Tuberculosis preventive treatment in a Brazilian prison: acceptability, completion, and perspectives of persons deprived of liberty and their family members

Background: Tuberculosis (TB) poses a major public health challenge in carceral settings. In Brazil, persons deprived of liberty experience a TB risk 26 times that of the general population. Tuberculosis Preventive Treatment (TPT) is a critical yet underutilized strategy in prisons, in part due to limited empirical evidence to guide implementation. Methods: We conducted a pilot TPT program using the 3HP regimen in a male prison in Campo Grande, Mato Grosso do Sul, Brazil. We assessed feasibility, acceptability, and factors influencing treatment adherence. We evaluated the TPT care cascade from eligibility through treatment completion. We also conducted focus groups with persons deprived of liberty who received TPT, as well as interviews with their family members, to examine understanding of TB infection and disease and to identify barriers and facilitators to TPT completion. Results: Of 50 eligible individuals, 45 (90%) initiated TPT; of those who initiated, 37 (82.2%) completed treatment. The regimen was well tolerated, with 76% of participants reporting no side effects. Qualitative analysis revealed lack of knowledge around latent TB infection and substantial TB-associated fear and stigma; framing latent infection as "dormant bacteria" helped mitigate these concerns. Key facilitators of TPT initiation and completion included trust in and accompaniment by the healthcare team delivering TPT, and the desire to protect one's own health and others’. Many PDL expressed a preference for short-course regimens, including potential one-month options. Main barriers included peer stigma, treatment disruptions due to transfers and releases, and structural challenges including distrust of prison staff and difficulty accessing routine healthcare both in prison and in the community. Conclusion: The 3HP regimen demonstrated high acceptability and completion among persons deprived of liberty in a Brazilian prison. Optimizing implementation will require complementary prison-wide efforts for TB education and destigmatization, administration by trusted healthcare professionals, and proactive follow-up to ensure treatment continuity after transfer and release.