Infectious Disease
Impact of the COVID-19 pandemic on incarceration and tuberculosis notification rates among individuals who are incarcerated in Europe and the Americas Amy Zheng* Amy Zheng Lena Faust Joshua Warren Leonardo Martinez
Background
People who are incarcerated are at higher risk for tuberculosis (TB) infection and disease due to the prison environment (e.g., overcrowding and poor ventilation) as well as individual risk factors (e.g., malnutrition and substance use). COVID-19 led to major disruptions in diagnosis and care TB programs globally. However, the impact of the pandemic on prison population counts and TB notification rates among people who are incarcerated, a high-risk, vulnerable group, is unknown.
Methods
In collaboration with the Pan American Health Organization (PAHO), European Centre for Disease Control and Prevention, and European World Health Organization Regional Office, we collected tuberculosis notification and incarceration data from 2010-2022. A joint hierarchical Bayesian time-series model with a negative binomial distribution was developed to predict prison population counts and TB notification rates for each country from 2020-2022. We compared these predicted estimates to observed trends to evaluate the impact COVID-19 on incarceration and TB notification rates.
Results
Of the 101 countries in Europe and PAHO, 79 and 45 countries were included for incarceration and notification rate outcomes, respectively. The impact of COVID-19 on incarceration levels was highly heterogeneous across countries and regions (Figure 1). In Europe, most countries reported lower TB notification rates in 2020 (16/21 countries) and 2020 (17/21 countries). In the Americas majority of countries had drops in TB notification rates during the pandemic (Figure 1). Countries in the Americas with greatest decreases in TB notification rates during the pandemic were more likely to be countries with a high tuberculosis burden in prisons (e.g., El Salvador, Venezuela, Peru).
Conclusion
Our findings suggest that the COVID-19 pandemic has substantially impacted tuberculosis notification rates in prisons. Countries with larger tuberculosis epidemics in prisons were especially impacted by the pandemic.
