Treatment of latent tuberculosis infection in incarcerated people: a systematic review

Abstract

Background: The estimated number of people deprived of liberty is increasing, with 11.55 million incarcerated globally in 2021. Transmission of Mycobacterium tuberculosis strains is facilitated in over-crowded, poorly ventilated settings, such as jails and penitentiaries. Moreover, inmates may show individual risk factors for the development of tuberculosis disease. Treatment regimens for latent tuberculosis infection (LTBI) may require up to 9 months of drug exposure and are characterized by adverse events (AE) and low completion rates.

Objectives: To describe current scientific evidence on feasibility, acceptability, and completion rate of LTBI treatment in prison or correctional institutes.

Data sources: Articles were retrieved from MEDLINE/PubMed, no time restriction was applied.

Study eligibility criteria: Human retrospective and prospective studies published on LTBI treatment in incarcerated populations were included.

Assessment of risk of bias: Bias assessment plots and Egger weighted regression test were used to determine the risk of bias.

Methods of data synthesis: Absolute and relative frequencies were assessed for qualitative data. Pooled proportion of included study groups and 95% confidence interval estimates, weighted for sample sizes, were illustrated in forest plots. I² indicator association were used for true variability and overall variation. Fixed and random-effects models were chosen depending on the estimated between-study heterogeneity.

Results: Of the 11 selected studies, only 1 was conducted in a high tuberculosis incidence country. Overall, completion rates ranged from 26% to 100% across the included studies. Reason for the discontinuation of treatment were transfer to other facilities, release, or loss to follow-up (range, 0-74%), incidence of AEs (range, 0-18%), and refusal or withdrawal from treatment (range, 0-16%).

Conclusions: Implementation of short-course regimens in prisons should be considered given the low incidence of AEs observed; however, inmates consistently refused to complete LTBI treatment, thus underlining the need for improvement in retention in care.

Keywords: Incarcerated; LTBI; Latent tuberculosis infection; Outcome; Prisons; Systematic review; Treatment.