Low detection rate and therapeutic success of tuberculosis in a prison in Ecuador

Abstract

Objective. Evaluate the control of pulmonary tuberculosis in a detention center and identify the risk factors associated with unsuccessful treatment in the largest prison in Ecuador. Methods. Surveillance data from the prison and a cohort of inmates diagnosed with tuberculosis (TB) between 2015 and 2016 were analyzed. Records without treatment outcome information were excluded. The percentage of patients with respiratory symptoms and TB incidence rate were estimated. Factors associated with unsuccessful treatment were estimated with binomial logistic regression. Results. Of 59 846 medical consultations, 3% of respiratory symptoms were identified and, of these, 326 inmates had TB; 184 of them were analyzed. The incidence rate of TB in the prison was 3 947/100 000 inhabitants. Treatment was successful in 70.4% (65.6% cured; 4.8% treatment completed) and unsuccessful in 29.4% (12.5% lost during follow-up, 5% deceased, 1.1% treatment failure, 10.8% not evaluated). Seropositivity for human immunodeficiency virus (HIV) was associated with an increased risk of unsuccessful treatment (relative risk: 1.66, 95% confidence interval: 1.33-2.07). Conclusion. The incidence of TB in the prison was 123 times higher than in the general population of Ecuador. Prisoners co-infected with HIV-TB are at greater risk of not having a successful treatment, and articulation is required between the ministries of health and justice that allows the proper implementation of health protocols and the End TB Strategy.