Important note: Information in this article was accurate in 2003. The state of the art may have changed since the publication date. Dear Correctional Colleagues:
In my infectious diseases referral clinic in a state prison in California, at least once a week I encounter a patient who has a chronic medical condition for which no treatment was pursued prior to incarceration. Whether it is mental illness, HIV, HCV, LTBI, or a myriad of other treatable and/or curable conditions, the reality is that this nation's jails and prisons have become the primary source of medical services for a significant percentage of our fellow citizens. Work by our colleague Rick Altice has demonstrated that for many inmates with HIV infection, the first offer of testing and/or treatment came during incarceration. David Thomas, Dianne Rechtine, and colleagues in Florida were able to show that directly observed therapy in a prison setting can yield remarkable results in the treatment of HIV disease. How can these lessons be applied to this country's strategic plan for the elimination of tuberculosis?
As noted in the recent report to congress entitled "The Health Status of Soon-To-Be-Released Inmates," we know that inmates are disproportionately burdened by tuberculosis infection and disease. It is estimated that over 500,000 individuals with LTBI are released from jail or prison every year, and that the rate of active tuberculosis in inmates is at least five times that found in persons in the free community. Clearly, many inmates are also struggling with mental illness, alcoholism, substance abuse, poverty, and other problems that impact upon their willingness and ability to faithfully adhere to the long treatment course required for LTBI and TB disease.
Once again, we in correctional/public health are called upon to turn this challenge into an opportunity: to use the period of incarceration of our patients as a time to diagnose, educate, and treat those of our patients who are infected with tuberculosis. By doing so, we not only make an impact on the health of our patients, but also contribute to the nation's public health efforts to eliminate TB.
This month, Dr. Renee Ridzon provides a review of the current status of tuberculosis in corrections, and HEPP Report editors provide a summary of a CDC-sponsored conference held January 25-26 in San Antonio on the management of HCV in corrections. This month's HIV 101 is a useful table to guide the treatment of LTBI.
After reading this issue, you should be familiar with the diagnosis and treatment of MTB in the incarcerated, and have a better understanding of current issues involved in the management of HCV in the correctional setting.
Joseph Bick, M.D.
Co-Chief Editor
030201
HEPP2003-0202
©1997,1998,1999,2000,2001,2002, 2003. The recently formed HIV Education Prison Project (HEPP) is a medical education program that targets a growing population, inmates in correctional facilities, that has been underserved in HIV care. It is part of the Brown University AIDS Program. Permission to use and reproduce portions of this newsletter is hereby granted provided that author and publication are fully credited and both copyright and permission notice appear with reprinted material. Inquiries may be directed to heppnews@brown.edu. Website: HIV Education Prison Project.
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