title: Tuberculosis incidence and treatment completion among Ugandan prison inmates.
abstract: BACKGROUND
  The Uganda Prisons Service (UPS) is responsible for the health of approximately 32 500 inmates in 233 prisons. In 2008 a rapid UPS assessment estimated TB prevalence at 654/100 000, three times that of the general population (183/100 000). Although treatment programs exist, little is known about treatment completion in sub-Saharan African prisons.
  
  
  METHODS
  We conducted a retrospective study of Ugandan prisoners diagnosed with TB from June 2011 to November 2012. We analyzed TB diagnosis, TB-HIV comorbidity and treatment completion from national registers and tracked prison transfers and releases.
  
  
  RESULTS
  A total of 469 prisoners were diagnosed with TB over the 1.5-year period (incidence 955/100 000 person-years). Of 466 prisoners starting treatment, 48% completed treatment, 43% defaulted, 5% died and 4% were currently on treatment. During treatment, 12% of prisoners remaining in the same prison defaulted, 53% of transfers defaulted and 81% of those released were lost to follow-up. The odds of defaulting were 8.36 times greater among prisoners who were transferred during treatment.
  
  
  CONCLUSIONS
  TB incidence and treatment default are high among Ugandan prisoners. Strategies to improve treatment completion and prevent multidrug resistance could include avoiding transfer of TB patients, improving communications between prisons to ensure treatment follow-up after transfer and facilitating transfer to community clinics for released prisoners.
authors.affiliation: <label>*</label>Epidemic Intelligence Service, Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.
authors.forename: A
authors.initials: A
authors.lastname: Schwitters
authors.affiliation: <label><sup>†</sup></label>Uganda Prisons Service, Kampala.
authors.forename: M
authors.initials: M
authors.lastname: Kaggwa
authors.affiliation: <label><sup>‡</sup></label>Division of Global HIV/AIDS, Center for Global Health, CDC, Entebbe, Uganda.
authors.forename: P
authors.initials: P
authors.lastname: Omiel
authors.affiliation: <label><sup>‡</sup></label>Division of Global HIV/AIDS, Center for Global Health, CDC, Entebbe, Uganda.
authors.forename: G
authors.initials: G
authors.lastname: Nagadya
authors.affiliation: <label><sup>†</sup></label>Uganda Prisons Service, Kampala.
authors.forename: N
authors.initials: N
authors.lastname: Kisa
authors.affiliation: <label><sup>‡</sup></label>Division of Global HIV/AIDS, Center for Global Health, CDC, Entebbe, Uganda.
authors.forename: S
authors.initials: S
authors.lastname: Dalal
mesh_terms: D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D055118:Medication Adherence; D015995:Prevalence; D011329:Prisoners / Q000706:statistics & numerical data*; D011330:Prisons; D012189:Retrospective Studies; D013997:Time Factors; D014376:Tuberculosis / Q000188:drug therapy / Q000453:epidemiology*; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents