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. 2014 Jan 30;9(1):e87262.
doi: 10.1371/journal.pone.0087262. eCollection 2014.

High tuberculosis prevalence in a South African prison: the need for routine tuberculosis screening

Lilanganee Telisinghe  1 , Katherine L Fielding  2 , Justin L Malden  1 , Yasmeen Hanifa  1 , Gavin J Churchyard  3 , Alison D Grant  2 , Salome Charalambous  4
Affiliations

High tuberculosis prevalence in a South African prison: the need for routine tuberculosis screening

Lilanganee Telisinghe et al. PLoS One. .

Abstract

Background: Tuberculosis is a major health concern in prisons, particularly where HIV prevalence is high. Our objective was to determine the undiagnosed pulmonary tuberculosis ("undiagnosed tuberculosis") prevalence in a representative sample of prisoners in a South African prison. In addition we investigated risk factors for undiagnosed tuberculosis, to explore if screening strategies could be targeted to high risk groups, and, the performance of screening tools for tuberculosis.

Methods and findings: In this cross-sectional survey, male prisoners were screened for tuberculosis using symptoms, chest radiograph (CXR) and two spot sputum specimens for microscopy and culture. Anonymised HIV antibody testing was performed on urine specimens. The sensitivity, specificity and predictive values of symptoms and investigations were calculated, using Mycobacterium tuberculosis isolated on sputum culture as the gold standard. From September 2009 to October 2010, 1046 male prisoners were offered enrolment to the study. A total of 981 (93.8%) consented (median age was 32 years; interquartile range [IQR] 27-37 years) and were screened for tuberculosis. Among 968 not taking tuberculosis treatment and with sputum culture results, 34 (3.5%; 95% confidence interval [CI] 2.4-4.9%) were culture positive for Mycobacterium tuberculosis. HIV prevalence was 25.3% (242/957; 95% CI 22.6-28.2%). Positive HIV status (adjusted odds ratio [aOR] 2.0; 95% CI 1.0-4.2) and being an ex-smoker (aOR 2.6; 95% CI 1.2-5.9) were independently associated with undiagnosed tuberculosis. Compared to the gold standard of positive sputum culture, cough of any duration had a sensitivity of 35.3% and specificity of 79.6%. CXR was the most sensitive single screening modality (sensitivity 70.6%, specificity 92.2%). Adding CXR to cough of any duration gave a tool with sensitivity of 79.4% and specificity of 73.8%.

Conclusions: Undiagnosed tuberculosis and HIV prevalence was high in this prison, justifying routine screening for tuberculosis at entry into the prison, and intensified case finding among existing prisoners.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Study inclusions, losses to follow-up and tuberculosis outcomes.
TB = Tuberculosis.
See this image and copyright information in PMC

References

    1. Baussano I, Williams BG, Nunn P, Beggiato M, Fedeli U, et al. (2010) Tuberculosis incidence in prisons: a systematic review. PLoS Med 7: e1000381. - PMC - PubMed
    1. Vinkeles Melchers NV, van Elsland SL, Lange JM, Borgdorff MW, van den Hombergh J (2013) State of affairs of tuberculosis in prison facilities: a systematic review of screening practices and recommendations for best TB control. PLoS One 8: e53644. - PMC - PubMed
    1. United Nations Office on Drugs and Crime (2006 ) HIV/AIDS prevention, care, treatment and support in prison settings: a framework for an effective national response. Vienna.
    1. Noeske J, Ndi N, Mbondi S (2011) Controlling tuberculosis in prisons against confinement conditions: a lost case? Experience from Cameroon. Int J Tuberc Lung Dis 15: 223–227, i. - PubMed
    1. Tuberculosis Coalition for Technical Assistance and International Committee of the Red Cross (2009) Guidelines for Control of Tuberculosis in Prisons.

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