Zheng Amy, Faust Lena, Harries Anthony D, Avedillo Pedro, Akodu Michael, Galvan Miranda, Barreto-Duarte Beatriz, Andrade Bruno B, Ugarte-Gil César, Garcia-Basteiro Alberto L, Espinal Marcos, Warren Joshua L, Martinez Leonardo
Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA; Department of Global Health, Boston University School of Public Health, Boston, MA, USA.
Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
Lancet Public Health. 2025 Apr;10(4):e285-e294. doi: 10.1016/S2468-2667(24)00325-6.
The COVID-19 pandemic disrupted tuberculosis control programmes globally; whether or not this disproportionately affected people who were incarcerated is unknown. We aimed to evaluate changes in incarceration and tuberculosis notifications in prisons in Europe and the Americas during the COVID-19 pandemic.
Data from WHO Pan American Health Organization (PAHO) and WHO Europe were used to conduct a joint hierarchical Bayesian negative binomial time-series. This approach accounted for world region, country-specific temporal trends, and country-specific autocorrelated random effects to simultaneously model and predict both annual prison population (ie, the offset) and prison tuberculosis cases (ie, the primary outcome). Results were used to calculate percentage differences between predicted and observed annual tuberculosis notifications and prison populations during the COVID-19 pandemic years (2020-22).
In total, 22 of 39 countries from PAHO and 25 of 53 countries from WHO Europe were included (representing 4·9 million people incarcerated annually), contributing 520 country-years of follow-up. Observed tuberculosis notifications in prisons were lower than predicted in 2020 (-26·2% [95% credible interval -66·3 to 7·8), 2021 (-46·4% [-108·8 to 3·9]), and 2022 (-48·9 [-124·4 to 10·3]). These decreasing trends were consistent across Europe and the Americas, but larger decreases were seen in low-burden settings in 2020 (-54·8% [-112·4 to -4·8]) and 2021 (-68·4% [-156·6 to -2·9]), high-burden settings in 2021 (-89·4% [-190·3 to -10·4]), and Central and North America in 2021 (-100·3% [-239·0 to -6·3]). Observed incarceration levels were similar to predicted levels (<10% difference overall) during all COVID-19 pandemic years.
Tuberculosis notifications in prisons from 47 countries in Europe and the Americas were lower than expected (at times >50% lower) during COVID-19 pandemic years, despite consistent incarceration levels. Reasons for this change in tuberculosis notifications might be multifactorial and include missed diagnoses and implementation of COVID-19 pandemic measures, reducing transmission. Greater prioritisation of people who are incarcerated is needed to ensure appropriate access to care in the face of future pandemics.
Canadian Institutes of Health Research, National Institutes of Health, and Oswaldo Cruz Foundation, Brazil.
新冠疫情扰乱了全球结核病控制项目；这种情况是否对被监禁人群产生了不成比例的影响尚不清楚。我们旨在评估新冠疫情期间欧洲和美洲监狱中监禁人数和结核病通报情况的变化。
利用世界卫生组织泛美卫生组织（PAHO）和世界卫生组织欧洲区域办事处的数据进行联合分层贝叶斯负二项式时间序列分析。这种方法考虑了世界区域、国家特定的时间趋势以及国家特定的自相关随机效应，以同时建模和预测年度监狱人口（即偏移量）和监狱结核病病例（即主要结果）。结果用于计算新冠疫情期间（2020 - 2022年）预测的和观察到的年度结核病通报数与监狱人口数之间的百分比差异。
总共纳入了来自PAHO的39个国家中的22个以及来自世界卫生组织欧洲区域办事处的53个国家中的25个（每年代表490万人被监禁），提供了520个国家年的随访数据。2020年（-26.2%[95%可信区间 -66.3至7.8]）、2021年（-46.4%[-108.8至3.9]）和2022年（-48.9[-124.4至10.3]）监狱中观察到的结核病通报数低于预测值。这些下降趋势在欧洲和美洲是一致的，但在2020年（-54.8%[-112.4至 -4.8]）和2021年（-68.4%[-156.6至 -2.9]）的低负担地区、2021年（-89.4%[-190.3至 -10.4]）的高负担地区以及2021年（-100.3%[-239.0至 -6.3]）的中北美洲下降幅度更大。在整个新冠疫情期间，观察到的监禁水平与预测水平相似（总体差异<10%）。
在新冠疫情期间，欧洲和美洲47个国家监狱中的结核病通报数低于预期（有时低>50%），尽管监禁水平保持稳定。结核病通报数变化的原因可能是多方面的，包括漏诊以及新冠疫情防控措施的实施减少了传播。在未来面对大流行时，需要更加优先考虑被监禁人群，以确保他们能够获得适当的医疗服务。
加拿大卫生研究院、美国国立卫生研究院以及巴西奥斯瓦尔多·克鲁兹基金会。
