Tuberculosis control in prisons: current situation and research gaps

• Tuberculosis (TB) and multidrug-resistant (MDR)-TB prevention and control are major global health priorities among the communicable diseases.
• There are major challenges in TB, MDR-TB, and TB/HIV prevention and control in the penitentiary services (prisons).
• The authors present the challenges, gaps, and next steps to address these challenges from the perspective of the recently introduced post-2015 End TB Strategy.
• The focus of past research has rarely been on the most at-risk populations, such as prisoners, as these neglected populations are more sensitive to research ethics. The authors call for further research with a focus on prisons.

SummaryBackgroundTuberculosis (TB) in penitentiary services (prisons) is a major challenge to TB control. This review article describes the challenges that prison systems encounter in TB control and provides solutions for the more efficient use of limited resources based on the three pillars of the post-2015 End TB Strategy. This paper also proposes research priorities for TB control in prisons based on current challenges.MethodsArticles (published up to 2011) included in a recent systematic review on TB control in prisons were further reviewed. In addition, relevant articles in English (published 1990 to May 2014) were identified by searching keywords in PubMed and Google Scholar. Article bibliographies and conference abstracts were also hand-searched.ResultsDespite being a serious cause of morbidity and mortality among incarcerated populations, many prison systems encounter a variety of challenges that hinder TB control. These include, but are not limited to, insufficient laboratory capacity and diagnostic tools, interrupted supply of medicines, weak integration between civilian and prison TB services, inadequate infection control measures, and low policy priority for prison healthcare.ConclusionsGovernmental commitment, partnerships, and sustained financing are needed in order to facilitate improvements in TB control in prisons, which will translate to the wider community.