Mapping scientific evidence on the epidemiology of tuberculosis in prison inmates: a scope review protocol

Abstract

This review protocol aims to map the scientific evidence available in national and international literature regarding the epidemiology of tuberculosis in the prison system. The protocol was developed based on the guidelines of the Joanna Briggs Institute (JBI) and the methodology proposed by Arksey and O'Malley, in addition, it will meet the recommendations of the Preferred Reporting Items for Systematic and Meta-Analyzes - Extension for Scoping Reviews (PRISMA-ScR). This protocol will guide the systematization of the development of the scoping review for the description and mapping of key concepts, evidence and gaps in the review topic.
Keywords: protocol, scoping review, tuberculosis, prisoners, prisons.

1. Introduction Tuberculosis (TB) is a communicable disease, considered one of the 10 leading causes of death worldwide, and is also the leading cause of death by a single infectious agent, surpassing HIV (WHO, 2020). Associated with the living conditions of the population, the occurrence and transmission of TB are higher in places of high demographic density, with absence or precarious infrastructures of basic sanitation and housing, malnutrition, illicit drug use and difficult access to health services. The Brazilian National Tuberculosis Control Program (PNCT) has elected as the most vulnerable populations to TB the Population Deprived of Freedom (PPL) the homeless and the people with the human immunodeficiency virus (HIV) (BRAZIL, 2014). It is remarkable that the prison system is a potentially TB-transmitting environment, where overcrowding, ventilation and lighting are deficient, poor nutrition, lack or precarious health services, in addition to the social weaknesses inherent in the individual himself, such as the use of illicit and licit drugs or comorbidities, have contributed to this reality (DARA et al., 2015) Some studies show limitations for early detection of the disease in the prison system, as mistaken concepts about TB, both among inmates and among health workers (FERREIRA JÚNIOR; OLIVEIRA; MARIN-LÉON, 2013). Another study brings the patient’s experience, and refers to the delay in the diagnosis of the disease related to the naturalization of the lack of assistance to PPL, to the interpretation of the prison as a place of "death" and "suffering" and the deprivation of the right to health for detainees due to their position before society (SOUZA et al., 2012), which highlights the inequity of access to health care for this population group. Thus, this context points to another major challenge in the control of the disease: the need for changes in the conceptions about the right to health in PPL (VALENÇA et al., 2016). Through a previous literature review in the databases Medical Literature Analysis and Retrieval System Online- MEDLINE; Scientific and technical literature of Latin America and the Caribbean/BVS- LILACS; Scientific Electronic Library Online- Scielo, with the intersection of the descriptors: "tuberculosis", "Prisons" and "review" adopting the boolean expression "AND" were found only 12 review studies that address this theme, six (50.0%) systematic reviews of the literature, two (16.7%) systematic reviews and meta-analyses, two (16.7%) integrative reviews of the literature, one (8.3%) named as a comprehensive review of the literature and one (8.3%) scoping review. Among the six systematic literature review studies two of them do not specifically address tuberculosis in the prison system, but rather the health situation in PPL and in this context presents TB as one of the health problems (GOIS; OLIVEIRA; SILVEIRA, 2012; FERREIRA et.al., 2020). One of them also concerns not only TB, but the management of outbreaks of contagious diseases in the prison system (BEAUDRY et. al., 2020). Among the other systematic review studies we found one that addresses the coinfection of TB-HIV in the prison system, another that refers to multi-resistant TB in prisons in former Soviet countries and one that aims to identify the incidence of TB in prisons (EDGE et. al., 2016; DROZININ; JOHNSON; JOHNSON, 2017; BAUSSANO et.al., 2010). Two other systematic reviews and meta-analyses aimed to estimate the prevalence of TB in PPL, however, one of them analyzed only the prevalence of TB in the prison system of Ethiopia (MOREIRA et al., 2019; MELESE; DEMELASH, 2017). The two integrative reviews of the literature had the guiding theme of research, respectively, the predisposing factors of TB in the prison system and the systematization of the knowledge produced on TB, only in Brazilian prisons (SILVA et al., 2019; VALENÇA et al., 2016). The study called "Comprehensive Literature Review" brings health experiences of women trapped in sub-Saharan Africa, not only having TB as the main disease, but several health problems faced in the prison system (VAN HOUT; MHLANGA-GUNDA, 2018). Finally, the only scoping review found investigates interventions for the detection of TB in prisoners in sub-Saharan Africa (KUUPIEL et al., 2020). 1.1 Justification of the study After the preliminary review of the literature it is possible to observe the need for a study to map the scientific evidence of TB in the prison system in a more comprehensive way, since the studies found, mainly systematic reviews, present more specific objectives, where the guiding question seeks an outcome. Therefore, we propose, through this protocol, to develop a scoping review, where we will have a broader objective of investigation regarding the literature of the epidemiology of TB in the prison system, since a study mapping the publications developed on the subject can help researchers to find gaps in existing research, guide new problems in this context, and compare the results of studies of several populations. 1.2 Guiding question of the review We will have as guiding question of the review: "What is the scientific evidence on the epidemiology of tuberculosis in the prison system?". According to the Dictionary of Epidemiology (PORTA, MIQUEL, 2014) epidemiology is defined as: "The study of the occurrence and distribution of events, states and processes related to health in specific populations, including the study of the determinants that influence these processes and the application of this knowledge to the control of relevant health problems". The epidemiology of tuberculosis will be defined in this study as results of incidence, prevalence, associations, comparisons, predictions or descriptions, resulting from studies that have as "specific population" the population deprived of liberty and that present as "health events, states and processes": • TB health care: prevention, diagnosis and treatment; • TB treatment outcomes; • TB predisposing factors; • effects of TB prevention and control programs; • Use of health/social services in TB cases; 1.3 Study objectives 1.3.1 General objective The Scoping Review aims to map the scientific evidence available in the literature regarding the epidemiology of tuberculosis in the prison system. 1.3.2 Specific objectives • Mapping key concepts, evidence and gaps of the review theme; • Providing a broad overview of the topic studied; 2. Method To develop the scoping review we will use as reference the methodology of the Joanna Briggs Institute being applied carefully the guidelines of its manual (PETERS et al., 2020) and the recommendations of the PRISMA-Scr Checklist (Appendix 1) an extension of the PRISMA checklist to systematic reviews and meta-analyses created in 2018 containing 20 essential report items and two optional items to be included upon completion of the scoping review (TRICCO et al., 2018). 2.1 Inclusion criteria In accordance with the recommendations of the Joanna Briggs Institute, we have adopted the following strategy: Population (P), Concept (C), Context (C) (JBI, 2015) 2.1.1 Population Publications whose study participants include persons deprived of liberty of both sexes, who are responsible for the violation of criminal law as an adult in the country where the study was conducted. 2.1.2 Concept Studies presenting tuberculosis in all its clinical forms will be considered according to the International Classification of Diseases version 10 - ICD-10 (Appendix 2). 2.1.3 Context Research that presents data on prison services of legal age. 2.1.4 Types of study Quantitative studies and review studies in Portuguese, English and Spanish. The quantitative studies will include observational studies (ecological, case-control, cohort and cross-sectional studies) and experimental studies that present data on the epidemiology of tuberculosis in the prison system. Publications that aim to investigate other infectious diseases in the prison system and present little data on tuberculosis will be excluded; TB relationship with drug use in PPL/ immigrants with TB in PPL/ co-infection with HIV and Hepatitis C (in these cases, only those information associated with the results, if it is the objective of the study, will be excluded); molecular epidemiology/molecular characteristic; lineal variation; TB after leaving the prison system; evaluation of drug resistance of strains; evaluation of sensitivity test methods; evaluation of the performance of TB screening scores; experience of prisoners with TB (qualitative studies); case studies; analysis of the cost of TB tests in PPL; prisoners of war with TB; qualitative studies (interviews); abstracts of official documents of consensus of TB control in the prison system. In relation to multidrug resistant TB (TB/MDR), only publications that present incidence and prevalence results, that evaluate drug multidrug resistance in PPL with TB or those that present isolated data for both TB/MDR and TB/general) will be included. 2.2 Search strategy The search strategy will be developed in three stages: First stage: It consisted of a search limited to two databases: Medical Literature Analysis and Retrieval System Online- MEDLINE and Scientific and Technical Literature of Latin America and the Caribbean/BVS- LILACS. The initial search aimed to analyze the words and terms indexed in the titles and abstracts of the publications used to describe the population, concept and context of the theme addressed. The terms and keywords found in the publications were: incarceration, prison system, prison system, prisons; prison, prisoner, population deprived of liberty, persons deprived of liberty; tuberculosis, in Portuguese and Prisons; Prisoners, Prison Inmate; tuberculosis, in English. A consultation with the Health Sciences Descriptors (Decs) of the Virtual Health Library (VHL) was carried out and it was possible to verify that "prisons/prisons and tuberculosis/tuberculosis" are the only ones considered descriptors in health (Decs, 2020). Second step: it will consist of a second search using all the keywords and indexed terms identified in the first step. The Database will consist of: Medical Literature Analysis and Retrieval System Online- MEDLINE; Scientific and technical literature of Latin America and the Caribbean/BVS- LILACS; Scopus (Elsevier) and Scientific Electronic Library Online- Scielo. From the previous review of the literature performed in the first stage and after consulting the Mesh we present an example of the phrase of the search: (Tuberculosis OR Tuberculoses OR "Kochs Disease" OR "Koch’s Disease" OR "Koch Disease" OR "Mycobacterium tuberculosis Infection" OR "Mycobacterium tuberculosis Infections") AND (Prisons OR Prison OR Penitentiaries OR Tiary OR Prisoners OR PenitenInmate") Third stage: the authors will examine the reference lists of the studies included in the review in order to find other publications that have not been seen in the sources examined. Search strategies and databases will be included in the Appendix. 2.2 Selection of studies The selection of studies will be performed by two reviewers, at this stage one will not have access to what the other is selecting. A third reviewer may be included if there are divergences in the selection criteria between the first two reviewers. Initially duplicate articles will be excluded, this process will be carried out from the reference manager Zotero, later a screening will be developed (screened) of the articles that contain in their titles and abstracts the terms applied in the search phrases. Once the studies are selected, the reviewers will analyze the titles and abstracts of the articles, then the publications relevant to the objectives of the study will be considered eligible for reading in full. Finally, after a full reading in pairs the publications that are not in accordance with the inclusion criteria and guiding question may be excluded, however, the justifications of each of the exclusions will be presented in the flow chart of the results. 2.3 Data extraction Data extraction will be developed by two independent and qualified evaluators. A form based on the JBI source model will be used, an instrument that details the evidence, characteristics and extraction results. The form was adapted according to the needs of the present study (Appendix 3). 2.5 Plan of analysis and presentation of results The first stage of presentation of the results will consist of the selection process of the studies. This stage will be presented according to the PRISMA-Scr flowchart (TRICCO et al., 2018). The results of the analyses will be presented through a qualitative synthesis that will describe and categorize the concepts, populations and contexts analyzed, accompanied by diagrams or tables with data referring to the distribution of sources per year, countries of origin, area of intervention, research methods, among others, according to the objectives of the review (PETERS et al., 2020). 3 Financing: In order to conduct the present study, there will be no funding by funding agencies, and the authors are entirely responsible for the costs arising from the development of the research. 4 Conflicts of interest: The authors declare that there is no conflict of interest regarding the current research.

摘要
本审查方案旨在梳理国内外文献中关于监狱系统结核病流行病学的科学证据。该方案基于乔安娜·布里格斯研究所（JBI）的指南和Arksey与O'Malley提出的方法论，同时满足《系统评价和荟萃分析报告项目——范围评价扩展》（PRISMA-ScR）的建议。本方案将指导范围评价的系统化发展，以描述和映射评价主题中的关键概念、证据和空白。
关键词：方案，范围评价，结核病，囚犯，监狱。

1. 引言
结核病（TB）是一种传染病，被认为是全球十大死因之一，也是由单一传染性因素引起的死亡率最高的疾病，超过HIV（世界卫生组织，2020年）。与人群的生活条件相关，结核病的发病率和传播率在人口密度高的地区更高，基本卫生和住房基础设施缺失或脆弱，营养不良，非法药物使用以及难以获得医疗服务。巴西国家结核病控制计划（PNCT）已将自由受限人群（PPL）、无家可归者和人类免疫缺陷病毒（HIV）携带者选为最易受结核病感染的高危人群（巴西，2014年）。值得注意的是，监狱系统是一个可能传播结核病的环境，其中拥挤、通风和照明不足，营养不良，医疗服务缺乏或不稳定，加上个人本身固有的社会弱点，如非法和合法药物的滥用或合并症，都导致了这一现状（DARA等，2015年）。一些研究表明，在监狱系统中，对疾病的早期检测存在局限性，因为囚犯和卫生工作者对结核病的错误认识（FERREIRA JÚNIOR；OLIVEIRA；MARIN-LÉON，2013年）。另一项研究提到了患者的体验，并指出疾病诊断延迟与对PPL缺乏援助的自然化，将监狱视为“死亡”和“痛苦”之地，以及由于在社会中的地位而剥夺了囚犯的健康权，这突显了该人群群体在获得医疗服务方面的不平等性（SOUZA等，2012年），从而指出了疾病控制中的另一个重大挑战：需要改变对PPL健康权的观念（VALENÇA等，2016年）。通过在MEDLINE、拉丁美洲和加勒比海科学技术文献/巴西卫生图书馆（BVS-LILACS）和科学电子图书馆在线（Scielo）数据库中对“结核病”、“监狱”和“评价”等描述符进行布尔表达式“AND”的交集检索，我们发现只有12项关于该主题的综述研究，其中6项（50.0%）为文献系统评价，2项（16.7%）为系统评价和荟萃分析，2项（16.7%）为文献综合评价，1项（8.3%）被称为文献综合评价，1项（8.3%）为范围评价。

在6项文献系统评价研究中，其中2项并未专门针对监狱系统中的结核病，而是针对PPL的健康状况，并在此背景下将结核病视为其中一种健康问题（GOIS；OLIVEIRA；SILVEIRA，2012年；FERREIRA等，2020年）。其中1项还涉及监狱系统传染病的爆发管理（BEAUDRY等，2020年）。在其他文献系统评价研究中，我们发现1项研究针对监狱系统中的TB-HIV共感染，1项研究涉及前苏联国家监狱中的多重耐药结核病，1项研究旨在确定监狱中结核病的发病率（EDGE等，2016年；DROZININ；JOHNSON；JOHNSON，2017年；BAUSSANO等，2010年）。另外2项系统评价和荟萃分析旨在估计PPL中结核病的患病率，然而，其中1项仅分析了埃塞俄比亚监狱系统中结核病的患病率（MOREIRA等，2019年；MELESE；DEMELASH，2017年）。2项文献综合评价的研究分别以研究为导向，分别针对监狱系统中结核病的易感因素和巴西监狱中产生的关于结核病的知识的系统化（SILVA等，2019年；VALENÇA等，2016年）。一项名为“综合文献评价”的研究介绍了被困在撒哈拉以南非洲的女性所面临的健康经历，她们不仅患有结核病，而且在监狱系统中还面临其他健康问题（VAN HOUT；MHLANGA-GUNDA，2018年）。最后，唯一找到的范围评价研究调查了撒哈拉以南非洲囚犯中结核病的检测干预措施（KUUPIEL等，2020年）。

1.1 研究的合理性
在初步文献回顾后，可以观察到有必要进行一项研究，以更全面地梳理监狱系统中结核病的科学证据，因为找到的研究，主要是系统评价，具有更具体的目标，其中指导问题寻求结果。因此，我们通过本方案提出，通过范围评价，我们将具有关于监狱系统中结核病流行病学文献的更广泛的调查目标，因为一项映射该主题出版物的研究可以帮助研究人员找到现有研究的空白，引导新问题，并比较多个群体研究的成果。

1.2 评价的指导问题
我们将把以下问题作为评价的指导问题：“监狱系统中结核病流行病的科学证据是什么？”根据流行病学词典（PORTA，MIQUEL，2014年），流行病学被定义为：“研究特定人群中与健康相关的事件、状态和过程的发生和分布，包括研究影响这些过程的决定因素，以及将此知识应用于控制相关健康问题的应用。”
在本研究中，结核病的流行病学被定义为由以下研究结果组成：发病率、患病率、关联、比较、预测或描述，这些研究结果以“特定人群”为自由受限人群，并以“健康事件、状态和过程”为：•
结核病医疗服务：预防、诊断和治疗；•
结核病治疗结果；•
结核病易感因素；•
结核病预防和控制计划的影响；•
结核病病例中的健康/社会服务使用；

1.3 研究目标
1.3.1 一般目标
范围评价旨在梳理关于监狱系统中结核病流行病学的文献中可用的科学证据。
1.3.2 具体目标
•
映射评价主题的关键概念、证据和空白；•
提供对研究主题的广泛概述；

2. 方法
为了开发范围评价，我们将参考乔安娜·布里格斯研究所的方法论，并仔细应用其手册（PETERS等，2020年）的指南和PRISMA-Scr清单（附录1）的建议，这是2018年创建的用于系统评价和荟萃分析的PRISMA清单的扩展，包含20项基本报告项目，以及在完成范围评价时可选的两项项目（TRICCO等，2018年）。
2.1 纳入标准
根据乔安娜·布里格斯研究所的建议，我们采用了以下策略：人群（P）、概念（C）、背景（C）（JBI，2015年）
2.1.1 人群
包括剥夺自由人群的出版物，无论性别，均为在其所在国违反刑事法律的成年人。
2.1.2 概念
将呈现所有临床形式的结核病的研究视为符合国际疾病分类第10版-ICD-10（附录2）。
2.1.3 背景
呈现关于合法年龄监狱服务的的研究。
2.1.4 研究类型
葡萄牙语、英语和西班牙语的定量研究和综述研究。定量研究包括观察性研究（生态学、病例对照、队列和横断面研究）和呈现监狱系统中结核病流行病学数据的实验研究。旨在调查监狱系统中其他传染病并呈现少量结核病数据的出版物将被排除；PPL/移民中的TB与药物使用的关系/PPL中的TB与HIV和丙型肝炎的共感染（在这些情况下，如果研究目标是相关的，将仅排除与结果相关的信息）；分子流行病学/分子特征；线性变异；监狱系统外的TB；对TB耐药菌株的评估；对敏感性测试方法的评估；对TB筛查评分的性能评估；囚犯的TB经历（定性研究）；案例研究；对PPL中TB测试成本的评估；患TB的战俘；定性研究（访谈）；监狱系统中TB控制官方文件共识的摘要。
关于多重耐药结核病（TB/MDR），仅包括呈现发病率、患病率结果，评估患有TB的PPL的药物多重耐药性，或呈现TB/MDR和TB/一般）的孤立数据的出版物。

2.2 检索策略
检索策略将分为三个阶段：第一阶段：限于两个数据库：医学文献分析和检索系统在线-MEDLINE和拉丁美洲和加勒比海科学技术文献/巴西卫生图书馆（BVS-LILACS）。初步检索旨在分析用于描述主题中人群、概念和背景的出版物标题和摘要中索引的单词和术语。在出版物中发现的术语和关键词包括：incarceration、prison system、prison、prisoner、population deprived of liberty、persons deprived of liberty、tuberculosis、in Portuguese and Prisons、Prisoners、Prison Inmate、tuberculosis、in English。对虚拟卫生图书馆（VHL）的健康科学描述符（Decs）进行了咨询，发现“prisons/prisons and tuberculosis/tuberculosis”是唯一被认为是健康（Decs，2020年）描述符的。

第二阶段：将使用第一阶段中确定的全部关键词和索引术语进行第二次检索。数据库将包括：医学文献分析和检索系统在线-MEDLINE、拉丁美洲和加勒比海科学技术文献/巴西卫生图书馆（BVS-LILACS）、Scopus（Elsevier）和科学电子图书馆在线-Scielo。

从第一阶段进行的文献回顾和咨询Mesh中，我们提供了一个检索语句的示例：（Tuberculosis OR Tuberculoses OR "Kochs Disease" OR "Koch’s Disease" OR "Koch Disease" OR "Mycobacterium tuberculosis Infection" OR "Mycobacterium tuberculosis Infections") AND (Prisons OR Prison OR Penitentiaries OR Tiary OR Prisoners OR PenitenInmate")

第三阶段：作者将检查已纳入评价的研究的参考文献列表，以找到在检查的来源中尚未看到的其他出版物。
检索策略和数据库将包含在附录中。

2.2 研究的选择
研究的选择将由两位审稿人进行，在此阶段，一位审稿人将无法访问另一位审稿人正在选择的内容。如果前两位审稿人在选择标准之间存在分歧，则可能包括第三位审稿人。最初，将排除重复文章，此过程将从参考管理器Zotero中进行，然后将对包含在标题和摘要中使用搜索短语中应用的术语的文章进行筛选。
一旦选择研究，审稿人将分析文章的标题和摘要，然后考虑与研究的目的一致的出版物为合格，以进行全文阅读。最后，在成对全文阅读后，可能排除不符合纳入标准和指导问题的出版物，但将提出每个排除的理由，并在结果流程图中展示。

2.3 数据提取
数据提取将由两位独立且合格的评估员进行。将使用基于JBI来源模型的表格，这是一种详细说明证据、特征和提取结果的工具。表格根据本研究的需要进行了调整（附录3）。

2.5 结果分析和展示计划
结果展示的第一阶段将包括研究选择过程。此阶段将根据PRISMA-Scr流程图（TRICCO等，2018年）进行展示。

分析结果将通过定性综合分析进行展示，将描述和分类分析的概念、人群和背景，并辅以图表或表格，其中包含有关来源按年份、来源国、干预领域、研究方法等的分布数据，以及其他根据评价目标的数据（PETERS等，2020年）。

3. 资金：
为了开展本研究，将没有来自资助机构的资金，作者将完全负责由此产生的所有研究费用。

4. 利益冲突：
作者声明，在当前研究中不存在利益冲突。