High Prevalence of Latent Tuberculosis Infection among Persons Deprived of Liberty in a Malaysian Prison

Rising tuberculosis incidence and mortality necessitate enhanced attention to prevention in neglected high-risk venues like correctional facilities. We sought to identify prevalence and correlates of latent TB infection (LTBI) in Malaysias largest prison. From October 2019 to January 2023, people deprived of liberty (PDL) entering Kajang Prison underwent tuberculin skin testing, sputum examination, chest X-ray, and blood tests for HIV, HCV, and C-reactive protein (CRP); PDL with active tuberculosis were excluded. Multivariable logistic regression identified independent correlates of LTBI. Among 601 men without tuberculosis, median age was 42 (IQR 36-50) years with high prevalences of HIV (8.8%) and HCV (43.4%). LTBI prevalence was 68.2% (95%CI[64.4%-71.8%]); independent risk factors included opioid use disorder (OUD, AOR=1.95; 95%CI[1.25-3.05]), pre-incarceration homelessness (AOR=1.89; 95%CI[1.13-2.50]), and HCV (AOR=1.68; 95%CI[1.13-2.50]). Pre-incarceration cannabis use (AOR=0.69; 95%CI[0.39-0.96]) was negatively associated with LTBI, which was also found in people with HIV (AOR=0.10; 95%CI[0.01-0.51]). Among people without HIV, having OUD (AOR=2.32; 95%CI[1.48-3.68]), HCV (AOR=1.64; 95%CI[1.09-2.48]) and CRP [≥]5mg/ml (AOR=1.90; 95%CI[1.04-3.65]) were independently associated with LTBI, while methamphetamine use reduced odds of LTBI (AOR=0.58; 95%CI[0.33-0.98]). LTBI prevalence in Malaysias largest prison was high, highlighting the need for routine screening and implementation of TB preventive therapy in high-risk settings like prisons.