Infectious Disease
Population-level tuberculosis burden attributable to incarceration and impacts of decarceral interventions in Latin America: a mathematical modeling study Yiran E Liu* Yiran Liu Yasmine Mabene Sergio Camelo Jeremy Goldhaber-Fiebert Julio Croda Jason R Andrews
Globally, tuberculosis (TB) incidence has declined by 8.7% since 2015, with 10.6 million cases in 2022. In contrast, Latin America has seen a 19% increase in TB incidence, highlighting the need to understand and address key TB drivers in the region, including incarceration. In Latin America, the prison population has quadrupled since 1990, and TB risk in prisons is 26 times higher than in the general population. In 2022, 9% of diagnosed TB cases in the region occurred in prisons. The true population attributable fraction (PAF) for incarceration is unknown but likely greater, due to under-diagnosis and to prison-acquired infections that progress and spread outside of prison. To assess the true role of incarceration as a TB driver, we developed and calibrated a compartmental transmission model for six diverse countries across Latin America: Argentina, Brazil, Colombia, El Salvador, Mexico, and Peru. We estimate that in 2019, the PAF for incarceration ranged from 6.4% (95% CrI; 4.0-9.8) in Mexico to 57.6% (51.1-63.2) in El Salvador. This corresponds to a range of absolute incident cases from 926 (623-1960) in Argentina to 31,837 (24,723-41,258) in Brazil. These estimates are commensurate with PAFs for other key TB risk factors like HIV and undernutrition. Looking forward, compared to a base-case scenario of stable incarceration rates, we find a substantial impact of decarceration on population TB incidence over a ten-year period (Fig 1). For instance, in Brazil, a 50% decrease in entry rates, 50% increase in release rates, or both by 2034 could reduce population TB incidence by 13.1% (9.0-18.0), 13.2% (7.3-20.4), or 21.0% (13.8-29.1). Our findings reveal the outsized population TB burden attributable to incarceration in Latin America and the potential for decarceral interventions to re-ignite TB progress in the region.
Fig 1. A) Incarceration prevalence under each scenario. B) Percent difference in population TB incidence in 2034 relative to stable scenario.
