KAMPALA, Uganda — Uganda’s prison system is on the brink of a full-blown tuberculosis crisis. A new study by the Makerere University School of Public Health reveals that inmates are seven times more likely to contract TB than the general population—underscoring a public health emergency hiding in plain sight.
With 259 prison facilities housing over 62,000 people at any given time—and a staggering annual turnover of 140,000 inmates—conditions have become ripe for the unchecked spread of TB and HIV, two of the country’s deadliest infectious diseases.
Back in 2008, a rapid assessment put TB prevalence in prisons at 654 cases per 100,000—already triple that of the general population.
Today, Makerere’s researchers warn that the situation has deteriorated even further. Overcrowding, poor ventilation, and delayed diagnosis have made prisons incubators for both active and latent TB infections.
“Many inmates arrive already infected or quickly contract TB inside,” the report notes. “The lack of early diagnosis only fuels the transmission cycle.”
The TB-HIV double burden is particularly devastating. While Uganda has made headway with the UNAIDS “95-95-95” HIV treatment goals—especially in ensuring patients stay on antiretroviral therapy—prisons still lag dangerously behind in diagnosis and viral suppression.
The study calls for urgent structural and clinical interventions, including:
- Universal TB screening using GeneXpert or Xpert Ultra, not just symptom checklists.
- Mass access to chest X-rays and advanced diagnostic tools to detect early or asymptomatic TB.
- Integration of TB and HIV services to streamline detection, treatment, and prevention.
- Expanded access to TB Preventive Therapy (TPT) using Uganda’s newer 3HP regimen—currently underutilized in prisons.
The current system of using “cough monitors”—peer-selected inmates who help detect TB—has shown promise but remains underfunded and poorly supported.
These monitors lack the training, equipment, and incentives needed to function effectively in such high-risk environments.
The researchers also stress that improving prison infrastructure is just as critical as medical upgrades. Decongestion, better airflow, and isolation units are vital to stemming transmission.
“TB prevention cannot succeed in cells built for 20 but holding 80 people,” the report states bluntly.
There’s also a strong push for non-custodial sentencing—especially for non-violent offenders—to ease overcrowding and reduce exposure risk.
With nearly one-quarter of the world’s population carrying latent TB—and a significant risk of it becoming active among those living with HIV—the crisis in Uganda’s prisons isn’t just about inmates.
It’s a national health concern that could spill over into communities without swift, targeted action.
Makerere’s findings present Parliament, the Ministry of Health, and the Uganda Prisons Service with a stark choice: act now—or watch a curable disease spiral out of control behind bars.
