Prison Inmates Benefit from Much Shorter Tuberculosis Treatment Regimen, Study Shows

By Korry, Elaine | Daily News (Los Angeles, CA), November 19, 2016 | Go to article overview

Prison Inmates Benefit from Much Shorter Tuberculosis Treatment Regimen, Study Shows


Korry, Elaine, Daily News (Los Angeles, CA)


Jails and federal prisons in California and elsewhere are adopting new treatment guidelines for latent tuberculosis infection based on research showing that it can be treated effectively during a much shorter period.

A recent study led by local and state health officials compared the new and more traditional treatment protocols in the jail system of Santa Clara County. It found a 12-week two-drug regimen is as effective as the traditional nine-month single-drug approach to treating latent infection, which is not contagious but without treatment can progress to active disease. Plus the shorter regimen significantly boosted the percentage of inmates who completed treatment.

"Essentially what we found was a huge improvement in the completion rate for latent TB infection," said Maria Juarez-Reyes, lead author of the clinical trial and an assistant clinical professor at Stanford University and.

Santa Clara County has California's fifth-largest jail system, with approximately 4,000 inmates, and the state as a whole has nearly double the national incidence rate of active TB, a highly contagious bacterial infection that can be fatal if not treated properly.

The Centers for Disease Control and Prevention reports that 4 to 6 percent of active TB cases are diagnosed in correctional facilities, where the population is considered at high-risk because of close living quarters, a history of inadequate medical care, underlying medical conditions such as elevated rates of HIV infection and higher levels of substance abuse.

Treating active TB is a high priority, but public health officials are also concerned about the incidence of latent TB infection, in which a patient tests positive for TB but is not yet sick. Over 6 percent of California's population -- 2.4 million people -- is estimated to have latent TB, and the majority of those infected don't know it.

Treating latent infection in jails is a cornerstone of the strategy to suppress TB, because it prevents the infection from progressing to active disease. Yet such treatment often falls short. The CDC found only about a third of inmates complete the traditional nine-month, twice-weekly treatment regimen with isoniazid, a widely used antibiotic. The completion rate was even lower -- 18 percent -- at the Santa Clara County Jail.

"To complete treatment is very difficult because it takes too long," said Juarez-Reyes. "The average length of stay was three and a half months before they were transferred or released." When they were released, inmates would receive information about county TB clinics where they could complete their treatment on the outside, but the follow-up rate was "very, very low."

Juarez-Reyes and her fellow researchers reduced the doses of medication from 72 to 12 and shortened the duration of treatment by two-thirds.

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In 2012, the jail switched from the nine-month drug protocol to a regimen of 12 weekly doses of a combination of isoniazid and a second antibiotic, rifapentine. To assess the outcome, the researchers directly observed 91 patients who received the 3-month drug cocktail and compared their results to a similar group of patients who in the past had undergone the 9-month treatment.

The scientists concluded that the shorter regimen was as effective as the longer one and that the completion rate soared -- from 18 percent to 85 percent.

"This is really fantastic," said co-author Neha Shah with the Tuberculosis Control Branch of the state public health department. "The implication is we can get more people through treatment, treat them effectively before they break down and get sick and can infect other people."

Researchers were also reassured to see the 12-dose regimen was well tolerated -- even by jail inmates who have a higher rate of substance abuse, which can harm the liver. …

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