Burden, factors associated with drug resistance, and treatment outcomes of tuberculosis in prisons in Lima–Callao, Peru, 2024: a multicenter retrospective cohort study

Tuberculosis (TB) remains a major public health problem in prisons, where overcrowding, delayed diagnosis, and limited continuity of care may increase disease burden and worsen outcomes. We aimed to estimate the registered TB burden, describe treatment outcomes, and identify factors associated with drug-resistant TB and unfavorable outcomes in prisons in Lima–Callao, Peru, during 2024. We conducted a multicenter retrospective cohort study using routinely collected TB surveillance data from 12 prisons. All patients diagnosed with TB who initiated and/or received treatment during 2024 were included. The registered TB burden was estimated as the number of diagnosed and recorded TB cases per 1,000 inmates. Treatment outcome analyses were restricted to patients with recorded programmatic outcomes. Poisson regression with robust variance was used to estimate crude and adjusted relative risks (aRRs) with 95% confidence intervals (CIs). Overall, 2,060 TB cases were recorded among 33,268 inmates, corresponding to a registered TB burden of 61.9 cases per 1,000 inmates, in the context of a mean overcrowding rate of 160.3%. The registered burden varied across facilities from 0.0 to 122.8 cases per 1,000 inmates, with the highest values observed in Huacho, Lurigancho, and Cañete. The median age was 31 years, and pulmonary TB accounted for 94.0% of cases. Drug-resistant TB was identified in 292 patients (14.2%). In adjusted analyses, drug-resistant TB was associated with younger age and a longer symptom-to-diagnosis interval (aRR per additional day: 1.007; 95% CI: 1.006–1.009). Among patients with documented treatment outcomes ( n = 1,347), 1,231 (91.4%) were cured or completed treatment, whereas 116 (8.6%) experienced death, treatment failure, or loss to follow-up. TB/HIV coinfection was associated with unfavorable outcomes (aRR: 4.383; 95% CI: 2.406–7.985). Prisons in Lima–Callao had a high and heterogeneous registered TB burden. Strengthening systematic screening, timely molecular diagnosis, drug-resistance surveillance, treatment continuity, and structural interventions may reduce missed diagnoses and improve treatment outcomes.