Smear positive pulmonary tuberculosis and HIV co-infection in prison settings of North Gondar Zone, Northwest Ethiopia

Background: In correctional settings tuberculosis is a public health concern. The incarcerated population is at greater risk for tuberculosis (TB) than the general population. The aim of this study was to determine the prevalence of smear positive pulmonary tuberculosis (PTB) and associated risk factors in prison settings. Methods: A cross-sectional study was conducted among prisoners of North Gondar zone where all inmates with a history of cough for ≥ 2 weeks were included. Socio-demographic characteristics and potential risk factors were assessed using a structured questionnaire. Spot-morning-spot sputum samples were collected, smears were prepared and stained with Auramine O stain and examined through light emitting diode- fluorescence microscope. All samples positive for acid-fast bacilli were further examined by GeneXpert MTB/RIF assay. Data was analyzed using SPSS version 20 and a P-value < 0.05 was taken as statistically significant. The multivariable logistic regression analysis was used to determine the association between risk factors and prison tuberculosis. Results: A total of 282 prison inmates suspected of PTB were enrolled in the study. The overall prevalence of smear positive PTB infection was 5.3 % (15/282), but none of the smear positive TB cases were resistant to rifampicin. The prevalence of HIV infection among TB suspected prisoners and smear positive PTB cases was 6 and 27 %, respectively. Moreover, smear positive PTB disease was significantly associated with smoking status, malnutrition, number of prison inmates per cell, poor cell ventilation, and a history of contact with TB patients. Conclusion: The prevalence of smear positive pulmonary tuberculosis among north Gondar prison inmates was still high although lower than previous reports. There was a high prevalence of HIV among smear positive PTB cases. Reducing the burden of prison inmates in a particular cell, preventing malnutrition, establishing ventilation system can possibly minimize the transmission of tuberculosis among prisoners.