TB in prisons is a public health issue

The alarming findings from the recent report by Makerere University School of Public Health serve as a wake-up call that we cannot afford to ignore. 

Nearly half of the country’s prison population is infected with latent tuberculosis (TB), with active TB rates eight times higher than in the general population. This is not just an issue within the prison system but rather a national public health emergency. 

Overcrowding, poor ventilation, malnutrition, and high HIV prevalence have created a perfect breeding area for TB transmission within prison walls. Facilities designed for 22,000 inmates now hold more than 79,000. In such conditions, latent TB, which is normally dormant, can easily become active, spreading rapidly among inmates, staff, and eventually into the communities to which prisoners return. This crisis, as revealed by a national survey of 6,000 inmates and staff, requires urgent action because the statistics are alarming. 

More than 48 percent of inmates have latent TB, and active TB rates are highest among newly incarcerated individuals, especially in western Uganda and Kampala. These infections are not isolated, but they are connected to the community and perpetuated by systemic neglect. TB is a preventable and curable disease. However, more than 4,700 Ugandans die from it each year, and more than half of TB patients face severe financial hardship. 

The disease affects individuals in their most productive years, causing a ripple effect through families, workplaces, and the economy. TB is as much an economic issue as it is a medical one. While the government's commitment to incorporating these findings into the 2025–2030 National TB and HIV/Aids Strategy is a positive step, mere promises will not solve the crisis. 

Actions such as regular TB screening upon entry to prisons, regular symptom checks, the use of digital X-rays and mobile testing vans, and immediate isolation and treatment of infected individuals are all needed. Providing preventive treatment to all eligible inmates, regardless of their HIV status, is crucial. This is not just about protecting the health of inmates but it is about safeguarding the nation. As emphasised by Dr Mary Boyd of the CDC, controlling TB in prisons is essential for community health. If left unaddressed, prisons will continue to be breeding grounds for TB, including its dangerous multidrug-resistant forms. Uganda is one of the 30 countries with the highest TB burden globally. We must invest financially, politically, and socially to reverse this trend. Ignoring this issue risks undoing decades of progress in the global fight against TB.