Tuberculosis (TB) remains a serious public health threat in Uganda’s correctional facilities, with new research showing that prison inmates are seven times more likely to be infected with TB compared to the general population.
The study, conducted by researchers from the Makerere University School of Public Health, highlights critical gaps in diagnosis, treatment, and prevention, and calls for urgent reforms to protect inmates, prison staff, and the broader community.
Uganda’s 259 prison facilities are home to approximately 62,000 people at any one time, with an annual turnover of more than 140,000 inmates.
The combination of overcrowding, poor ventilation, and inadequate access to quality healthcare has created an ideal environment for the rapid spread of TB and HIV , two of the country’s deadliest infections.
A rapid assessment from 2008 estimated the TB prevalence among people in prison (PIP) at 654 cases per 100,000 more than three times higher than the general population. The current findings show the situation has worsened, especially among newly incarcerated individuals who often arrive with undiagnosed infections or rapidly acquire TB due to exposure.
The prevalence of HIV among prison inmates in Uganda is almost double that of the general population. TB is the leading killer among people living with HIV (PLHIV), and the dual burden in prisons puts thousands at risk.
Although Uganda has made significant progress toward the second 95 of the UNAIDS targets of ensuring 95% of people with HIV receive sustained antiretroviral therapy, the first (diagnosis) and third (viral suppression) targets remain elusive within prison settings.
The Makerere University school of public health research team recommends the implementation of universal GeneXpert testing, not just symptom based screening, as a critical step toward curbing the TB epidemic in prisons.
The current diagnostic tools and practices often miss asymptomatic or early stage cases, contributing to unchecked transmission.
The study calls for enhanced TB case finding, improved access to chest X-ray diagnostics, and a scale-up of routine mass screening using the Xpert MTB/RIF testing platform.
Cough monitors, who are peer-selected inmates, play a key role in early detection but remain under-supported and lack adequate training and equipment.
Nearly one quarter of the global population is estimated to have latent TB infection (LTBI), with 5–20% progressing to active disease. For people living with HIV, this progression is even more likely. LTBI is a ticking time bomb in overcrowded and under-resourced prisons.
The survey also found gaps in the delivery of TB preventive treatment (TPT), particularly among eligible PLHIV. Uganda’s transition to the more effective 3HP regimen, a once-weekly combination of isoniazid and rifapentine for three months offers promise, but uptake within the Uganda Prisons Services (UPS) remains limited by resources and diagnostic constraints.
To tackle the growing TB crisis in Uganda’s prisons, researchers recommends:
Universal TB screening using GeneXpert or Xpert Ultra, not just symptom-based checklists
Improved prison infrastructure, including better ventilation and decongestion through non-custodial sentencing
Scaling up TPT and ART programs for PLHIV in prison
Integration of TB and HIV services for timely detection, treatment, and prevention
Investment in isolation units and referral systems for TB and MDR-TB management
Expanded training for peer educators and health staff within prison systems