Bacteriologically-confirmed pulmonary tuberculosis in an Ethiopian prison: Prevalence from screening of entrant and resident prisoners

English version

Autoři: Eliyas Tsegaye Sahle ^aff001; Jill Blumenthal ^aff003; Sonia Jain ^aff003; Shelly Sun ^aff003; Jason Young ^aff003; Tsegahun Manyazewal ^aff001; Habtamu Woldeamanuel ^aff001; Lemma Teferra ^aff005; Beniam Feleke ^aff006; Olivier Vandenberg ^aff007; Zilma Rey ^aff009; Melissa Briggs-Hagen ^aff009; Richard Haubrich ^aff010; Wondwossen Amogne ^aff001; John Allen McCutchan ^aff003
Působiště autorů: ADDIS-VP Project, Ethiopian Public Health Association, Addis Ababa, Ethiopia ^aff001; École de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium ^aff002; University of California San Diego, San Diego, California, United States of America ^aff003; Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia ^aff004; Ethiopian Federal Prison Administration, Addis Ababa, Ethiopia ^aff005; Centers for Disease Control and Prevention, Addis Ababa, Ethiopia ^aff006; Environmental and Occupational Health Research Centre (CRSET), School of Public Health, Université Libre de Bruxelles, Brussels, Belgium ^aff007; Division of Infection & Immunity, University College London, London, United Kingdom ^aff008; Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America ^aff009; Gilead Sciences, Foster City, California, United States of America ^aff010
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0226160

Souhrn

Background

Pulmonary Tuberculosis (PTB) is a major health problem in prisons. Multiple studies of TB in regional Ethiopian prisons have assessed prevalence and risk factors but have not examined recently implemented screening programs for TB in prisons. This study compares bacteriologically-confirmed PTB (BC-PTB) prevalence in prison entrants versus residents and identifies risk factors for PTB in Kality prison, a large federal Ethiopian prison located in Addis Ababa, through a study of an enhanced TB screening program.

Methods

Participating prisoners (n = 13,803) consisted of 8,228 entrants screened continuously and 5,575 residents screened in two cross-sectional waves for PTB symptoms, demographics, TB risk factors, and medical history. Participants reporting at least one symptom of PTB were asked to produce sputum which was examined by microscopy for acid-fast bacilli, Xpert MTB/RIF assay and MGIT liquid culture. Prevalence of BC-PTB, defined as evidence of Mycobacterium tuberculosis (MTB) in sputum by the above methods, was compared in entrants and residents for the study. Descriptive analysis of prevalence was followed by bivariate and multivariate analyses of risk factors.

Results

Prisoners were mainly male (86%), young (median age 26 years) and literate (89%). Prevalence of TB symptoms by screening was 17% (2,334/13,803) with rates in residents >5-fold higher than entrants. Prevalence of BC-PTB detected by screening in participating prisoners was 0.16% (22/13,803). Prevalence in residents increased in the second resident screening compared to the first (R1 = 0.10% and R2 = 0.39%, p = 0.027), but remained higher than in entrants (4.3-fold higher during R1 and 3.1-fold higher during R2). Drug resistance (DR) was found in 38% (5/13) of culture-isolated MTB. Risk factors including being ever diagnosed with TB, history of TB contact and low Body Mass Index (BMI) (<18.5) were significantly associated with BC-PTB (p<0.05).

Conclusions

BC-PTB prevalence was strikingly lower than previously reported from other Ethiopian prisons. PTB appears to be transmitted within this prison based on its higher prevalence in residents than in entrants. Whether a sustained program of PTB screening of entrants and/or residents reduces prevalence of PTB in prisons is not clear from this study, but our findings suggest that resources should be prioritized to resident, rather than entrant, screening due to higher BC-PTB prevalence. Detection of multi- and mono-DR TB in both entrant and resident prisoners warrants regular screening for active TB and adoption of methods to detect drug resistance.

Klíčová slova:

Tuberculosis – Tuberculosis diagnosis and management – Extensively drug-resistant tuberculosis – Prisons – Prisoners – Medical risk factors – Sputum

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