Research links prison sentence to increase in tuberculosis

Tuberculosis, the leading cause of death from a single pathogen worldwide, causes more than 1.5 million deaths each year. New research from the University of Cincinnati finds that being in prison or having been a former prisoner is responsible for high rates of multidrug-resistant (MDR) tuberculosis.

The study was published in The Lancet Regional Health – Americas.

“TB is a huge public health problem globally, and approximately half a million people are diagnosed with multidrug-resistant TB each year,” says Moises Huaman, MD, of the UC Division of Infectious Diseases College of Medicine. “Multi-drug resistant tuberculosis is difficult to treat; these patients may require longer treatments, and the risk of treatment failure and death is higher. »

Multidrug-resistant tuberculosis is tuberculosis caused by a bacterial strain resistant to isoniazid and rifampicin, the two basic antibiotics in first-line treatment for tuberculosis.

The research is a collaboration between UC, the Center for Technological, Biomedical and Environmental Research (CITBM) in Peru, the Borstel Research Center in Germany and researchers from Brazil, Spain and Italy. Investigators sought to identify resistance patterns and key drivers of recent transmission of multidrug-resistant tuberculosis in a region of Peru with high tuberculosis prevalence.

“We wanted to understand how multidrug-resistant TB is transmitted in the hot spots of Lima/Callao, Peru,” says Huaman, who is also medical director of the Hamilton County TB Control Clinic.

“We studied 171 strains of tuberculosis from 2017 to 2019 that were treated in Callao. All of these strains came from patients diagnosed with multidrug-resistant tuberculosis. Some of these strains came from individuals who were in prison. We found that transmission “multidrug-resistant tuberculosis” is very common in the region. One of the main factors associated with the transmission of multidrug-resistant TB is either being in prison or having previously been in prison. “

Researchers identified patterns of molecular resistance and defined recent transmissions.

“Tuberculosis is a disease where if a person is exposed to the bacteria in prison, they may not get sick until they return to the community,” Huaman explains. “This shows that while transmission can occur in prisons, multidrug-resistant TB and the potential for spread extends beyond prison boundaries and into the community.

“Our research identifies prisons as one of the main drivers of the multidrug-resistant TB epidemic, and that’s important because then you can intervene. You can plan prison-focused TB testing and control strategies. Additionally, having systems where you can also screen after people are released from prison is important.”

Huaman says a second important finding of the research is that it contradicts traditional thinking that the multidrug-resistant tuberculosis epidemic was primarily driven by patients who did not take prescribed medications. He says most of the cases included in the study resulted from primary transmission of multidrug-resistant TB strains and that one of the main sources of this transmission was prisons.

Hopefully, Huaman says, this will lead to more targeted interventions.

“Efforts are underway to control tuberculosis, and I believe our data will help the global community better understand how important it is to control the epidemic of multidrug-resistant tuberculosis in prisons,” he says.

“Our group and others are studying what are the most cost-effective interventions to control and eliminate tuberculosis. (For) a disease that links lower socioeconomic conditions and disadvantaged populations, (it is essential) to be able to implement sustainable interventions for these vulnerable populations.