Steps to enhance TB control in prison facilities for both high and middle/low income countries.

<p>Steps to enhance TB control in prison facilities for both high and middle/low income countries.</p

State of Affairs of Tuberculosis in Prison Facilities: A Systematic Review of Screening Practices and Recommendations for Best TB Control

<div><h3>Background</h3><p>Prisoners are at high risk of developing tuberculosis (TB), causing morbidity and mortality. Prison facilities encounter many challenges in TB screening procedures and TB control. This review explores screening practices for detection of TB and describes limitations of TB control in prison facilities worldwide.</p> <h3>Methods</h3><p>A systematic search of online databases (e.g., PubMed and Embase) and conference abstracts was carried out. Research papers describing screening and diagnostic practices among prisoners were included. A total of 52 articles met the inclusion criteria. A meta-analysis of TB prevalence in prison facilities by screening and diagnostic tools was performed.</p> <h3>Results</h3><p>The most common screening tool was symptom questionnaires (63·5%), mostly reporting presence of cough. Microscopy of sputum with Ziehl-Neelsen staining and solid culture were the most frequently combined diagnostic methods (21·2%). Chest X-ray and tuberculin skin tests were used by 73·1% and 50%, respectively, as either a screening and/or diagnostic tool. Median TB prevalence among prisoners of all included studies was 1,913 cases of TB per 100,000 prisoners (interquartile range [IQR]: 332–3,517). The overall annual median TB incidence was 7·0 cases per 1000 person-years (IQR: 2·7–30·0). Major limitations for successful TB control were inaccuracy of diagnostic algorithms and the lack of adequate laboratory facilities reported by 61·5% of studies. The most frequent recommendation for improving TB control and case detection was to increase screening frequency (73·1%).</p> <h3>Discussion</h3><p>TB screening algorithms differ by income area and should be adapted to local contexts. In order to control TB, prison facilities must improve laboratory capacity and frequent use of effective screening and diagnostic tools. Sustainable political will and funding are critical to achieve this.</p> </div

Measures of TB occurrence by WHO region and income area according to the World Bank classification (median; interquartile range).

<p><i>Note</i>:</p>*<p>data available from one study.</p><p>Source: <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0053644#pone.0053644-World1" target="_blank">[14]</a>.</p

Overview of all screening and diagnostic procedures by income area as classified by the World Bank.

*<p>P-value derived from the Wald Test for the association between a screening procedure and income area.</p><p>Source: <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0053644#pone.0053644-World1" target="_blank">[14]</a>.</p

Plot illustrating the median and interquartile range of TB prevalence per 100,000 prison population for different screening and diagnostic tools used in prison facilities.

<p>Plot illustrating the median and interquartile range of TB prevalence per 100,000 prison population for different screening and diagnostic tools used in prison facilities.</p

Flow chart of search strategy.

<p>Flow chart of search strategy.</p

Incidence rates of active TB (%) and prison screening and diagnostic procedures by income area as classified by the World Bank.

<p><i>Note:</i> NA: Not available;</p>*<p>Data not precisely available.</p><p>Source: <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0053644#pone.0053644-World1" target="_blank">[14]</a>.</p

Limitations of current TB control programmes in prison facilities.

<p>Limitations of current TB control programmes in prison facilities.</p