High burden of tuberculosis in Malaysian prisons

Recognizing the gap of information in this area in Malaysia, the University of Malaya's Centre of Excellence for Research in AIDS (CERiA) with support from the HIR Grant launched a series of research studies to define the size of the TB problem in Malaysian Prisons and to determine appropriate interventions to control the spread of TB in Malaysia's correctional system.

The research is led by Professor Dr. Adeeba Kamarulzaman, the Dean of the University of Malaya's Faculty of Medicine and the Director of CERiA and Dr. Haider Al-Darraji, a visiting research fellow in CERiA in collaboration with Academic Icon, Professor Frederick Altice from Yale University, USA.

The study was launched with a series of standardized tuberculin (Mantoux) surveys in both Kajang prison in Selangor and Pengkalan Chepa prison in Kelantan involving representative samples of prisoners and prison officers. Both sites revealed extraordinarily high prevalence of tuberculin reactivity (inactive TB) amongst prisoners and prison staff alike (88.8%, 87.6%, 80.95% in Kajang prisoners, Pengkalan Chepa prisoners and Kajang prison staff, respectively). These figures are the highest ever reported figures of tuberculin positivity in prison settings and highlight the high likelihood of ongoing transmission of TB in Malaysian prisons.

The research team also recently introduced the latest diagnostic technology for diagnosis of active TB, namely GeneXpert MTB/RIF, into Malaysia following the strong endorsement by the World Health Organization (WHO) for the use of this technology in diagnosing active TB. The utilization of this new technology which allows for rapid diagnosis of TB (within 2 hours) and the gold-standard, TB culture in a cross-sectional study in Kajang Prison revealed a very high prevalence of active TB disease amongst HIV-infected and uninfected prisoners (12% and 6%, respectively).

The overall prevalence of previously undiagnosed active TB disease was 7.7%, which is 77 times higher than that of the Malaysian general population. Since July 2013, the research team has established an intensified TB screening unit upon entry to Kajang prison, focusing primarily on HIV-infected, but also targeting symptomatic HIV-uninfected prisoners. Preliminary data from this study also revealed high levels of previously undiagnosed active TB especially amongst HIV infected prisoners.

This research established by CERiA has provided for the first time a standardized empiric data about the high burden of TB in the Malaysian prison system, has improved timely access to proper TB-related prevention and treatment to this marginalized population, and has contributed to improvement in the overall survival in the targeted prison (Kajang).

Reducing the rate of TB in the prison system through this intensified case finding and prevention and treatment program will contribute towards the overall control of TB in Malaysia which in recent years has shown an increase in the number of new reported cases after many decades of good control.