Treatment of latent tuberculosis infection in incarcerated people: a systematic review

Background: The estimated number of people deprived of liberty is increasing, with 11.55 million incarcerated globally in 2021. Transmission of Mycobacterium tuberculosis strains is facilitated in over-crowded, poorly ventilated settings, such as jails and penitentiaries. Moreover, inmates may show in-dividual risk factors for the development of tuberculosis disease. Treatment regimens for latent tuber-culosis infection (LTBI) may require up to 9 months of drug exposure and are characterized by adverse events (AE) and low completion rates.Objectives: To describe current scientific evidence on feasibility, acceptability, and completion rate of LTBI treatment in prison or correctional institutes.Data sources: Articles were retrieved from MEDLINE/PubMed, no time restriction was applied.Study eligibility criteria: Human retrospective and prospective studies published on LTBI treatment in incarcerated populations were included.Assessment of risk of bias: Bias assessment plots and Egger weighted regression test were used to determine the risk of bias. Methods of data synthesis: Absolute and relative frequencies were assessed for qualitative data. Pooled proportion of included study groups and 95% confidence interval estimates, weighted for sample sizes, were illustrated in forest plots. I2 indicator association were used for true variability and overall variation. Fixed and random-effects models were chosen depending on the estimated between-study heterogeneity.Results: Of the 11 selected studies, only 1 was conducted in a high tuberculosis incidence country. Overall, completion rates ranged from 26% to 100% across the included studies. Reason for the discon-tinuation of treatment were transfer to other facilities, release, or loss to follow-up (range, 0-74%), incidence of AEs (range, 0-18%), and refusal or withdrawal from treatment (range, 0-16%). Conclusions: Implementation of short-course regimens in prisons should be considered given the low incidence of AEs observed; however, inmates consistently refused to complete LTBI treatment, thus underlining the need for improvement in retention in care. Tommaso Matucci, Clin Microbiol Infect 2023;29:714 & COPY; 2023 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.