Prison moves weaken tuberculosis treatment success

Tuberculosis is concentrated among people deprived of liberty, and past research has even shown higher TB treatment completion rates among incarcerated people compared with the general population. Yet the everyday realities of incarceration include frequent movements — transfers between facilities and releases back to the community — and little has been known about how those disruptions affect a person’s chances of finishing treatment. In a retrospective cohort study led by researchers including corresponding author Yasmine Mabene, investigators set out to quantify the impact of these movements on treatment outcomes. The team linked person-level incarceration records with TB notification data from the Notifiable Disease Information System for the Brazilian state of Mato Grosso do Sul, covering January 2006 through December 2018. From those linked records they built a cohort of people who were newly diagnosed with drug-susceptible TB and who began treatment while incarcerated. By comparing those who stayed in the same carceral facility during their treatment to those who were transferred or released before treatment ended, the study aimed to reveal whether movements related to incarceration create barriers to completing TB therapy.

To measure the association between incarceration-related movements and treatment success, researchers matched incarceration histories to TB notifications in the Notifiable Disease Information System for Mato Grosso do Sul (January 2006–December 2018). They included individuals with newly diagnosed drug-susceptible TB who initiated treatment while incarcerated and then categorized them by whether they remained in the same carceral facility, were transferred to other facilities, or were released to the community during treatment. The cohort comprised 1,274 people who started treatment while incarcerated: 849 (66.6%) remained in the same facility, 259 (20.3%) were transferred, and 166 (13.0%) were released during treatment. Treatment success within eight months occurred in 72.3% (614/849) of those who stayed put, 61.0% (158/259) of those transferred, and 49.4% (82/166) of those released. Using covariate-adjusted relative risk, the study found that transfers were associated with a 1.4-fold higher risk of unfavorable outcomes (95% CI: 1.2 to 1.7) and releases with a 1.6-fold higher risk (95% CI: 1.3 to 2.0) compared with staying in the same facility. Those released less than two months into treatment faced an especially large risk (adjusted relative risk [aRR]: 2.1, 95% CI: 1.6–2.6).

The findings point to a clear and practical problem: movements tied to incarceration — transfers between facilities and releases to the community — are common and appear to undermine the strong treatment completion rates often seen in carceral settings. By interrupting continuity of care, these moves more than modestly increase the likelihood of unfavorable outcomes, and very early release during treatment carries the highest risk. That suggests interventions should focus on maintaining uninterrupted TB treatment across any change in custody and ensuring smooth handoffs between prison healthcare and community health services after release. The authors conclude that strategies to guarantee continuity of care across carceral facilities and between prison and community health systems are urgently needed. If such coordinated approaches are implemented, they could help preserve the treatment advantage observed in incarcerated populations and improve outcomes for people impacted by incarceration.