Important note: Information in this article was accurate in 2005. The state of the art may have changed since the publication date.
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American Journal of Preventive Medicine Vol. 29; No. 4: P. 295-301 (11.05.05) - Monday, December 12, 2005
Mary C. White, PhD; Jacqueline P. Tulsky, MD; Enrique Menendez, MD; Joe Goldenson, MD; L. Masae Kawamura, MD
The authors used a sample from a completed randomized trial in 1998-1999 of education or incentive versus usual care to improve therapy completion after release from the San Francisco County Jail. To measure therapy completion and active TB development, records from the jail, the county Tuberculosis Clinic, and the California TB Registry were used.
Of 527 inmates, 31.6 percent (n=176) completed therapy, of whom 59.7 percent (n=105) finished it in jail. Compared to US- born inmates, foreign-born inmates residing in the United States for five or fewer years were less likely to complete therapy (adjusted odds ration [AOR]=0.49, 95 percent confidence interval [CI]=0.28-0.85). Those with more education were more likely to complete TB therapy (AOR=1.06, 95 percent CI=1.01-1.12).
In follow-up, three inmates developed active TB, resulting in an annual rate of 108 per 100,000. Compared with California rates, the subjects were 59 times as likely to develop active TB (standardized morbidity ratio of 59.2, 95 percent CI=11.2- 145.1). None had completed therapy, none were new immigrants, and two were known to be HIV-positive at diagnosis.
"Completion of therapy for LTBI is a challenge, but the active TB seen in this jail cohort emphasizes the importance of continued efforts to address TB risk in this population," concluded the researchers.
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