Factors associated with tuberculosis symptom reporting among persons deprived of liberty in Brazil during active case finding: a cross-sectional study

Introduction Active case finding (ACF) can improve tuberculosis (TB) diagnosis in high-burden populations. Many programmes rely on symptom evaluation as the first screening step; however, symptom reporting may vary according to the context of evaluation. Methods We performed a cross-sectional analysis of persons deprived of liberty (PDL) diagnosed with TB in an ACF programme conducted in two male Brazilian prisons from February 2023 to February 2025. Every 4 months, participants underwent sputum testing by GeneXpert Ultra (Xpert) and culture. Study nurses administered symptom questionnaires during the initial evaluation. Individuals with positive results were interviewed by a physician. We compared characteristics of individuals with microbiologically confirmed TB according to their symptom reporting at initial screening and medical consultation, which was used to define four groups (e.g., combinations of symptomatic/asymptomatic at each of the two symptom assessments). Results Among 6919 PDL screened, 448 (6.4%) had microbiologically confirmed TB. We included 292 (65.1%) individuals in the analysis, after excluding those with missing clinical information and consults >15 days after screening. 113 (38.7%) reported symptoms at initial screening, while 192 (65.8%) reported symptoms at medical consultation (p<0.001). Compared with individuals asymptomatic at both evaluations, those who reported symptoms at the two instances were more likely to have medium or high semiquantitative Xpert results (45.0% vs 11.4%, p<0.001), report symptomatic cellmates (61.0% vs 25.2%, p<0.001), have higher LunitTB scores (95.1 vs 91.9; p=0.037) and lower body mass index (19.4 vs 21.4, p<0.001). There was a trend of more cavitary lesions (60.9% vs 50.0%, p=0.073) and bilateral disease (56.7% vs 45.0%, p=0.056) in chest X-ray of participants with symptomatic than asymptomatic TB at medical consultation. Conclusions More than half of individuals who reported no TB symptoms at initial screening endorsed symptoms at first medical consultation. Clinical severity and contextual factors can influence TB symptom reporting during ACF.