The challenge of tuberculosis control in prisons, Sao Paulo state, Brazil

Setting
Sao Paulo State has an estimated population of 41,6 million of inhabitants in 2007. It has 146 prisons with an estimated population of 145,401 prisoners. Since 1996, Sao Paulo State Secretary of Health (SSH) and Penitentiary Administration Secretary (PAS) came priorizing the tuberculosis control into prison system. There are not walls that stop progression and transmission of disease to general population, so it is a consensus the necessity to control.  To get tuberculosis is not part of prison conviction. 
Objective
To evaluate the control of tuberculosis at prison system by secondary data.
Methodology
Using information systems from Sao Paulo State, TBWEB and LABTB, were constructed historical series using indicators of finding cases, incidence rate, percentage of HIV-positive, supervised treatment (DOT) coverage and cure rates.
Results
Probably TB cases are becoming higher because of information system and active case finding improvement  (428 TB new cases in 2000 and 913 in 2007). There was an increment of identification of symptomatic respiratory (6,401 were examined in 2003 and 17,050 in 2007) with consequent reduction of positivity of acid fast bacilli in the period, represented by 6,7% in 2003 and 5,2% in 2007. In 2000 the co-infection percentage among TB new cases were 22 and in 2007 this percentage was 9.2% much lower than the first one. Those values were similar to general population. The cure rates of TB new cases were 55.8% in 1998 and 73.3% in 2007. Also observes an important increase in percentage of outpatient (ambulatory cases) on DOT comparing 1998 to 2007 with coverage of 70.0% of DOT informed cases.
Conclusions
Epidemiological and Operational indicators demonstrated advances on TB control at prison system. The challenge will be to maintain TB in the agenda of SSH and PAS priorities to guarantee the maintenance of good indicators.