Prevalence of Tuberculosis in HIV-positive Prisoners: A Systematic Review and Meta-analysis.

Tuberculosis (TB) and HIV constitute the main burden of infectious diseases worldwide. Imprisonment is an important risk factor for contracting TB, especially among those living with HIV. This systematic review summarizes the available data on the prevalence of TB among HIV-positive prisoners; which may support improved targeted TB/HIV prevention plans. We electronically examined published studies up to December 2017 with the aim of finding articles that investigated the prevalence of TB in HIV-positive prisoners. MEDLINE, SCOPUS, Embase, and Web of Science electronic databases were searched with no restriction on language or time. A random effects model was used to conduct the meta-analysis and generate a summary estimate for the global prevalence of TB among HIV-positive prisoners; and subgroup estimates by continent. The meta-analysis included 22 studies published from 1992 to 2016. In total, 2,465 articles were retrieved and 22 papers met inclusion criteria. Eligible papers contained 220,101 prisoners, with 1,611 cases of TB in 6,126 HIV-positive subjects. Globally, the pooled prevalence of TB in HIV-positive prisoners was 32.6% [95% confidence interval (CI): 27.5% to 38.2%; p-value for heterogeneity=0.001]. Results of the subgroup analysis by continent were as follows: Africa, 14% (CI: 8% to 24%); North/South America, 37% (CI: 31% to 44%); Asia, 35% (CI: 12% to 68%); and Europe, 25% (CI: 12% to 45%).

CONCLUSIONS: The prevalence of TB among HIV-positive prisoners is high worldwide. Screening of TB in this population is essential for the treatment of both diseases. Syndemics of TB and HIV in prisoners during the past three decades have created an alarming situation across the world. Hence, coordinated policies are essential for the early identification and effective treatment of this vulnerable population.