A landmark survey conducted by the Makerere University School of Public Health (MakSPH), in collaboration with the Uganda Prisons Service (UPS) and the Ministry of Health, has uncovered a startling public health crisis: Uganda’s prison population has eight times the tuberculosis (TB) prevalence of the general population. Nearly half of all inmates are estimated to have latent TB.
Released on May 15, 2025, The Uganda National Prevalence Survey on Tuberculosis, HIV, and COVID-19 in Prisons was funded by PEPFAR and supported technically by the U.S. Centers for Disease Control and Prevention (CDC).
The survey paints a sobering picture of disease transmission within Uganda’s overcrowded, poorly ventilated correctional facilities.
“Prisons are high-risk, high-transmission environments. One undetected case can trigger an outbreak,” said Dr. James Kisambu, Commissioner for Prison Health Services. “In such settings, mandatory TB testing is not a rights violation—it is a public health necessity.”
Alarming Statistics on TB and HIV in Prisons;
- Active TB prevalence: 1,900 per 100,000 inmates (8× the national rate)
- Latent TB infection: 48% of inmates (38% among female prisoners)
- HIV prevalence: 11% of inmates (vs. 5.1% nationally)
- Female prisoners: 21%
- Male prisoners: 11%
- Prison staff: 2%
“These figures confirm what we’ve long feared: prisons are disease incubators due to overcrowding, poor ventilation, and prolonged confinement,” said Dr. Simon Kasasa, Principal Investigator and Senior Lecturer at MakSPH.
Currently, Uganda’s 257 prison facilities—built for 16,612 inmates—are housing over 56,400 individuals, representing a staggering 340% occupancy rate. The health implications are severe:
- 95% of prisons lack natural ventilation
- 80% of prison wards are too overcrowded for physical distancing
“Diseases do not respect bars or borders. Women in prisons bear the brunt of invisibility in health programming,” said Deputy Commissioner General Samuel Akena.
Akena emphasized the urgent need for gender-responsive strategies, warning that incarcerated women face significantly higher health risks—especially regarding HIV—yet remain marginalized in health policy design.
Progress and Gaps in HIV and TB Response
Uganda’s prison system has made commendable progress in HIV management:
- 92% of HIV-positive inmates are aware of their status
- 99% are on antiretroviral therapy (ART)
- However, only 70% have achieved viral suppression
“While we’ve made progress on HIV care, TB lags behind in diagnosis and access to treatment,” noted Dr. George Tumusinze, Program Manager and Research Associate.
Traditional symptom-based screening methods missed nearly half of the TB cases identified in the survey, according to Prof. Rhoda Wanyenze, Dean of MakSPH and lead investigator.
“We must adopt WHO-recommended diagnostics like GeneXpert, TB LAM, and digital chest X-rays with computer-aided detection (CAD) to detect and treat TB cases early,” she urged.
So far, UPS has installed 14 GeneXpert machines in high-volume facilities. However, experts warn that urgent nationwide scale-up of modern diagnostics is essential.
Since 2010, the CDC and PEPFAR have invested over $18 million in improving health services in Uganda’s prisons, including $550,000 allocated specifically for the recent TB survey. These investments have expanded testing and treatment services, trained staff, and improved infrastructure.
“This work doesn’t just protect inmates—it safeguards communities when prisoners are reintegrated,” said Dr. Mary Boyd, CDC Uganda Country Director.
Some critics, including Members of Parliament, have raised concerns about the implications of mandatory TB testing on individual rights. However, public health experts argue that in high-transmission settings, individual choice must be weighed against community protection.
“When done with dignity and linked to prompt treatment, mandatory screening is not coercive—it’s a safeguard for all,” Dr. Kisambu emphasized.
Dr. Charles Olaro, Director General of Health Services, described the national prison TB survey as a pivotal moment in Uganda’s efforts to eliminate tuberculosis.
“We cannot meet our 2030 TB elimination goals without confronting the prison crisis head-on,” he said.
Key Recommendations from the Report:
- Institutionalize routine mass TB screening across all prison facilities
- Scale up use of molecular diagnostics and digital tools for early detection
- Upgrade infrastructure to address overcrowding and poor ventilation
- Prioritize vulnerable groups, especially women
- Allocate dedicated resources to strengthen prison health systems
Without decisive action, Uganda’s national TB targets will remain out of reach.
Uganda’s fight against TB and HIV cannot succeed unless its most marginalized populations are included. The health of incarcerated people is not isolated—it is intricately connected to the health of the broader society. This report is a wake-up call: failing to act is no longer an option