Magazine article Corrections Forum

Tuberculosis in Corrections

Magazine article Corrections Forum

Tuberculosis in Corrections

Article excerpt

Tuberculosis (TB) continues to disproportionately afflict persons incarcerated in correctional facilities in the United States (U.S.). A recent study examining surveillance data for all persons with TB disease reported in the U.S. between 1993 and 2003 found that the rate of TB disease among federal (29.4 cases/100,000) and state (24.2/100,000) prison inmates was markedly higher than the rate among non-inmates (6.7/100,000). Over half (53.7%) of the inmates with TB disease were housed in local jails, and compared to non-inmates, they were younger, more likely to be male, US-born and from racial and ethnic minorities. Not surprisingly, inmates more often had a history of excess alcohol use, illicit drug use and homelessness during the year prior to TB diagnosis

Co-infection with human immunodeficiency virus (HIV) was common among inmates with TB disease. Among males between the ages of 18 and 64, 25% of the incarcerated were known to be HIV-infected compared to 18% for noninmates

Further, despite a higher rate of directly observed therapy among inmates than noninmates, treatment completion rates tended to be worse among inmates than noninmates, particularly among those who were HIV-infected

As most prisoners with TB are eventually released, failure to complete treatment in this population poses a significant risk not only to the individual health of the patient, but also to the public health of the community. While the study did not examine the reasons for worse TB treatment outcomes among inmates, several factors may have been contributory. The study spanned 1993 to 2003, and during the early part of this period, TB control efforts were simultaneously recovering from the relative neglect of the previous decade and coping with the emerging HIV/AIDS epidemic. Additionally, the authors suggest that the poor inmate outcomes observed may be the product of fragmentation of care in correctional settings due to inmate transfer between institutions and release from incarceration, which challenge coordinated care to ensure treatment completion

Certainly, socioeconomic factors associated with incarceration may have posed a barrier to healthcare as those who are incarcerated may have less access to care and/or under-utilize care

The Challenges of TB Control

Local jails have been particularly implicated in TB transmission, and TB control has been challenging in this setting. A study of TB cases in Maricopa County, Arizona, published in 2005, demonstrated the challenges of TB control in jails. Of 300 TB cases reported in the county from 1999 to 2000, 73 (24%) occurred in persons who had a history of incarceration in the county jail. Similar to national statistics, TB patients with a history of incarceration had higher rates of homelessness and substance abuse than other TB patients. The TB patients in the study who had been in the county jail were incarcerated a total of 370 times, but spent a median of only two days in jail each time they were incarcerated. This short length of stay and the requirement of at least 48 hours to place and read a tuberculin skin test (TST) may explain why 83% of inmates had no record of tuberculin skin testing in jail. Innovative strategies for screening.

Occupational Hazards of TB Infection

TB is an occupational hazard for healthcare professionals who work in correctional settings

Past studies have demonstrated a relatively high incidence of latent TB infection (LTBI) in correctional healthcare workers, 3 with infection rates estimated to be as high as 6.6%. However, a recent study of correctional healthcare workers suggested that a significant proportion of LTBI may be acquired outside the workplace. The study authors surveyed correctional healthcare professionals in Rhode Island, Maryland and Texas. Tuberculin skin testing practices varied by site, and two-step testing (i.e. repeat tuberculin skin testing one to three weeks following an initial negative TST result) was generally not used. …

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