Prisons as boosters of tuberculosis and drug resistance tuberculosis transmission in Latin America
Imprisonment is an important but commonly forgotten social determinant of health and in the last decades, tuberculosis (TB) in prisons has been recognised as an important driver of the total burden of TB. Overcrowding, poor ventilation, malnutrition, lack of access to health care and comorbidities, among others, fuel this association. The population attributable fraction due to incarceration increased from 4.5 to 9.7% from 2011 to 2017 and a study in Georgia found that up to 31% of cases of multidrug-resistant (MDR) TB were related to prisons, pointing out that the incarceration environment can select MDR strains with increased fitness, more capable of spreading in general populations.
In Central and South America, the situation is quickly deteriorating as the number of persons deprived of their liberty (PDL) is dramatically increasing, leading to occupancy of more than 200% in several countries and the incidence of TB in PDL is 26 times the observed in the general population, representing the highest ratio worldwide.