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Review
. 2021 Apr 24;397(10284):1591-1596.
doi: 10.1016/S0140-6736(20)32578-2. Epub 2021 Apr 8.

The escalating tuberculosis crisis in central and South American prisons

Katharine S Walter  1 , Leonardo Martinez  2 , Denise Arakaki-Sanchez  3 , Victor G Sequera  4 , G Estigarribia Sanabria  5 , Ted Cohen  6 , Albert I Ko  7 , Alberto L García-Basteiro  8 , Zulma Vanessa Rueda  9 , Rafael A López-Olarte  10 , Marcos A Espinal  10 , Julio Croda  11 , Jason R Andrews  2
Affiliations
Review

The escalating tuberculosis crisis in central and South American prisons

Katharine S Walter et al. Lancet. .

Abstract

In the past decade, tuberculosis incidence has declined in much of the world, but has risen in central and South America. It is not yet clear what is driving this reversal of progress in tuberculosis control. Since 2000, the incarcerated population in central and South America has grown by 206%, the greatest increase in the world. Over the same period, notified tuberculosis cases among the incarcerated population (hereinafter termed persons deprived of their liberty [PDL], following the Inter-American Commission on Human Rights) have risen by 269%. In both central and South America, the rise of disease among PDL more than offsets tuberculosis control gains in the general population. Tuberculosis is increasingly concentrated among PDL; currently, 11% of all notified tuberculosis cases in central and South America occur among PDL who comprise less than 1% of the population. The extraordinarily high risk of acquiring tuberculosis within prisons creates a health and human rights crisis for PDL that also undermines wider tuberculosis control efforts. Controlling tuberculosis in this region will require countries to take urgent measures to prioritise the health of PDL.

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Conflict of interest statement

Declaration of interests RAL-O serves as Tuberculosis Prevention, Control and Elimination Advisor at the HIV, Hepatitis, Tuberculosis and Sexually Transmitted Infections Unit of the PAHO. MAE is Director of the Department of Communicable Diseases and Environmental Determinants of Health at the PAHO. All other authors declare no competing interests.

Figures

Figure 1:
Figure 1:. Change in notified tuberculosis cases among PDL and the general population from 2011 to 2017
Change in notified tuberculosis cases for each country, ordered by cumulative change in tuberculosis burden over time, and change including all countries in both central and South America. Time series of case notifications among PDL differ across countries (appendix p 4); to characterise regional trends over a consistent time frame, we used cubic splines to extrapolate and interpolate missing years of case notifications among PDL for a 6-year period (2011–17) as described in the appendix (p 5). PDL=persons deprived of liberty.
Figure 2:
Figure 2:. Increasing burden of tuberculosis among PDL in central and South America
(A) Tuberculosis case notification rate among PDL in the most recent year of reported data (from 2014 [Belize] to 2018 [several countries]; appendix p 4). The percentage of tuberculosis notifications among PDL in central America (B) and South America (C) from 2008 to 2018. Countries with more than ten cases among PDL are included for central America and more than 100 cases among PDL for South America. Time series of case notifications among PDL differ across countries (appendix p 4). PDL=persons deprived of liberty.
See this image and copyright information in PMC

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