Al-Darraji Haider Abdulrazzaq Abed, Kamarulzaman Adeeba, Altice Frederick L
Centre of Excellence for Research in AIDS, Faculty of Medicine, University of Malaya, Kuala Lumpur 59990, Malaysia.
BMC Public Health. 2014 Jan 10;14:22. doi: 10.1186/1471-2458-14-22.
Prisons continue to fuel tuberculosis (TB) epidemics particularly in settings where access to TB screening and prevention services is limited. Malaysia is a middle-income country with a relatively high incarceration rate of 138 per 100,000 population. Despite national TB incidence rate remaining unchanged over the past ten years, data about TB in prisons and its contribution to the overall national rates does not exist. This survey was conducted to address the prevalence of latent TB infection (LTBI) in Malaysia's largest prison.
From July to December 2010, all HIV-infected and a comparative group of HIV-uninfected prisoners housed separately in Kajang prison were asked to participate in the survey after explaining the study protocol. Subjects providing informed consent were interviewed using a structured questionnaire followed by the placement of tuberculin skin test (TST) with 2 TU of PPD RT-23 to subjects not being treated for active TB. TST was read after 48-72 hours and indurations of ≥ 5 mm and ≥ 10 mm were considered positive among HIV-infected and HIV-uninfected subjects, respectively. Additionally, HIV-infected inmates underwent phlebotomy for CD4 lymphocyte count assessment. A logistic regression model was explored to determine factors associated with TST positivity.
Overall, 286 subjects (138 HIV-infected and 148 HIV-uninfected) had complete data and TST results. The majority were men (95.1%), less than 40 years old (median age 36.0, SD 7.87), and Malaysians (93.3%). Most (82.5%) had been previously incarcerated and more than half (53.1%) reported sharing needles just prior to their incarceration. TST was positive in 88.8% (84.7% among HIV-infected and 92.5% among HIV-uninfected subjects) and was independently associated with being HIV-uninfected (AOR = 2.97, p = 0.01) and with frequent previous incarcerations (AOR = 1.22 for every one previous incarceration, p = 0.01) after adjusting for other potential confounding factors.
The prevalence of LTBI was extraordinary high in this sample of Malaysian prisoners, regardless of their age or HIV status. This warrants further examination of the size of the problem of TB in other congregate settings and the establishment of an evidence-based TB control program in Malaysian prisons with integrated TB, HIV and substance abuse components.
监狱持续助长结核病疫情，尤其是在结核病筛查和预防服务获取受限的环境中。马来西亚是一个中等收入国家，监禁率相对较高，每10万人口中有138人被监禁。尽管过去十年全国结核病发病率保持不变，但关于监狱结核病及其对全国总体发病率贡献的数据并不存在。本次调查旨在了解马来西亚最大监狱中潜伏性结核感染（LTBI）的流行情况。
2010年7月至12月，在向加影监狱中分别关押的所有感染HIV的囚犯以及一组未感染HIV的对照囚犯解释研究方案后，邀请他们参与调查。获得知情同意的受试者接受结构化问卷调查，随后对未接受活动性结核病治疗的受试者进行2 TU PPD RT - 23的结核菌素皮肤试验（TST）。48 - 72小时后读取TST结果，HIV感染受试者和未感染HIV受试者中硬结直径≥5 mm和≥10 mm分别被视为阳性。此外，对感染HIV的囚犯进行静脉穿刺以评估CD4淋巴细胞计数。探索逻辑回归模型以确定与TST阳性相关的因素。
总体而言，286名受试者（138名感染HIV和148名未感染HIV）有完整数据和TST结果。大多数是男性（95.1%），年龄小于40岁（中位年龄36.0岁，标准差7.87），且为马来西亚人（93.3%）。大多数（82.5%）曾被监禁，超过一半（53.1%）报告在入狱前曾共用针头。TST阳性率为88.8%（感染HIV的受试者中为84.7%，未感染HIV的受试者中为92.5%），在调整其他潜在混杂因素后，TST阳性与未感染HIV独立相关（比值比[AOR]=2.97，p = 0.01）以及与既往频繁入狱相关（每多一次既往入狱，AOR = 1.22，p = 0.01）。
在这个马来西亚囚犯样本中，LTBI的患病率极高，无论其年龄或HIV状况如何。这需要进一步研究其他聚集场所结核病问题的规模，并在马来西亚监狱建立一个包含结核病、HIV和药物滥用综合内容的循证结核病控制项目。
