly among those who had been released while still on treatment. In order to optimize the benefit, initiation of LTBI must carefully be considered upon the patient's prison term, as well as coordination among the relevant organizations to ensure continuity of care after release

Pulmonary tuberculosis and non-recent immigrants in Japan – some issues for post-entry interventions

Foreign-born persons are considered one of the high-risk populations for tuberculosis (TB), and numerous studies have discussed the potential role of pre-entry TB screening for immigrants. However, rates of TB disease among immigrants can remain high several years after entry. In Japan, approximately 50% of TB among foreign-born persons occurs among those who have entered Japan more than five years before being diagnosed, i.e. non-recent immigrants. However, little attention has been paid so far to the issue of TB control among the non-recent immigrants. A detailed analysis of the Japan Tuberculosis Surveillance data was therefore conducted to describe the characteristics of TB among non-recent immigrants and discuss policy implications in terms of post-entry interventions in Japan. The main findings were as follows: 1) the proportion of pulmonary TB cases aged 65 years and older was higher among non-recent than recent immigrants (9.8% vs 1.2%); 2) the proportion of those with social risk factors including homelessness and and being on social welfare assistance was higher among non-recent than recent immigrants; and 3) the proportion of those detected via routine screening at school or workplace was significantly lower among non-recent immigrants aged between 25 and 64 than among recent immigrants in the same age group (15.4% vs 28.7%). Our results suggested the need to increase the opportunities for and simultaneously improve the take-up rate of community-based screening for non-recent immigrants

Evaluation of “international transfer-out” among foreign-born pulmonary tuberculosis patients in Japan – what are the implications for a cross-border patient referral system?

Abstract Background Tuberculosis (TB) patients crossing borders pose a serious challenge to global TB control efforts. The objectives of our study were firstly, to evaluate the trend and size of foreign-born pulmonary TB patients, who had been notified and initiated treatment in Japan but have transferred out of the country while still on treatment; and secondly, to conduct a detailed analysis of these patients and identify possible risk factors for international transfer-out, and discuss policy implications for a cross-border patient referral system for foreign-born TB patients in Japan. Methods We conducted a cross-sectional study whereby aggregated cohort data of pulmonary TB cases newly notified to the Japan TB Surveillance system between 1 January 2011 and 31 December 2015 were analyzed. Multinomial logistic regression analysis was conducted to identify and compare the risk factors for international transfer-out. Results Among the 668 foreign-born patients whose treatment outcome had been evaluated as “transferred- out”, 51.3% has in fact moved to outside Japan between 2011 and 2015. The proportion of such international transfer-out of total foreign-born patients who had transferred out has more than doubled during the study period, from 23.3% in 2011 to 57.7% in 2015. Some of the risk factors for international transfer-out were being a full-time worker (Relative risk [RR] 2.86, 95% confidence interval [CI] 2.04, 3.99), being diagnosed within 0 to 2 years of arriving to Japan (RR 8.78, 95% CI 4.30,17.90) and within 3 to 5 years (RR 7.53, 95% CI 3.61, 15.68), sputum smear positive (RR 1.95, 95% CI 1.53, 2.48), and coming from Indonesia (RR 1.86, 95% CI 1.13, 3.03). Conclusions Providing continuity of care for mobile population is one of the keys to achieving the WHO’s End TB Strategy targets for 2030, and results of our study indicate that a cross-border referral system should be an integral part of TB control among foreign-born persons in Japan

Profile of tuberculosis among the foreign-born population in Japan, 2007–2014

The proportion of foreign-born people among the newly notified tuberculosis (TB) patients has been increasing in recent years and potentially poses a new challenge to TB control in Japan. In this report, we analysed the data from the Japan TB surveillance system between 2007 and 2014 to gain an overview of the trends and characteristics of foreign-born TB patients in Japan. We found that the proportion of foreign-born TB patients was especially high among the younger age groups – 44.1% among the 20–29 years age group in 2014. The largest groups of foreign-born patients were from China and the Philippines; however, the number of those from Nepal and Viet Nam was on the rise. Students comprised the second largest professional category group for TB after regular workers, and its proportion increased over the study period. Compared to Japan-born TB patients, foreign-born patients were more likely to be diagnosed through routine medical check-ups. Treatment successes and patients still on treatment were significantly lower among foreign-born patients than their Japan-born counterparts; and transferred-out and unknown outcomes were higher. Our results indicated that distinctive subgroups within the foreign-born population in Japan, especially students and regular workers, might have a higher risk of developing TB. Measures to ensure early diagnosis and treatment adherence should be adapted to such populations

Characteristics of newly notified LTBI patients who initiated treatment in Japan, 2007–2014.

<p>Characteristics of newly notified LTBI patients who initiated treatment in Japan, 2007–2014.</p

Treatment outcome of multidrug-resistant tuberculosis in Japan – the first cross-sectional study of Japan tuberculosis surveillance data

Abstract Background Multidrug resistant-tuberculosis (MDR-TB) is a major global health concern. Its treatment requires toxic medications, is longer and costlier than drug-susceptible TB, and often results in productivity losses and poor outcomes. In Japan, a TB middle-burden country, reports on treatment outcome of MDR-TB patients have only been institution-based. We thus sought to shed some light on the nationwide treatment status and outcome of MDR-TB patients in Japan. Methods Characteristics and treatment status and outcome of MDR-TB patients notified between 2011 and 2013 were evaluated using the data from the Japan TB Surveillance (JTBS) system. Since the treatment outcome from the surveillance data was not directly linked to any clinical records or drug susceptible test results, we also analyzed the treatment duration of MDR-TB cases in an attempt to validate our results. Results Between 2011 and 2013, a total of 172 MDR-TB patients had been notified to the JTBS as MDR-TB. 68.6% (118/172) were males and 70.9% (122/172) were Japan-born – however, over the study period, the proportions of foreign-born, of those in the age group 15–64 years old and of new cases have increased. The overall treatment completion rate was 57.0%, however, when restricted to patients aged 64 years old and below, the rate improved to 71.6%. Treatment duration of 29.2% of those patients who had been recorded as “treatment completed” in fact fell short of the 540 days, the minimum duration as recommended by the Japanese guideline. Conclusions Increasing proportion of new cases, and of younger age groups among the MDR-TB patients indicate new transmissions. Better strategies for early detection and containment of MDR-TB are urgently needed. The overall treatment completion rate was 57.0% over the three-year study period. However, when restricting the result to those aged 64 years old and below, the rate improved to 71.6%, which was comparable to similarly industrialized countries. Due to the limitations of the JTBS data, a comprehensive survey of all MDR-TB patients may be necessary to provide more concrete evidence for decision-making

Adjusted odds ratios from multiple logistic regression predicting non-completion of LTBI treatment, in Japan, registered between 2007 and 2014.

<p>Adjusted odds ratios from multiple logistic regression predicting non-completion of LTBI treatment, in Japan, registered between 2007 and 2014.</p

LTBI notification by mode of detection, 2007–2014.

<p>LTBI notification by mode of detection, 2007–2014.</p

Characteristics of a cumulative total of LTBI patients notified in Japan between 2007 and 2014 who initiated treatment, by their treatment status.

<p>Characteristics of a cumulative total of LTBI patients notified in Japan between 2007 and 2014 who initiated treatment, by their treatment status.</p