BUSINESS WIRE - 44 Montgomery St, 39th Floor, San Francisco, CA 94104; Tel: (415) 986-4422; FAX: (415) 788-5335 - Tuesday, 9 September 1997.
"In addition, these policies should establish appropriate sites for civil detention and detain persistently non adherent patients until successful completion of therapy is almost certain," said senior author of the study Bernard Lo, M.D., UCSF professor of medicine and director of the UCSF Program in Medical Ethics.
Lo and research colleagues conducted an analysis of TB patients who persistently do not complete their nine-month long drug therapy treatment.
"Despite all efforts of TB controllers to provide treatment and social services, a small number of patients -- about 1.3 percent -- do not comply," Lo said. "Because these patients are not completing treatment, they pose a threat to public health."
To minimize the public health risk, California implemented a law in 1994 to allow either criminal or civil detention of persistently non adherent TB patients. According to the UCSF study, criminal detention assures that patients are available for treatment and the threat of jail may motivate patients to adhere to treatment. Civil detention, such as in a hospital setting, focuses on treatment and gives public health officials control over the case.
Analyzing the program, Lo and colleagues looked at 12 California counties with the largest number of newly reported TB cases in 1994, accounting for more than 85 percent of the state's reported TB cases. They found that TB controllers sought the civil detention and or arrest of 67 patients during the one-year study period: 53 of the patients were put in jail for an average of 83 days and 14 were detained in a civil facility for two weeks. Eighteen patients were excluded from the study because they either died or moved away.
The UCSF researchers analyzed the success of the state control program on the remaining 49 detained patients, and found that 84 percent (41) completed therapy.
"To enhance the care of TB patients who persistently do not comply with treatment, TB controllers should have the resources as well as the responsibility to make reasonable attempts to provide housing, psychiatric care, and substance abuse treatment before detaining such patients," Lo said. "In addition, the state should provide appropriate facilities for civil detention, rather than detain non adherent TB patients in jail, which raises ethical issues."
Finally, the duration of detention needs to balance the goals of completing therapy while minimizing intrusions on freedom, according to the UCSF researchers.
Tuberculosis cases increased almost 20% nationally and increased more than 35% in children between 1985 to 1992. Many factors such as the acquired immunodeficiency syndrome (AIDS) epidemic, increases in substance abuse and homelessness, increased immigration, and lack of patient compliance contributed to the increased number of cases of TB, according to an accompanying editorial in the Sept. 10 issue of JAMA. However, many feel the TB resurgence has been the result of policy maker neglect of TB control mandates which dismantled programs that kept TB under control, according to the editorial.
Since the UCSF study, improvements have been made to control TB in California. For example, there has been more funding for civil detention centers, such as hospital-type settings, and TB controllers in the state have begun working on guidelines for other services for TB patients who are mentally ill and who are substance abusers, Lo said.
Co-authors of the study are: Tom Oscherwitz, J.D., former policy analyst, UCSF Program in Medical Ethics; Jacqueline Peterson Tulsky, M.D., UCSF assistant professor of medicine; Steve Roger, health program specialist, California Tuberculosis Control Branch, California Department of Health Services; Stan Sciortino, MPH, California Tuberculosis Control Branch, California Department of Health Services; Ann Alpers, J.D., UCSF assistant professor of medicine; Sarah Royce, M.D., MPH, branch chief, California Tuberculosis Control Branch, California Department of Health Services.
(End of advance for release 3 p.m. CDT, Tuesday, Sept. 9, to Coincide with Publication in JAMA)
--30--jm/sf as/sf
CONTACT: University of California, San Francisco Lordelyn P. del Rosario, 415/476-2557
Today's News On The Net - Business Wire's full file on the Internet with Hyperlinks to your home page. URL: http://www.businesswire.com
Copyright (c) 1997/BUSINESS WIRE. Reproduced with permission. Reproduction of this article (other than one copy for personal reference) must be cleared through the Permissions Desk, Business Wire, 1185 Avenue of the Americas, 3rd Floor, New York, NY 10036; Tel: (212) 575-8822; FAX: (212) 575-1854.
970909
BW970905
Copyright © 1997 - Business Wire. All rights reserved. Reproduced with permission. Reproduction of this article (other than one copy for personal reference) must be cleared through the Business Wire, Permissions Desk, Business Wire, 1185 Avenue of the Americas, 3rd Floor, New York, NY 10036; Tel: (212) 575-8822; FAX: (212) 575-1854. http://www.businesswire.com.
AEGiS is a 501(c)3, not-for-profit, tax-exempt, educational corporation. AEGiS is made possible through unrestricted funding from Broadway Cares/Equity Fights AIDS, Elton John AIDS Foundation, the National Library of Medicine, Pacific Life Foundation and donations from users like you.
Always watch for outdated information. This article first appeared in 1997. This material is designed to support, not replace, the relationship that exists between you and your doctor.
AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.
Copyright ©1980, 1997. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .