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The effect of incarceration on TB treatment outcomes

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BACKGROUND: TB notifications in Latin American prisons have more than doubled over the past two decades; however, treatment outcomes and their determinants among incarcerated individuals in this region are not well understood.

METHODS: Newly diagnosed drug-susceptible TB cases reported to Brazil´s Information System for Notifiable Diseases (Sistema de Informação de Agravos de Notificação, SINAN) between January 2015 and December 2017 were included. Multivariate logistic regression was used to assess socio-economic and clinical factors associated with treatment success among incarcerated individuals.

RESULTS: Incarcerated individuals (n = 17,776) had greater treatment success than non-incarcerated individuals (n = 160,728; 82.2% vs. 75.1%; P < 0.0001), including after adjusting for demographic and clinical risk factors (adjusted odds ratio aOR 1.27, 95% CI 1.19–1.34). These differences were partially mediated by increased use of directly observed therapy among incarcerated individuals (DOT) (61% vs. 47%; P < 0.001), which was associated with greater efficacy in the incarcerated population (aOR 2.56 vs. aOR 2.17; P < 0.001). DOT was associated with improved treatment success among incarcerated subpopulations at elevated risk of poor outcomes.

CONCLUSION: TB treatment success among incarcerated individuals in Brazil is higher than non-incarcerated individuals, but both fall below WHO targets. Expanding the use of DOT and services for socially and medically vulnerable individuals may improve outcomes in carceral settings.

Keywords: DOTS; incarceration; treatment outcomes; tuberculosis

Document Type: Research Article

Affiliations: 1: Yale School of Medicine, New Haven, CT, USA 2: School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil 3: National Tuberculosis Control Programme, Brasília, DF, Brazil 4: School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil, Public Health, Oswaldo Cruz Foundation, Campo Grande, MS, Brazil, Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 5: Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA

Publication date: March 1, 2022

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  • The International Journal of Tuberculosis and Lung Disease (IJTLD) is for clinical research and epidemiological studies on lung health, including articles on TB, TB-HIV and respiratory diseases such as COVID-19, asthma, COPD, child lung health and the hazards of tobacco and air pollution. Individuals and institutes can subscribe to the IJTLD online or in print – simply email us at [email protected] for details.

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