Tuberculosis control in Ethiopian prisons: A forgotten front in the end TB Strategy

Abstract

Tuberculosis (TB) continues to be one of the most devastating infectious diseases worldwide, with more than 10 million new TB cases and 1.5 million TB-related deaths reported annually [1]. Despite being preventable and curable, TB remains a leading cause of antimicrobial resistance (AMR)-related mortality, accounting for nearly one-quarter of all AMR deaths globally [2]. Low- and middle-income countries, including Ethiopia, shoulder the greatest TB burden worldwide [1,3]. Correctional facilities, especially prisons, constitute one of the most neglected yet pivotal settings for tuberculosis control and prevention [4]. The combination of overcrowding, inadequate ventilation, poor nutrition, lack of access to clean water, delayed case detection, and limited access to preventive interventions makes the prevention of Mycobacterium tuberculosis transmission particularly challenging [4]. Consequently, incarcerated populations remain disproportionately burdened by TB infection and disease, representing a critical but under-addressed component of national and global TB elimination strategies [5]. Thus, prisons represent one of the most overlooked yet critical environments for TB control and prevention as inmates are a marginalized population at exceptionally high risk of developing and transmitting the disease. Globally, 11 million people are incarcerated, 1.4 million of them in Africa [6], and the burden of TB among incarcerated populations is estimated to be up to ten times higher than in the general population [4,5]. Yet, these settings and the most vulnerable population living in the prisons are often excluded from national TB surveillance and health system planning. Experiences from multiple correctional facilities across Ethiopia reveal that, despite adherence to national TB guidelines, major systemic barriers continue to undermine effective disease control and prevention. This viewpoint draws on direct observations across multiple correctional facilities in Ethiopia and interviews with prison health professionals and individuals undergoing TB treatment while incarcerated.