Nearly half of Uganda’s prison population has latent tuberculosis (TB), with the rate of active TB infection reaching 1,900 cases per 100,000 inmates—eight times higher than the national average, according to findings from the Uganda National Prevalence Survey on Tuberculosis, HIV, and COVID-19.
The survey, released on May 15, 2025, was conducted by Makerere University School of Public Health (MakSPH) in collaboration with the Uganda Prisons Service (UPS) and the Ministry of Health. It was funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and received technical support from the U.S. Centers for Disease Control and Prevention (CDC).
Dr. Simon Kasasa, the study’s Principal Investigator, revealed that TB infection risk increases with the length of stay in prison, especially for those incarcerated for three years or more.
“TB infection was significantly higher among male prisoners at 48% compared to 38% for females,” Dr. Kasasa said. The risk also rose with age, particularly among prisoners aged 65 and older.
The survey identified overcrowding and poor ventilation in prison facilities as major contributors to the high TB burden. Uganda’s prison system currently houses about 56,400 inmates—95% of whom are male—against a holding capacity of just 16,612, representing 340% occupancy.
HIV prevalence in prisons also remains high. The report shows that 11% of prisoners are HIV-positive—double the national rate. Female inmates are the most affected, with 21% living with HIV, compared to 11% of male inmates and only 2% among prison staff.
Despite the grim statistics, the study noted positive trends. HIV prevalence among prisoners dropped from 15% in 2013 to 11% in 2023. Among staff, prevalence declined dramatically from 12% to 2%. Dr. George Tumusinze, a Program Manager and Research Associate, pointed out that while 99% of HIV-positive inmates are on antiretroviral therapy (ART), only 70% have achieved viral suppression. “This highlights concerns about treatment efficacy,” he said.
Mr. Samuel Akena, Deputy Commissioner General of Prisons, described the survey as a milestone. “This survey is historic. It represents one of the most comprehensive efforts to understand the health status of people in prisons in Uganda,” Akena said. He called for coordinated efforts, stressing that “the time for piecemeal responses is over.”
Dr. Charles Olaro, Director General of Health Services at the Ministry of Health, said the findings provide a crucial baseline for policy and intervention planning. “Despite our efforts, we are still grappling with the burden of TB. Our progress toward eliminating it by 2030 has not been as swift as we had hoped,” he said.
Professor Rhoda Wanyenze, Dean of the School of Public Health and one of the lead investigators, urged stakeholders to act swiftly. “Traditional symptom-based screening missed nearly half of TB cases. We must institutionalize regular mass TB screening using advanced diagnostics like digital chest X-rays, GeneXpert, and TB LAM,” she said.
The U.S. CDC has supported the Uganda Prisons Service with over $18 million since 2010 to strengthen HIV and TB prevention, treatment, and care. Of that, $550,000 was allocated to this survey. Dr. Mary Boyd, CDC Uganda Director, said the investment aims to ensure inmates remain healthy during and after incarceration. “This work facilitates safe reintegration into communities and reduces public health risks like untreated TB,” she said.
Dr. James Kisambu, Commissioner for Prison Health Services, defended mandatory TB screening in prisons. “Prisons are high-risk, high-transmission environments. One undetected case can spark an outbreak. Mandatory screening, when done with dignity and linked to treatment, is a public health necessity,” he said.
The researchers emphasized the need for gender-sensitive interventions, as female inmates face disproportionately higher health risks. Mr. Akena underscored this point, stating, “Women in prison face higher risks, yet often remain invisible in program planning. If we are serious about health equity, we must prioritize gender-responsive strategies.”
Uganda currently operates 257 prisons across 16 administrative regions. Of these, 80% are overcrowded, and 95% lack sufficient natural ventilation. Health experts warn that these conditions accelerate the spread of airborne diseases.
The full study team included experts from MakSPH, the Uganda Prisons Service, the Ministry of Health, and U.S. CDC Uganda/Atlanta and PEPFAR USG agencies.
As the country digests these findings, officials and health advocates are calling for a coordinated, urgent response. The health of those behind bars, they insist, is deeply connected to the health of the communities they return to.
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