Burden of Tuberculosis and Human Immunodeficiency Virus among the Incarcerated Population in India: A Systematic Review and Meta-analysis

encounter systemic obstacles when trying to obtain health care both within and outside of prisons. 7The TB epidemic in prisons, both in India and globally, receives very little attention. 8As an integral part of the TB-HIV collaborative activities, with shared data from the National AIDS Control Program (NACP), the TB India report 2024 presented the TB screening report for prison inmates. 9Before 2024, WHO was not tracking or reporting TB cases in prisons; however, the global TB Burden Report-2024 expanded the coverage of data collection for five topics, including prisons. 10 Given the importance, a systematic review and meta-analysis was conducted to estimate the pooled prevalence of HIV and TB among prison inmates in India.Furthermore, to the best of the IntroductIonPrison inmates are disproportionately affected by tuberculosis (TB), HIV, and other related infections, including hepatitis B and C, and sexually transmitted infections (STIs). 1-3A recent meta-analysis found that TB is 10 times more common in jails than in the general population. 4Additionally, each year, millions of people enter and leave prison, which presents a risk to the community because studies have shown that TB that is circulating in prison may spread to nearby communities.According to reports, the global HIV prevalence among prison inmates is 50 times higher than that of the general population. 5According to a systematic review and metaanalysis, the prevalence of HIV among prisoners globally was 3.4% [95% confidence interval (CI) 3.2-3.6%],with regional variations: 3.0% (95% CI 3.3-4.3%) in Asia, 6% (95% CI -0.0 to 2.0%) in Africa, 4% (95% CI 3.0-4.0%) in North America, and 5.0% (95% CI 0.0-11%) in Europe. 5Using 20,695 bio-behavioral samples from 26 Indian states and Union Territories, the 17th round of HSS (HIV sentinel surveillance) conducted across eight population groups, including prisoners, at 53 surveillance sites estimated the seroprevalence at 1.93% (95% CI 1.75-2.12). 6Within prisons, sharing injection equipment, tattooing, sexual violence, unprotected sex, and vertical transmission are common ways for the spread of HIV, STIs, and viral hepatitis.Furthermore, members of socioeconomically disadvantaged groups, the poor, and those with low educational attainment are frequently overrepresented in prisons, and they all 1,