Factors associated with tuberculosis symptom reporting among persons deprived of liberty in Brazil during active case finding: a cross-sectional study

Introduction: Active case finding (ACF) can improve tuberculosis (TB) diagnosis in high-burden populations. Many programmes rely on symptom evaluation as the first screening step; however, symptom reporting may vary according to the context of evaluation. Methods: We performed a cross-sectional analysis of persons deprived of liberty (PDL) diagnosed with TB in an ACF programme conducted in two male Brazilian prisons from February 2023 to February 2025. Every 4 months, participants underwent sputum testing by GeneXpert Ultra (Xpert) and culture. Study nurses administered symptom questionnaires during the initial evaluation. Individuals with positive results were interviewed by a physician. We compared characteristics of individuals with microbiologically confirmed TB according to their symptom reporting at initial screening and medical consultation, which was used to define four groups (e.g., combinations of symptomatic/asymptomatic at each of the two symptom assessments). Results: Among 6919 PDL screened, 448 (6.4%) had microbiologically confirmed TB. We included 292 (65.1%) individuals in the analysis, after excluding those with missing clinical information and consults >15 days after screening. 113 (38.7%) reported symptoms at initial screening, while 192 (65.8%) reported symptoms at medical consultation (p