Seroprevalence of antibodies against SARS-CoV-2 in the school community in Campo Grande, state of Mato Grosso do Sul, Brazil, October 2021-November 2022.

Introduction: With the reopening of schools during the coronavirus disease 2019 (COVID-19) pandemic, it was imperative to understand the role of students and education professionals in the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In this paper, we determined the seroprevalence of the SARS-CoV-2 anti-nucleocapsid antibodies in the school community in Campo Grande, the capital and most populous city of the state of Mato Grosso do Sul (Brazil) and evaluated its association with sex, school level, and school type. Materials and methods: The survey was carried out in 20 public and private schools in the urban region of Campo Grande using the TR DPP® COVID-19 immunoglobulin M/immunoglobulin G (IgM/IgG) kit from the Immunobiological Technology Institute (Bio-Manguinhos, Rio de Janeiro, Brazil). Testing was carried out in three periods: from October to December 2021; from March to July 2022; and from August to November 2022. The participants were students aged 6-17 years enrolled in primary or secondary schools and professionals of different ages and roles. Results: During the first testing period, 162 participants were seropositive for the IgM and/or IgG anti-nucleocapsid SARS-CoV-2 antibodies, with an estimated seroprevalence of 19.6% using Bayesian multilevel regression. In the second period, 251 participants were seropositive (estimated seroprevalence, 34.6%), while in the third period, 393 participants were seroconverted (estimated seroprevalence, 56.7%). In 2022, there was an increase in the seroconversion rate compared to that in 2021. The most frequently described acute manifestations in the three periods were fever, headache, sore throat, and runny nose. In terms of the demographic profile, there was no predominance of seropositivity between the sexes, although women represented approximately 70% of the study population. There were also no differences between students and school staff. Discussion: The results made it possible to evaluate the extent of SARS-CoV-2 transmission in the school community through immunity developed against the virus, in addition to providing information about COVID-19 symptoms in children, adolescents, and adults.

Delay in the diagnosis and treatment of tuberculosis in prisons in Mato Grosso do Sul, Brazil.

BACKGROUND: The number of tuberculosis (TB) cases in prisons is higher than that in the general population and has been reported as the most common cause of death in prisons. This study evaluated the delay in the diagnosis and treatment of TB in Brazilian prisons. METHODS: A retrospective cohort study was conducted between 2007 and 2015 using data from the five largest male prisons in Mato Grosso do Sul, Brazil. TB case data was collected from the National Database of Notifiable Diseases (SINAN), GAL-LACEN, and prison medical records. The following variables were recorded: prison, year of diagnosis, age, race, education, HIV status, smoking status, comorbidities, number of symptoms, percentage of cures, delay in diagnosis, patient delay, provider delay, laboratory delay, and delay in treatment. Descriptive statistics were used for the variables of interest. RESULTS: A total of 362 pulmonary TB cases were identified. The average time between the first symptom and reporting of data was 94 days. The mean time between symptom onset and laboratory diagnosis was 91 days. The average time from symptom onset to first consultation was 80 days. The time between diagnosis and treatment initiation was 5 days. CONCLUSIONS: Delays were significant between reporting of the first symptoms and diagnosis and significantly smaller from the time between notification and start of treatment. Control strategies should be implemented to diagnose cases through active screening, to avoid delays in diagnosis and treatment, and to reduce TB transmission.

Prevalence and associated factors of mental health disorders among Brazilian healthcare workers in times of the COVID-19 pandemic: A web-based cross-sectional study.

The COVID-19 pandemic in Brazil affected mental health among healthcare workers. To objective of this study was to evaluate the mental health of healthcare workers in in the central-west region of the Brazil, estimating the prevalence of mental health disorders, and investigating associated factors, perceptions of safety, and self-perceptions about mental health in times of the COVID-19 pandemic. The questionnaire was divided into two parts that included general information and perceptions about the work process and identified symptoms using the Depression Anxiety Stress Scale-21 (DASS-21), and multiple linear regression analysis was conducted. A total of 1,522 healthcare workers participated in the survey. Overall prevalence of symptoms was calculated for depression (58.7%), anxiety (59.7%), and stress (61.7%). Physicians had 3.75 times greater risk of depression (1.59-8.85, 95% CI). Independent variables associated with depression symptoms were not feeling safe with the way services were organized (1.12:1.03-1.21, 95% CI) and self-perception of poor mental health (8.06: 4.03-16.10% CI). Working in management was protective, and married professionals had 12% lower risk of exhibiting symptoms of depression (0.79-0.99, 95% CI). Participants with self-perception of poor mental health had 4.63 greater risk for symptoms of anxiety (2.58-8.31, 95% CI). Protective factors were not having sought support for mental health (0.90: 0.82-0.99, 95% CI), having a graduate degree (0.71: 0.54-0.94, 95% CI), and not having been diagnosed with COVID-19 (0.90: 0.83-0.98, 95% CI). Perception of poor mental health was associated with 6.95-fold greater chance of developing stress symptoms. Protective factors from stress were having a degree in dentistry (0.81: 0.68-0.97, 95% CI), residing in Mato Grosso do Sul (0.91: 0.85-0.98, 95% CI), and not having sought mental health support services (0.88: 0.82-0.95, 95% CI). The prevalence of mental health disorders is high among healthcare workers, and is associated with professional category, organization of services provided, and self-perception of poor mental health, reinforcing the need for preventative measures.

Delay in the diagnosis and treatment of tuberculosis in prisons in Mato Grosso do Sul, Brazil

ABSTRACT Background: The number of tuberculosis (TB) cases in prisons is higher than that in the general population and has been reported as the most common cause of death in prisons. This study evaluated the delay in the diagnosis and treatment of TB in Brazilian prisons. Methods: A retrospective cohort study was conducted between 2007 and 2015 using data from the five largest male prisons in Mato Grosso do Sul, Brazil. TB case data was collected from the National Database of Notifiable Diseases (SINAN), GAL-LACEN, and prison medical records. The following variables were recorded: prison, year of diagnosis, age, race, education, HIV status, smoking status, comorbidities, number of symptoms, percentage of cures, delay in diagnosis, patient delay, provider delay, laboratory delay, and delay in treatment. Descriptive statistics were used for the variables of interest. Results: A total of 362 pulmonary TB cases were identified. The average time between the first symptom and reporting of data was 94 days. The mean time between symptom onset and laboratory diagnosis was 91 days. The average time from symptom onset to first consultation was 80 days. The time between diagnosis and treatment initiation was 5 days. Conclusions: Delays were significant between reporting of the first symptoms and diagnosis and significantly smaller from the time between notification and start of treatment. Control strategies should be implemented to diagnose cases through active screening, to avoid delays in diagnosis and treatment, and to reduce TB transmission.

The role of prisons in disseminating tuberculosis in Brazil: A genomic epidemiology study.

Background: Globally, prisons are high-incidence settings for tuberculosis. Yet the role of prisons as reservoirs of M. tuberculosis, propagating epidemics through spillover to surrounding communities, has been difficult to measure directly. Methods: To quantify the role of prisons in driving wider community M. tuberculosis transmission, we conducted prospective genomic surveillance in Central West Brazil from 2014 to 2019. We whole genome sequenced 1152 M. tuberculosis isolates collected during active and passive surveillance inside and outside prisons and linked genomes to detailed incarceration histories. We applied multiple phylogenetic and genomic clustering approaches and inferred timed transmission trees. Findings: M. tuberculosis sequences from incarcerated and non-incarcerated people were closely related in a maximum likelihood phylogeny. The majority (70.8%; 46/65) of genomic clusters including people with no incarceration history also included individuals with a recent history of incarceration. Among cases in individuals with no incarceration history, 50.6% (162/320) were in clusters that included individuals with recent incarceration history, suggesting that transmission chains often span prisons and communities. We identified a minimum of 18 highly probable spillover events, M. tuberculosis transmission from people with a recent incarceration history to people with no prior history of incarceration, occurring in the state's four largest cities and across sampling years. We additionally found that frequent transfers of people between the state's prisons creates a highly connected prison network that likely disseminates M. tuberculosis across the state. Interpretation: We developed a framework for measuring spillover from high-incidence environments to surrounding communities by integrating genomic and spatial information. Our findings indicate that, in this setting, prisons serve not only as disease reservoirs, but also disseminate M. tuberculosis across highly connected prison networks, both amplifying and propagating M. tuberculosis risk in surrounding communities. Funding: Brazil's National Council for Scientific and Technological Development and US National Institutes of Health.

All-cause and cause-specific mortality during and following incarceration in Brazil: A retrospective cohort study.

BACKGROUND: Mortality during and after incarceration is poorly understood in low- and middle-income countries (LMICs). The need to address this knowledge gap is especially urgent in South America, which has the fastest growing prison population in the world. In Brazil, insufficient data have precluded our understanding of all-cause and cause-specific mortality during and after incarceration. METHODS AND FINDINGS: We linked incarceration and mortality databases for the Brazilian state of Mato Grosso do Sul to obtain a retrospective cohort of 114,751 individuals with recent incarceration. Between January 1, 2009 and December 31, 2018, we identified 3,127 deaths of individuals with recent incarceration (705 in detention and 2,422 following release). We analyzed age-standardized, all-cause, and cause-specific mortality rates among individuals detained in different facility types and following release, compared to non-incarcerated residents. We additionally modeled mortality rates over time during and after incarceration for all causes of death, violence, or suicide. Deaths in custody were 2.2 times the number reported by the national prison administration (n = 317). Incarcerated men and boys experienced elevated mortality, compared with the non-incarcerated population, due to increased risk of death from violence, suicide, and communicable diseases, with the highest standardized incidence rate ratio (IRR) in semi-open prisons (2.4; 95% confidence interval [CI]: 2.0 to 2.8), police stations (3.1; 95% CI: 2.5 to 3.9), and youth detention (8.1; 95% CI: 5.9 to 10.8). Incarcerated women experienced increased mortality from suicide (IRR = 6.0, 95% CI: 1.2 to 17.7) and communicable diseases (IRR = 2.5, 95% CI: 1.1 to 5.0). Following release from prison, mortality was markedly elevated for men (IRR = 3.0; 95% CI: 2.8 to 3.1) and women (IRR = 2.4; 95% CI: 2.1 to 2.9). The risk of violent death and suicide was highest immediately post-release and declined over time; however, all-cause mortality remained elevated 8 years post-release. The limitations of this study include inability to establish causality, uncertain reliability of data during incarceration, and underestimation of mortality rates due to imperfect database linkage. CONCLUSIONS: Incarcerated individuals in Brazil experienced increased mortality from violence, suicide, and communicable diseases. Mortality was heightened following release for all leading causes of death, with particularly high risk of early violent death and elevated all-cause mortality up to 8 years post-release. These disparities may have been underrecognized in Brazil due to underreporting and insufficient data.

Yield, Efficiency, and Costs of Mass Screening Algorithms for Tuberculosis in Brazilian Prisons.

BACKGROUND: Tuberculosis (TB) is a major cause of morbidity and mortality among incarcerated populations globally. We performed mass TB screening in 3 prisons and assessed yield, efficiency, and costs associated with various screening algorithms. METHODS: Between 2017 and 2018, inmates from 3 prisons in Brazil were screened for TB by symptom assessment, chest radiography, sputum testing by Xpert MTB/RIF fourth-generation assay, and culture. Chest radiographs were scored by an automated interpretation algorithm (Computer-Aided Detection for Tuberculosis [CAD4TB]) that was locally calibrated to establish a positivity threshold. Four diagnostic algorithms were evaluated. We assessed the yield (percentage of total cases found) and efficiency (prevalence among those screened) for each algorithm. We performed unit costing to estimate the costs of each screening or diagnostic test and calculated the cost per case detected for each algorithm. RESULTS: We screened 5387 prisoners, of whom 214 (3.9%) were diagnosed with TB. Compared to other screening strategies initiated with chest radiography or symptoms, the trial of all participants with a single Xpert MTB/RIF sputum test detected 74% of all TB cases at a cost of US$249 per case diagnosed. Performing Xpert MTB/RIF screening tests only on those with symptoms had a similar cost per case diagnosed (US$255) but missed 35% more cases (73 vs 54) as screening all inmates. CONCLUSIONS: In this prospective study in 3 prisons in a high TB burden country, we found that testing all inmates with sputum Xpert MTB/RIF was a sensitive approach, while remaining cost-efficient. These results support use of Xpert MTB/RIF for mass screening in TB-endemic prisons.

Risk Stratification and Factors Associated with Abandonment of Tuberculosis Treatment in a Secondary Referral Unit.

PURPOSE: To study the factors associated with the risk of discontinuing active tuberculosis treatment among patients in an outpatient referral unit and to analyze the association between patients' abandonment risk score and their odds of discontinuing the treatment. PATIENTS AND METHODS: In this cohort study, tuberculosis patients were prospectively followed up from June 2012 through July 2019 at a secondary tuberculosis referral unit in Mato Grosso do Sul, Brazil. At initial consultation, patients were interviewed using a standardized questionnaire and were assigned a score for the risk of treatment abandonment by the nurse. Univariate and multivariate analyses were performed using logistic regression. RESULTS: One hundred and forty-eight patients were included in the study, of which 65.0% (96/148) were male. Their mean age was 43.3 ± 14.8 years (range: 18-89 years). Smoking, drug use, repeated admissions, and a high abandonment risk score were the variables associated with the highest risk of discontinuing the treatment. The rate of tuberculosis and human immunodeficiency virus coinfection was 37.2%. The overall rate of global treatment abandonment was 10.8% (95% confidence interval [CI]: 6.1-16.2). Upon stratification of patients that abandoned by the risk score, 22.9% (8/35) of the ones that abandoned had a high risk, 10.9% (6/55) had an intermediate risk, and 3.5% (2/58) had a low risk of treatment abandonment. In multivariate analysis, the factors associated with abandoning the treatment were smoking [adjusted odds ratio (aOR) = 4.91 (95% CI: 1.08, 22.32)] and undergoing retreatment (aOR) = 3.66 (95% CI: 1.04, 12 88). CONCLUSION: Smoking and undergoing retreatment were independent risk factors for tuberculosis treatment abandonment in this center. Risk stratification can help prioritize the strengthening of treatment adherence among patients at higher risk of abandoning treatment in referral units.

Maternal mortality according to race/skin color in Mato Grosso do Sul, Brazil, from 2010 to 2015 / Mortalidade materna segundo raça/cor, em Mato Grosso do Sul, Brasil, de 2010 a 2015

Abstract Objectives: to investigate the epidemiological profile, by race/skin color, of maternal deaths in the state of Mato Grosso do Sul, Brazil. Methods: the present epidemiological study of maternal death distribution by race/skin color was based on data extracted from Brazilian mortality and livebirth information systems from 2010 to 2015. The maternal mortality ratio and the specific maternal mortality ratio were calculated and analyzed according to obstetric variables. Results: the death risk for black (RR = 4.3, CI95%= 2.088.71) and indigenous women (RR = 3.7, CI95% 2.26.23) was approximately fourfold in comparison to the risk for white women. For direct causes of death, the state of Mato Grosso do Sul showed higher levels, 74.1%, as well as for most races/skin colors in the first triennium. The specific maternal mortality ratio was higher among black and indigenous women aged30 to 39 years old (416.7 and 651.8, respectively) per 100,000 live births (p<0.05). Conclusions: higher maternal mortality ratio for indigenous and black women and the predominance of deaths related to direct obstetric causes among race/skin color categories reflect inadequate health care during pregnancy and puerperium.

Resumo Objetivos: Analisar o perfil epidemiológico dos óbitos maternos segundo raça/cor em Mato Grosso do Sul. Métodos: Estudo epidemiológico dos óbitos maternos segundo raça/cor, a partir dos dados extraídos dos Sistemas de Informações de Mortalidade e de Nascidos Vivos, de 2010 a 2015. Foram calculadas a razão de mortalidade materna, razão de mortalidade materna específica e análise dos óbitos maternos segundo variáveis obstétricas. Resultados: O risco de óbito de mulheres pretas (RR = 4,3; IC95%= 2,088,71) e indígenas (RR = 3,7; IC95%= 2,26,23) foi aproximadamente quatro vezes maior quando comparadas às brancas. As causas obstétricas diretas apresentaram maiores frequências, tanto para o Estado de Mato Grosso do Sul, como para a maioria das raças/cor no primeiro triênio. A razão da mortalidade materna específica foi elevada entre as mulheres indígenas e pretas, 651,8 e 416,7 óbitos por 100 mil nascidos vivos, respectivamente, na faixa etária entre 30 a 39 anos (p<0,05). Conclusão: A elevada razão de mortalidade materna para as mulheres indígenas e pretas e o predomínio de óbitos relacionados às causas obstétricas diretas entre as categorias de raça/cor refletem a inadequada assistência à saúde no período gravídico puerperal.

Estudo multicêntrico da prevalência de tuberculose e HIV na população carcerária do Estado do Mato Grosso do Sul / Multicenter study of the prevalence of tuberculosis and HIV in the prison population of the State of Mato Grosso do Sul

INTRODUÇÃO: Estudos anteriores relataram maior prevalência de Tuberculose e HIV entre os prisioneiros do que na população geral no Brasil, mas existem dados limitados disponíveis para facilitar o desenvolvimento de intervenções efetivas neste cenário de alta transmissão. O objetivo deste estudo foi avaliar a prevalência e os fatores de risco associados à Tuberculose e ao HIV. METODOLOGIA: Realizado questionário para a amostra de detentos de 12 prisões em Mato Grosso do Sul (Brasil), prova tuberculínica, coletado sangue para teste de HIVe duas amostras de escarro para baciloscopia e cultura de participantes que relataram tosse de qualquer duração, de Janeiro a Dezembro de2013. RESUILTADOS: Foram recrutados 3.380 detentos, dos quais 2.861(84,6%) eram homens de 8 prisões e 519 (15,4%) eram mulheres de4 prisões. Entre os 1.020 (30%) indivíduos que relataram tosse, 691(68%) coletaram escarro e foram identificados 31 casos de tuberculose ativa, com uma prevalência de 917 por 100.000 detentos. A prevalência de tuberculose latente foi de 22,5% e 11,7% para homens e mulheres,respectivamente. Dos participantes, 55 (1,63%) são soropositivos: 45(1,58%) homens e 10 mulheres (1,93%). CONCLUSÕES: Observou-se que a prevalência de tuberculose ativa e HIV são mais elevadas entre detentos do que na população geral, o que indica um alto risco de infecção e transmissão dentro dessas configurações. Para melhorar o controle da tuberculose nas prisões é necessária a detecção de casos de TB ativa em presídios através da triagem frequente e detecção de casos passiva e ativa.

BACKGROUND: Prior studies have reported higher Tuberculosis and HIVprevalence among prisoners than the general population in Brazil, yet there are limited data available to facilitate the development of effectiveinterventions in this high-transmission setting. The aim of this study wasto evaluate the prevalence and risk factors associated with TB and HIV. METHODS: We administered a questionnaire and tuberculin skin test (TST)to a population-based sample of inmates from 12 prisons in Mato Grasso do Sul (Brazil) and collected sera for HIV testing and two sputum samplesfor smear microscopy and culture from participants reporting a cough ofany duration, from January to December 2013. RESULTS: We recruited 3,380inmates, of which 2,861 (84.6%) were males from 8 prisons, and 519(15.4%) were females from 4 prisons. Among the 1,020 (30%) subjectswho reported a cough, we obtained sputum from 691 (68%) and identified31 cases of active TB for a prevalence of 917 per 100,000 prisoners. The prevalences of LTBI were 22.5% and 11.7% for male and female prisoners, respectively. Of these participants, 55 (1.63%) tested HIV-positive: 45(1.58%) men and 10 women (1.93%). It is observed that the prevalence ofTB and HIV are higher in prisons than in urban populations, indicating ahigh risk of infection and transmission within these settings. CONCLUSIONS: It is observed that the prevalence of Tuberculose and HIV are higher inprisons than in urban populations, indicating a high risk of infection andtransmission within these settings. For enhancing TB control in prisons is necessary case detection for active TB in prison facilities through frequent screening and passive and active case-finding of inmates.

Impact of mass-screening on tuberculosis incidence in a prospective cohort of Brazilian prisoners.

BACKGROUND: Globally, prison inmates are a high-risk population for tuberculosis (TB), but the specific drivers of disease and impact of mass screening interventions are poorly understood. METHODS: We performed a prospective cohort study to characterize the incidence and risk factors for tuberculosis infection and disease in 12 Brazilian prisons, and to investigate the effect of mass screening on subsequent disease risk. After recruiting a stratified random sample of inmates, we administered a questionnaire to ascertain symptoms and potential risk factors for tuberculosis; performed tuberculin skin testing (TST); collected sera for HIV testing; and obtained two sputum samples for smear microscopy and culture, from participants reporting a cough of any duration. We repeated the questionnaire and all tests for inmates who remained incarcerated after 1 year. TST conversion was defined as TST ≥10 mm and an induration increase of at least 6 mm in an individual with a baseline TST <10 mm. Cox proportional hazard models were performed to identify risk factors associated with active TB. To evaluate the impact of screening on subsequent risk of disease, we compared TB notifications over one year among individuals randomized to screening for active TB with those not randomized to screening. RESULTS: Among 3,771 inmates recruited, 3,380 (89.6 %) were enrolled in the study, and 1,422 remained incarcerated after one year. Among 1,350 inmates (94.9 %) with paired TSTs at baseline and one-year follow-up, 25.7 % (272/1060) converted to positive. Among those incarcerated for the year, 10 (0.7 %) had TB at baseline and 25 (1.8 %) were diagnosed with TB over the subsequent year. Cases identified through active screening were less likely to be smear-positive than passively detected cases (10.0 % vs 50.9 %; p < 0.01), suggesting early case detection. However, there was no reduction in subsequent disease among individuals actively screened versus those not screened (1.3 % vs 1.7 %; p = 0.88). Drug use during the year (AHR 3.22; 95 % CI 1.05-9.89) and knows somebody with TB were (AHR 2.86; 95 % CI 1.01-8.10) associated with active TB during one year of follow up CONCLUSIONS: Mass screening in twelve Brazilian prisons did not reduce risk of subsequent disease in twelve Brazilian prisons, likely due to an extremely high force of infection. New approaches are needed to control TB in this high-transmission setting.

A Cross-Sectional Survey of HIV Testing and Prevalence in Twelve Brazilian Correctional Facilities.

BACKGROUND: Prior studies have reported higher HIV prevalence among prisoners than the general population in Brazil, but data have been derived from single prisons. The aim of this study was to evaluate HIV testing practices, prevalence and linkage to care among inmates in a network of 12 prisons. METHODS: We administered a questionnaire to a population-based sample of inmates from 12 prisons in Central-West Brazil and collected sera for HIV and syphilis testing from January to December 2013. We evaluated factors associated with HIV testing and infection using multivariable logistic regression models. Six months after HIV testing, we assessed whether each HIV-infected prisoner was engaged in clinical care and whether they had started antiretroviral therapy. RESULTS: We recruited 3,362 inmates, of whom 2,843 (85%) were men from 8 prisons, and 519 (15%) were women from 4 prisons. Forty-five percent of participants reported never having been tested for HIV previously. In multivariable analysis, the variables associated with previous HIV testing were lack of a stable partner (adjusted odds ratio [AOR]: 1.38; 95% CI: 1.18-1.60), completed more than four years of schooling (AOR 1.40; 95% CI: 1.20-1.64), history of previous incarceration (AOR: 1.68; 95% CI: 1.43-1.98), history of mental illness (AOR 1.52; 95% CI: 1.31-1.78) and previous surgery (AOR 1.31; 95% CI: 1.12-1.52). Fifty-four (1.6%) of all participants tested positive for HIV; this included 44 (1.54%) men and 10 (1.92%) women. Among male inmates, HIV infection was associated with homosexuality (AOR 6.20, 95% CI: 1.73-22.22), self-report of mental illness (AOR 2.18, 95% CI: 1.13-4.18), history of sexually transmitted infections (AOR 3.28, 95% CI: 1.64-6.56), and syphilis sero-positivity (AOR 2.54, 95% CI: 1.20-5.39). Among HIV-infected individuals, 34 (63%) were unaware of their HIV status; only 23 of these 34 (68%) newly diagnosed participants could be reached at six month follow-up, and 21 of 23 (91%) were engaged in HIV care. CONCLUSIONS: HIV testing rates among prison inmates are low, and the majority of HIV-infected inmates were unaware of their HIV diagnosis. Incarceration can be an opportunity for diagnosis and treatment of HIV among vulnerable populations who have poor access to health services, but further work is needed on transitional HIV care for released inmates.

Active and latent tuberculosis in Brazilian correctional facilities: a cross-sectional study.

BACKGROUND: Tuberculosis (TB) rates among prisoners are more than 20 times that of the general population in Brazil, yet there are limited data available to facilitate the development of effective interventions in this high-transmission setting. We aimed to assess risk factors for TB infection and evaluate the yield of mass screening for active disease among inmates. METHODS: We administered a questionnaire and tuberculin skin test (TST) to a population-based sample of inmates from 12 prisons in Central-West Brazil and collected sera for HIV testing and two sputum samples for smear microscopy and culture from participants reporting a cough of any duration. Hierarchical Poisson regression models were used to evaluate factors associated with latent tuberculosis infection (LTBI). RESULTS: We recruited 3,380 inmates, of which 2,861 (84.6%) were males from 8 prisons, and 519 (15.4%) were females from 4 prisons. Among the 1,020 (30%) subjects who reported a cough, we obtained sputum from 691 (68%) and identified 31 cases of active TB for a point prevalence of 917 (95% CI, 623-1302) per 100,000 prisoners. Evaluation of the two sputum smear samples failed to identify 74% of the TB cases, and 29% of the cases reported less than 2 weeks of symptoms. Obtaining a second culture identified an additional 7 (24%) cases. The prevalences of LTBI were 22.5% and 11.7% for male and female prisoners, respectively and duration of incarceration (in years) was associated with LTBI in male and female in the multivariable model (1.04, 95% CI, 1.01-1.07 and 1.34, 95% CI, 1.06-1.70, respectively). The prevalence of LTBI is 8.6% among newly incarcerated inmates, among whom LTBI prevalence significantly increased by 5% with each year of incarceration. CONCLUSIONS: Although the overall LTBI prevalence among inmates in Central-West Brazil is low, tuberculosis incidence is high (>1,800/100,00), likely due to the high force of infection among a largely susceptible inmate population. Efforts to reduce transmission in prisons may require mass screening for active TB, utilizing sputum culture in case-detection protocols.

Health-service performance of TB treatment for indigenous and non-indigenous populations in Brazil: a cross-sectional study.

BACKGROUND: Health-service evaluation studies are fundamental for proposing interventions and ensuring improvements in healthcare quality. The present study assesses the performance of health services for indigenous and non-indigenous populations with regard to tuberculosis (TB) control. METHODS: Interviews with TB patients who underwent treatment between 2009 and 2011 were conducted using the Primary Care Assessment Tool adapted for TB care in Brazil. RESULTS: Primary healthcare (PHC) was the first treatment for most patients at symptom onset, and the diagnoses were typically performed by specialized services. Many patients experienced delayed TB diagnoses that required more than three medical appointments (51% and 47% for indigenous and non-indigenous populations, respectively). Indigenous people received social support, such as basic-needs grocery packages (2.19 ± 1.63 vs. 1.13 ± 0.49 for non-indigenous people, p < 0.01) and home visits from health professionals, with an emphasis on the performance of directly observed treatment strategies (DOT; 4.57 ± 0.89 vs. 1.68 ± 1.04 for non-indigenous people, p < 0.01). CONCLUSIONS: Regardless of the differences between indigenous and non-indigenous populations, the time needed to receive a TB diagnosis was unsatisfactory for both groups. Furthermore, DOT must be performed with better coverage among non-indigenous patients.