Use of rapid molecular tuberculosis diagnostics across Brazil’s incarcerated population

Abstract Background Incarcerated individuals in Brazil are at high-risk of tuberculosis (TB), but their access to World Health Organization recommended diagnostics is poorly understood. Methods We conducted a retrospective cross-sectional study of newly diagnosed TB cases in Brazil’s notifiable disease registry, which includes information on diagnostic tests performed, from January 2015 through December 2018. We quantified reported use of TB diagnostics across incarcerated and non-incarcerated populations and tested for municipality-level factors associated with diagnostic usage among the incarcerated population with generalized linear regression. Results Between 2015 and 2018, 258,014 individuals were newly diagnosed with TB, including 27,400 (10.6%) incarcerated individuals. Among these, 27.5% had an Xpert MTB/RIF test reported; 71.5% had sputum smear; 34.1% had culture; 70.9% had chest radiography. Xpert MTB/RIF use was greater among incarcerated than non-incarcerated individuals (36.2% vs 26.5%, p<0.001). However, we found spatial heterogeneity in state-level use of both Xpert MTB/RIF (range: 4.7-72.4% cases diagnosed) and chest radiography (range: 11.7-88.4%) in prisons. We identified seven municipalities with large incarcerated populations (>5000) with rates of Xpert MTB/RIF usage below the national average in incarcerated individuals. Conclusion Prioritizing expansion of rapid molecular diagnostics in prisons, particularly in regions with limited current usage of molecular diagnostics, will be an essential component of TB control.