Abstract
Background: Prisoners are socially vulnerable population and have high risk for tuberculosis
(TB) and human immunodeficiency virus (HIV). This study was conducted to explore whether the TB
notification rate, patient characteristics, access to HIV care and TB treatment outcome of prisoners
differ from general TB patients in Chiang Rai province. Design/Methods: A retrospective analysis of two existing TB related electronic databases included TB registry (N=2,472, 11% were prisoners)
and drug-resistance surveillance TB database (smear positive=2,193, 6.6% were prisoners). The study
populations were patients aged over 18 years, living in Mueang District, Chiang Rai, and registered in
TB registry during 2007 to 2014. We analyzed data by classifying into prisoner and general TB patient
groups. Percentage proportions of each variable were compared using chi-Square test and p-value
for the difference between two proportions. Results: The TB notification rate of prisoners was 3.2
times higher than general population. Prisoner group was significantly younger (mean age = 36.5 vs
45 yrs), had higher proportion of male, smear positive, and higher rate of HIV co-infection (TB/HIV)
than general TB patients (p<0.05). The treatment outcomes of smear-positive in two groups were not
different. However, treatment outcomes of all types of TB in prisoners were better than general TB
population, i.e. higher success rate with lower rate for loss to follow-up (p=0.030). Prisoners with TB/
HIV significantly had less access to antiretroviral drugs (ARV) (p<0.001) but access to cotrimoxazole
was not different. Both groups had high proportions of regular alcohol drinking. Prisoners significantly
had higher proportions of smoking and drug use than general TB patients but lower proportions of
diabetes mellitus or hypertension. Almost 11% of general TB patients were previously incarcerated.
Conclusions: Although prisoners had higher notification rate for TB and higher HIV co-infection than
general TB patients, treatment outcomes were better. To enhance health equality, access to ARV
among prisoners with TB/HIV should be ensured.
