Lessons learned with tuberculosis active case finding in two prisons, municipality of Guarulhos, Sao Paulo, 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. Two prisons are located in the municipality of Guarulhos, metropolitan area of Sao Paulo and had about 2,480 prisoners in March, 2008.
Objective
To evaluate different tuberculosis strategies of active case finding in two prisons in the municipality of Guarulhos.
Method
A survey using a questionnaire by an interview with trained staff and supervised collection of sputum specimen of all prisoners at the moment of 19 visits done in the two prisons. Those specimen samples were sent to three certified laboratories with quality control for complete bacteriological examinations. The radiological screening was also previewed but not yet done.  
Results
Were interviewed 2,216 prisoners. Those 27.4% had cough and 15.2% referring  symptoms for two weeks and more. From 8.8% of those who had cough for more than two weeks had also expectoration. Laboratorial data of 2007 routine showed that 12.0% of prison population was examined by acid fast bacilli (AFB) at prison system. The symptomatic respiratory prevalence in those prisons (15.2%) was superior, therefore to the value found on routine of 146 units (12.0%), but the AFB positivity was 5.2% on routine and 0.6% on research, showing the active case finding was broad. Were diagnosed 15 TB patients where 11 were discovered by culture only. Mycobacteria other than tuberculosis (MOTT) were detected in 4 prisoners. Culture added 73.0% for AFB.
Conclusions
Cultures are essential for active case finding. There is the necessity to complete the research to find out the better strategy, under technical and operational point of view, for case finding at prison system in the State of Sao Paulo regarding the high number of prisons and distance between them.