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Description: 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, 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, 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.


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