Systematic review of the tuberculosis burden in prisons: Regional patterns and gaps in Latin America and the Caribbean.

Objective: To systematically review and synthesize the available literature on the prevalence and incidence of tuberculosis in incarcerated populations in Latin America and the Caribbean, identifying regional patterns, data gaps, and key challenges and providing recommendations for strengthening TB control strategies within prison settings. Methods: A systematic review was conducted across databases and reports using the following search terms: "tuberculosis", "prisons", "prisoners", "Latin America", "Caribbean", "inmates", and "social readaptation center". The review focused on prevalence rates, country-specific studies, total prison population studied by country, diagnostic methods used, and the frequency of TB reporting. Results: A total of 45 studies met the inclusion criteria, with most conducted in Brazil (60%), Colombia (13%), and Paraguay (9%). TB prevalence and incidence in prisons were found to be up to ten times higher than in the general population, with substantial variation in study design, diagnostic tools, and reporting standards. Structural risk factors such as overcrowding, HIV coinfection, and limited access to molecular diagnostics were frequently reported. Notably, no studies were found from Caribbean countries, and only one study was identified in Mexico, revealing significant regional data gaps. Conclusion: TB in Latin American prisons represents a serious but underreported public health crisis. The combination of elevated incidence, limited diagnostics, and fragmented surveillance highlights the urgent need for standardized, prison-specific TB control strategies and expanded research in underrepresented regions.