Impact of mass-screening on tuberculosis incidence in a prospective cohort of Brazilian prisoners.
Dayse Sanchez Guimarães PaiãoEverton Ferreira LemosAndrea da Silva Santos CarboneRenata Viebrantz Enne SgarbiAlexandre Laranjeira JuniorFellipe Matos da SilvaLetícia Marques BrandãoLuciana Squarizi Dos SantosVaneli Silva MartinsSimone SimionattoAna Rita Coimbra Motta-CastroMaurício Antônio PompílioJuliana UrregoAlbert Icksang KoJason Randolph AndrewsJulio Henrique da Rosa CrodaPublished in: BMC infectious diseases (2016)
Among 3,771 inmates recruited, 3,380 (89.6 %) were enrolled in the study, and 1,422 remained incarcerated after one year. Among 1,350 inmates (94.9 %) with paired TSTs at baseline and one-year follow-up, 25.7 % (272/1060) converted to positive. Among those incarcerated for the year, 10 (0.7 %) had TB at baseline and 25 (1.8 %) were diagnosed with TB over the subsequent year. Cases identified through active screening were less likely to be smear-positive than passively detected cases (10.0 % vs 50.9 %; p < 0.01), suggesting early case detection. However, there was no reduction in subsequent disease among individuals actively screened versus those not screened (1.3 % vs 1.7 %; p = 0.88). Drug use during the year (AHR 3.22; 95 % CI 1.05-9.89) and knows somebody with TB were (AHR 2.86; 95 % CI 1.01-8.10) associated with active TB during one year of follow up CONCLUSIONS: Mass screening in twelve Brazilian prisons did not reduce risk of subsequent disease in twelve Brazilian prisons, likely due to an extremely high force of infection. New approaches are needed to control TB in this high-transmission setting.