Prevalência de tuberculose no sistema prisional brasileiro

Abstract

Tuberculosis (TB) remains a major global public health problem, disproportionately affecting vulnerable populations, especially individuals deprived of liberty, whose structural and social conditions favor disease transmission. This study aimed to estimate the prevalence of tuberculosis among the incarcerated population in Brazil between 2019 and 2023 and to describe the epidemiological and clinical profile of reported cases. This is a cross-sectional study based on secondary data from the Notifiable Diseases Information System (SINAN), obtained through the Department of Informatics of the Unified Health System (DATASUS). All TB cases among individuals aged 20 years or older deprived of liberty between 2019 and 2023 were included. Annual prevalence was calculated based on the prison population reported by the National Council of Justice (CNJ), and the analyzed variables included sociodemographic and clinical characteristics. During the study period, 52,538 TB cases were reported in this population. The prevalence ranged from 1,155 cases per 100,000 inhabitants in 2021 to 1,632 cases per 100,000 in 2023, representing values 29 to 37 times higher than those observed in the general population. Most cases occurred among males (97.6%), individuals aged 20–39 years (84.3%), and those of mixed race (60.0%). The majority had low educational attainment (69.9%) and 39.7% were smokers. Regarding clinical variables, 61.6% underwent Directly Observed Treatment (DOT), 72.7% were new cases, and 74.0% achieved cure, although 12.7% abandoned treatment and 9.4% were transferred. TB-HIV coinfection was observed in 5.7% of cases, and among the drug susceptibility tests performed, 2.3% showed some form of resistance. In conclusion, tuberculosis among the incarcerated population presents a prevalence significantly higher than that of the general population, reflecting persistent social and structural vulnerabilities. The identified profile reinforces the need for specific public health policies aimed at expanding testing, strengthening DOT, integrating TB and HIV programs, improving environmental conditions, and ensuring continuity of care during transfers and after release from prison.