Latent TB infection and blood borne viruses in a London prison: a cross sectional survey
Prisoners have a high burden of physical and mental health issues and despite well-documented high rates of active tuberculosis in London’s prison population, limited data are available regarding the prevalence of latent TB infection (LTBI) and the blood borne viruses (BBV) HIV, Hepatitis B & C. We have undertaken a screening programme to assess the prevalence of LTBI and BBVs within male prisoners in London.
METHODS:
Prisoners at a large male-only prison were approached to participate in the study on their day of admission. With consent, blood was drawn for TB IGRA (Quantiferon In-Tube) and BBVs. A questionnaire enquiring about clinical and social risk factors for TB and BBVs was completed and a logistic regression model was used to examine risk factors for infection.
RESULTS:
515 (93%) of 552 eligible prisoners approached agreed to take part in the study. The majority of participants were under the age of 35 (58%) and 38% were born in the UK. Homelessness (53.8% 95%CIs:49.4-58.3), problem drinking (22.0% 95%CIs:18.5-25.9), and injecting drug use (8.0 95%CIs:5.8-10.7) were common. Prevalence of LTBI was 11.5% (95%CIs:8.8-14.8), Hepatitis B (past and current) 7.8% (95%CIs:5.6-1.7) and Hepatitis C (past and current) 4.7% (95%CIs:3.0-6.9). After adjusting for age, there was strong evidence that country of birth was associated with increased odds of LTBI (OR 3.96 95%CI:2.14-7.31). Restricting the analysis to UK-born individuals, there was strong evidence that homelessness was associated with increased odds of LTBI (OR 3.67 95%CI:1.08-12.39).
CONCLUSIONS:
High rates of LTBI, Hepatitis C and Hepatitis B were found in our study population. For individuals born in the UK, those with a history of homelessness were at highest risk of LTBI. These levels of need have major implications for public and personal healthcare planning and should be recognised through appropriate targeted health and social policy.