People in prisons and other penitentiary institutions are at an increased risk for TB compared with the general population, and they often have limited access to health care services. The estimated incidence of TB among people residing in prisons is 23 times higher than that among the general population (24). Data reviewed for the GDG meeting suggest that screening in prisons may improve early case detection, increase overall case detection and reduce TB prevalence. One observational study showed that a smaller proportion of TB patients in prisons whose disease was detected through screening were at an advanced stage of disease compared with those diagnosed through passive case-finding services (25). Two observational studies showed that TB screening in prisons may reduce TB prevalence in the facilities (26, 27). One trial showed that screening in prisons may increase case detection by more than 50% (28).
Based on this new evidence and the high risk of TB in this population, the GDG felt that this risk group now merited a strong recommendation for TB screening (see Web Annex B, Table 4, and Web Annex C, Table 3). The GDG felt that implementing TB screening in prisons has the potential to increase equity in access to health care, particularly in settings where health services in prisons are suboptimal.