The Independent Uganda: You get the Truth we Pay the Price
Kampala, Uganda | THE INDEPENDENT | Uganda’s prison system is facing a severe dual burden of tuberculosis and HIV, with infection rates significantly higher than those in the general population.
Findings from a study by Makerere University’s School of Public Health indicate that active TB infection in Uganda’s prisons is eight times higher than in the general population.
The survey conducted in 2023 in correctional facilities located in different parts of Uganda revealed close to half of the prisoners (48%) tested positive for latent TB.
People with latent TB infection do not feel sick and do not have symptoms. Dr. Simon Kasasa, the leader investigator of the survey whose results were released on Thursday told Uganda Radio Network that the person with a latent TB infection can develop TB disease at any time and become sick.
“You have the virus, but you don’t have the disease. You are living like any other person. With active TB, you have the disease, and you are already sick,” explained Kasasa, a senior lecturer in Department of Epidemiology and Biostatistics, School of Public Health, Makerere University.
The Dean of Makerere University School of Public Health (MakSPH), Professor Rhoda Wanyenze said the poor living conditions in prison can affect one’s immune system and therefore trigger latent TB to active TB.
“A 48% latent TB infection rate in a prison population should be cause for worry and prompt action. A high percentage of latent TB indicates a significant risk of active TB cases developing within prisons and potentially spreading outside prison walls,” she said.
According to WHO, the scourge of tuberculosis (TB) in prisons remains a persistent problem; rates among inmates remain much higher—from 5 to up to 50 times—than those of national averages across both the developed and the developing world.
Prisoners, and people who work in prisons, are known to be especially vulnerable to the disease. However, it is not known how many people in prison become infected with Mycobacterium tuberculosis or develop active TB each year compared with the general population.
Professor Wanyenze said the survey provides critical baseline and recommendations that will shape interventions and resource allocation.
“The implications extend beyond prison walls, as individuals released from incarceration can re-enter the community, posing a risk to the general population,” she warned.
WHO recommends that prison authorities put in place TB screening mechanisms before one is sent to the cells.
It also recommends that a person diagnosed with TB disease should begin treatment before they are integrated into the general correctional facility population.
For the survey, overcrowding, inadequate ventilation, and insufficient screening methods were major contributing factors to high rates of TB in prisons.
Deputy Commissioner General of Prisons Samuel Akena admits the Uganda prison carries a heavy burden of disease, especially tuberculosis and HIV.
“And this burden is shaped by the very environment in which people are confined—overcrowded, poor ventilation, and insufficient access to timely diagnosis and treatment,” he said. He said women in prison face disproportionately higher risks, yet often remain invisible in program planning.
“This is not acceptable. If we are serious about health equity, we must prioritize gender-responsive strategies within prisons,” said Akena.
Akena said as per international standards, Uganda’s prisons should be carrying only 20,000 prisoners but there were over 79,000 prisoners by the beginning of this week.
“There is overcrowding. We must accept it. Of course, some of the structures are old. British or colonial, with ventilations which are high there. But with the reforms, the structures are better,” he said.
“Any slightest entry of disease in such an environment is very dangerous. How we survived COVID. I think it put us at a very high level because they expected that everybody was going to flatten down,” Akena stressed.
Gaps in TB Diagnosis in prisons
The researchers found that some of the common TB diagnosis screenings were not very effective in detecting the bacteria, leading to what they described as missed diagnoses.
The said symptom screening missed 50% of the cases, while chest X-rays missed 40% of the cases. From the survey GeneXpert or molecular testing ultra-diagnosed 40% of the cases that symptom screening and chest X-ray screening missed.
They found that nearly 67% of the TB was imported due to missed or inadequate screening methods. The survey further found that 80% of the prisons were overcrowded and that 95% of the prison wards lacked ventilation.
They called for the strengthening of screening, improving of prison infrastructure, and the expansion of access to integrated TB and HIV services in prisons.
Ministry of Health responds
Newly appointed Director General of Health Services, Dr Charles Olaro said Uganda remains among the 30 HIV/TB high-burden countries.
He revealed that over 94,000 people were diagnosed with TB this year and that 30,000 of those are co-infected with HIV. He said congestion in prison becomes a medium of transmission of TB.
“So even if you had one case, it can become a potential for many more cases. So if prisons are a high risk for TB, we should have screening for TB every year. And if we do so, we should be able to identify those cases. Because we need to know that TB is treatable,” said Olaro.
