Prevalence of tuberculosis symptoms and latent tuberculous infection among prisoners in northeastern Malaysia
OBJECTIVE: To determine the prevalence and correlates of LTBI and active TB symptoms among Malaysian prisoners with and without human immunodeficiency virus (HIV) infection using the tuberculin skin test (TST) and the World Health Organization TB symptom-based screening instrument.
DESIGN: A cross-sectional survey of 266 prisoners was performed in Kelantan, Malaysia. Consenting participants underwent two-step TST and were screened for active TB symptoms. Standardized cut-offs of respectively ≥5 and ≥10 mm were used to define reactive TST among prisoners with and without HIV. Clinical and behavioral data were assessed and HIV-infected prisoners were stratified by CD4 status.
RESULTS: Overall LTBI prevalence was 87.6%, with significantly lower TST reactivity among HIV-infected than non-HIV-infected prisoners (83.6% vs. 91.5%, P < 0.05); however, TB symptoms were similar (16.9% vs. 10.1%, P = 0.105). On multivariate analysis, previous incarceration (aOR 4.61, 95%CI 1.76–12.1) was the only significant correlate of LTBI. Increasing age (aOR 1.07, 95%CI 1.01–1.13), lower body mass index (aOR 0.82, 95%CI 0.70–0.96) and TST-reactive status (aOR 3.46, 95%CI 1.20–9.97) were correlated with TB symptoms.
CONCLUSION: LTBI is highly prevalent, associated with previous incarceration, and suggests the need for routine TB screening on entry to Malaysian prisons.
Keywords: HIV; TB; prisons; screening; substance abuse; tuberculin skin test
Document Type: Research Article
Affiliations: 1: Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, New Haven, Connecticut, USA 2: Centre of Excellence for Research in AIDS, University of Malaya, Kuala Lumpur, Malaysia 3: Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, New Haven, Connecticut, USA; Centre of Excellence for Research in AIDS, University of Malaya, Kuala Lumpur, Malaysia 4: Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, New Haven, Connecticut, USA; Centre of Excellence for Research in AIDS, University of Malaya, Kuala Lumpur, Malaysia; Division of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, Connecticut, USA
Publication date: 01 December 2013
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