Article Impact Level: HIGH Data Quality: STRONG Summary of The Lancet Public Health, 10(4), e285–e294. https://doi.org/10.1016/S2468-2667(24)00325-6 Dr. Amy Zheng et al.
Points
- The study assessed how COVID-19 affected tuberculosis notifications in prisons across Europe and the Americas, using a Bayesian time-series model on WHO data from 47 countries and over 500 country-years.
- Researchers found a steep decline in TB notifications in prisons during 2020, 2021, and 2022, with reductions of 26.2 percent, 46.4 percent, and 48.9 percent compared to predicted values.
- The decrease in TB reporting was especially pronounced in low-burden countries and some high-burden regions like Central and North America, where declines reached as high as 100.3 percent in 2021.
- Importantly, prison population sizes remained stable throughout the pandemic, suggesting that the drop in TB notifications was not caused by fewer incarcerated individuals being at risk.
- The findings suggest that COVID-19 measures and healthcare disruptions likely led to the underdiagnosis of TB in prisons, underscoring the need to protect healthcare access for incarcerated people during pandemics.
Summary
This study aimed to evaluate the impact of the COVID-19 pandemic on tuberculosis (TB) notifications in prisons across Europe and the Americas, assessing whether disruptions disproportionately affected incarcerated populations. Using data from WHO’s Pan American Health Organization (PAHO) and WHO Europe, the study employed a hierarchical Bayesian negative binomial time-series model. The model accounted for regional and country-specific trends, alongside country-specific random effects, to compare predicted and observed TB notifications and prison populations. The study covered 22 of 39 countries from PAHO and 25 of 53 countries from WHO Europe, representing 4.9 million incarcerated individuals annually, with a total of 520 country-years of follow-up.
The results revealed decreased TB notifications in prisons during the COVID-19 pandemic. TB notifications were lower than expected in 2020, 2021, and 2022 by 26.2%, 46.4%, and 48.9%, respectively. The decrease was consistent across both regions, though more pronounced in low-burden settings, with reductions of 54.8% and 68.4% in 2020 and 2021, respectively. High-burden settings, particularly in Central and North America, saw even more significant declines, with a 100.3% drop in 2021. Notably, observed incarceration levels remained similar to predicted levels with less than a 10% difference across the pandemic years, suggesting that the decline in TB notifications was not due to reduced prison populations.
These findings indicate that TB notifications in prisons were substantially lower than expected during the pandemic, with up to 50% reductions in some regions. This decrease may be attributed to missed diagnoses and the implementation of COVID-19 mitigation measures, which may have reduced transmission. The study highlights the need for greater prioritization of incarcerated individuals to ensure continued access to healthcare, especially during future pandemics.
Link to the article: https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(24)00325-6/fulltext
References Zheng, A., Faust, L., Harries, A. D., Avedillo, P., Akodu, M., Galvan, M., Barreto-Duarte, B., Andrade, B. B., Ugarte-Gil, C., Garcia-Basteiro, A. L., Espinal, M., Warren, J. L., & Martinez, L. (2025). Changes in incarceration and tuberculosis notifications from prisons during the COVID-19 pandemic in Europe and the Americas: A time-series analysis of national surveillance data. The Lancet Public Health, 10(4), e285–e294. https://doi.org/10.1016/S2468-2667(24)00325-6
