Tuberculosis in prisons: A growing global health concern

In this chapter, we review data related to TB and prisons, including the relationship between TB epidemics in prisons and surrounding communities, diagnostic strategies for TBI and TB disease, and TPT. Focusing primarily on low–middle-income country settings, we discuss considerations concerning the implementation of prevention and control strategies in these contexts, with their unique challenges. We refer to “prisons” for convenience throughout this chapter, recognising that carceral settings are diverse and include jails, police stations, correctional facilities and other forms of detention, and to “people deprived of liberty” (PDL) for any person who is in judicial retention in one of these places. Although prison staff, visitors, and religious or health staff are also more exposed to TB in prisons and could spread it in the community, this chapter is focused on PDL, who represent the major part of the problem. The general findings presented here are applicable to most prison settings; however, specific implementation will always depend on the unique conditions of each country’s confinement context. TB affects vulnerable populations disproportionately, and prisons are a setting where multiple forms of vulnerability converge. The epidemiological rationale for focusing TB control efforts on prisons aligns with the moral obligation to address inequalities and injustices.