Prisoners in India 5 times more at risk of TB: Lancet study

Prisoners in India are five times more at risk of developing tuberculosis (TB) than the general population, according to a global study published in the Lancet Public Health journal.

Analysing data from 193 out of 195 countries between 2000 and 2019, an international team of researchers estimated the rate of TB in incarcerated persons for the first time.

The study, published in the July edition of the journal, found that the incidence of TB in India was 1,076 cases per 100,000 (one lakh) persons in prisons. The country's TB incidence for the year 2021 is 210 per 1 lakh population, according to the Global TB Report released by World Health Organisation (WHO) last year.

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Globally, people in prison are nearly 10 times more at risk of developing tuberculosis than the general population, the researchers found.

Approximately, 125,105 (1.2 lakh) of the 11 million people in prisons globally developed TB in 2019 – a rate of 1,148 cases per 100,000 people per year. This is significantly higher than the global incidence rate among all persons – 127 cases per 100,000 people per year, they said.

However, the case detection rate was very low -- just 53 per cent of all TB cases in prisons globally, according to the study.

The researchers found a strong relationship between country-level tuberculosis incidence rates and overcrowding in prisons.

“This connection between TB and overcrowding suggests that efforts to limit the number of people who are detained may be one potential public health tool to combat the TB epidemic in prisons,” study lead Leonardo Martinez from Boston University in the US said in a statement.

The greatest incidence rate in the African region -- 2,242 cases per 100,000 people per year -- is almost double the global estimate for this population, the researchers said.

The Americas region, largely driven by Central and South America, had the largest estimated absolute number of TB cases among incarcerated persons – 30,509, they said.

“These findings give us a much clearer picture of tuberculosis in prisons than we’ve ever had before," said Anthony D Harries, senior advisor at the International Union Against Tuberculosis and Lung Disease.

"The high rate of tuberculosis and low rate of detection indicates that current control measures are insufficient for preventing the spread of the disease in prisons globally. Therefore, further research is vital to identify and implement the most effective interventions," Harries said.

The high incidence rate globally and across regions, low case detection rates, and consistency over time indicate that this population represents an important, under-prioritised group, he added.

The researchers noted that continued failure to detect, treat, and prevent tuberculosis in prisons will result in the unnecessary disease and deaths of many incarcerated persons.

When incarcerated persons are released from prison they can take this infectious disease back into the communities in which they live, further contributing to the spread of tuberculosis globally, they noted.

"Greater focus and resources for addressing the tuberculosis epidemic in prisons are needed to protect the health of incarcerated people and their communities,” said Harries.

The team is currently working with several health organisations to attempt to update global guidelines on how to manage and reduce TB in prisons, as the most recent guidelines were written in the year 2000.

“One of the reasons this population is so neglected is because of the lack of data,” Martinez said.

“Our hope is that these results can help stakeholders understand the urgency of the issue and the amount of people in prisons that develop tuberculosis and remain undiagnosed for long periods of time and can spur them to take action, " he added.

TB is an infectious disease that most often affects the lungs and is caused by a type of bacteria. It spreads through the air when infected people cough, sneeze or spit.

The disease is preventable and curable. In 2021, an estimated 10.6 million people fell ill with TB worldwide while 1.6 million people died from the disease, according to WHO.