Background Active search for tuberculosis cases through mass screening is widely described as a tool to improve case detection in hyperendemic settings. However, its effectiveness in high-risk populations, such as incarcerated people, is debated. Methods Between 2017 and 2021, three rounds of mass screening were carried out in three Brazilian prisons. Social and health questionnaires, chest X-rays and Xpert MTB/RIF were performed. Results Over 80% of the prison population was screened. Overall, 684 cases of pulmonary tuberculosis were diagnosed. Prevalence across screening rounds was not statistically different. Among incarcerated persons with symptoms, the overall prevalence of tuberculosis per 100,000 persons was 8,497 (95% CI, 7,346–9,811), 11,115 (95% CI, 9,471–13,082), and 7,957 (95% CI, 6,380–9,882) in screening rounds one, two and three, respectively. Similar to our overall results, there were no statistical differences between screening rounds and within individual prisons. We found no statistical differences in CAD4TB scores across screening rounds among people with tuberculosis – the median scores in rounds 1, 2, and 3 were 82 (IQR, 63–97), 77 (IQR, 60–94), and 81 (IQR, 67–92), respectively. Conclusions In this environment with hyperendemic rates of tuberculosis, three rounds of mass screening did not reduce the overall tuberculosis burden. In prisons, where a substantial amount of TB is undiagnosed annually, a range of complementary interventions and more frequent TB screening may be required.

中文翻译：

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巴西对被监禁者进行大规模结核病筛查

背景 通过大规模筛查主动寻找结核病病例被广泛描述为改善高流行环境中病例发现的工具。然而，它对高危人群（例如被监禁者）的有效性存在争议。方法 2017 年至 2021 年间，在巴西三所监狱进行了三轮大规模筛查。进行了社会和健康调查问卷、胸部 X 光检查和 Xpert MTB/RIF。结果 超过 80% 的监狱人口接受了筛查。总共诊断出684例肺结核病例。各轮筛查的患病率没有统计学差异。在有症状的监禁人员中，每 10 万人中结核病筛查总患病率为 8,497 人（95% CI，7,346–9,811）、11,115 人（95% CI，9,471–13,082）和 7,957 人（95% CI，6,380–9,882）分别是第一轮、第二轮和第三轮。与我们的总体结果类似，筛选轮次之间以及各个监狱内没有统计差异。我们发现结核病患者在各轮筛查中 CAD4TB 评分没有统计学差异——第 1、2 和 3 轮的中位评分分别为 82 (IQR, 63–97)、77 (IQR, 60–94) 和 81 (IQR, 60–94)。 ，67-92），分别。结论 在结核病高流行的环境下，三轮大规模筛查并没有减少总体结核病负担。在监狱中，每年有大量结核病未确诊，可能需要采取一系列补充干预措施和更频繁的结核病筛查。