 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
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| The 131st Annual Meeting (November 15-19, 2003) of APHA |
Mary Castle White, RN, MPH, PhD, School of Nursing, University of California, San Francisco, 521 Parnassus Ave., Room N505, San Francisco, CA 94143-0608, (415) 476-5213, mcwhite@itsa.ucsf.edu, Jacqueline P. Tulsky, MD, Department of Medicine, School of Medicine, Positive Health Program, University of California, Box 0874, San Francisco, CA 94143-0874, Joe Goldenson, MD, Department of Public Health, San Francisco, Director/Medical Director San Francisco Jail Health Services, 650 5th Street, Suite 309, San Francisco, CA 94107, and L. Masae Kawamura, MD, Tuberculosis Control, San Francisco City and County Department of Health, 1001 Portrero Ave, San Francisco, CA 94110.
Background. Adherence to treatment of persons with latent tuberculosis infection (LTBI) after release from jail has been poor. Once diagnosed with LTBI and started on therapy, inmates are frequently lost to follow-up after release. Our baseline studies and published clinical trial results demonstrated that structured educational counseling sessions conducted in jail improved follow-up rates and completion of care after release. We questioned, however, whether the intervention would be as effective if administered by jail personnel, after the trial was finished. Methods. This AHRQ-funded cohort study examined the effect of education delivered by jail health personnel, to determine if the effect seen under study conditions could be maintained in a usual care setting. Two historical cohorts provided comparisons: inmates diagnosed and treated in jail prior to any interventional studies by our team; and inmates enrolled in our clinical trial who were educated by study personnel. Outcome measures were first visit to TB Clinic after release from jail and completion of therapy for LTBI. Data on demographics and characteristics of the session (length of time, language, materials given to inmate) were collected. Results. Characteristics of the inmates in the current cohort were similar to those of previous study cohorts: 66% were Spanish speaking, 92% were male, with a mean age of 32 (median 29). Of 193 inmates in the current cohort, 19.4% completed a first visit to clinic after release; this was not statistically different from the clinical trial cohort receiving a single educational session from study staff (24% came to clinic). This was, however, statistically different from the rate of completion of first visit in the historical cohort, studied before educational materials were developed, of whom only 3% came to clinic after release. To date, in the current cohort 46% of those who first came to clinic have successfully finished therapy, similar to 48% in the comparable group from the clinical trial. The educational session, which will be presented, is structured and has characteristics that make it relatively easy to provide to inmates. Discussion. The effect of a clinical trial on the behavior of subjects is known. In this observational study we demonstrate that an educational intervention, when carried out as part of usual care, has a somewhat lower success rate than it does when carried out by study personnel. The effect remains, however, and has implications for jail health care in diagnosis and treatment of inmates with latent tuberculosis infection.
Learning Objectives:
Keywords: TB, Jails and Prisons
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.