Case-finding of pulmonary tuberculosis on admission to a penitentiary centre.

SETTING

The prison population is considered to be at high risk of tuberculosis infection and illness. Therefore, a tuberculosis prevention and control program was put into effect upon the opening of a penitentiary center in Barcelona whose inmates suffered a high prevalence of intravenous drug use (IVDU) (48.4%) and HIV-1 infection (36.0%).

OBJECTIVE

To ascertain the prevalence of tuberculosis infection and pulmonary tuberculosis detected on admission to jail among those prisoners who had no history of tuberculosis; and to study as predictors of tuberculosis infection and illness the variables age, IVDU and HIV-1 infection.

DESIGN

Cross-sectional study.

RESULTS

Of the 729 prisoners studied, 56.2% were considered infected with Mycobacterium tuberculosis. Age was the only variable associated with the infection, with an Odds Ratio (OR) of 1.017 per year (Confidence Interval [CI] 95% = 1.006-1.029) (P = 0.004). The rates of HIV-1 and M. tuberculosis co-infection, which may run between 18.9% and 21.7%, reached 42.8% in the IVDU. A 2.7% prevalence of pulmonary tuberculosis was observed. The most accurate logistic regression model for pulmonary tuberculosis diagnosis (P = 0.09) includes the variables tuberculosis infection (OR = 13.00; CI 95% = 1.7-98), IVDU (OR = 2.60; CI 95% = 0.66-7.81) and age (OR = 1.05; CI 95% = 0.99-1.11).

CONCLUSION

Given the high prevalences observed, we propose the activation and maintenance of programs designed to seek out and identify cases of M. tuberculosis infection and illness within the prison population.