Mary Castle White, RN, MPH, PhD¹, Jacqueline P. Tulsky, MD², Enrique Menendez, MD¹, Joe Goldenson, MD³, and L. Masae Kawamura, MD⁴. (1) School of Nursing, University of California, San Francisco, 2 Koret Way., Room N505, San Francisco, CA 94143-0608, (415) 476-5213, mcwhite@itsa.ucsf.edu, (2) Department of Medicine, School of Medicine, Positive Health Program, University of California, Box 0874, San Francisco, CA 94143-0874, (3) Department of Public Health, San Francisco, Director/Medical Director San Francisco Jail Health Services, 650 5th Street, Suite 309, San Francisco, CA 94107, (4) Tuberculosis Control, San Francisco City and County Department of Health, 1001 Portrero Ave, San Francisco, CA 94110

Background. Testing for tuberculosis (TB) is routine in most jails, but adherence to therapy for latent TB infection (LTBI) after release is poor. We have followed a cohort of inmates with LTBI, most of whom were new immigrants from countries with high prevalence of TB, since 1998. Methods. Consecutive inmates in the San Francisco Jails were recruited in 1998-99 for a clinical trial of interventions to improve completion of therapy for LTBI. Before randomization, baseline data were gathered on all participants, including those who were not in the final analytic sample of persons released from jail before completing therapy. Data on therapy taken in jail was gathered, as well as completion or noncompletion of care in the community. In 2004 we linked identifying information with State of California TB Registry reports of active TB. Results. Over the 15-month enrollment period, 558 eligible inmates agreed to participate. In the current review of chart documentation, one was found to have been in treatment for active TB with close follow-up by the City and County TB Control Division during his jail time; this record was removed from this analysis. Of the 557, 2 were linked with subsequent reports of active TB. One had been released to the community after 98 days of INH in jail and did not complete therapy for LTBI. Six months later he was admitted to the hospital with active TB. The other was sent to another correctional facility after receiving INH for 16 days. He came back to jail within 3 months and remained in jail for another 8 months, but was not restarted on INH. Ten months later he was found to have active TB. The incidence of active TB in this cohort of 557 is 359 per 100,000. Discussion. While efforts to improve completion of therapy for LTBI among inmates have been only somewhat successful, continued efforts must be made in this group at high risk of progression to active disease. Prisoners have multiple risk factors that put them at risk of acquiring latent TB infection and having LTBI progress to active disease. Strengthening links among correctional facilities, and between correctional facilities and public health systems is urgently needed to address this preventable outcome.

Learning Objectives: At the end of this session, participants will be able to

• describe the risk factors that put incarcerated individuals at high risk for progression from latent TB to active disease
• Describe the system of links between correctional settings and public health that should be strengthened in order to improve completion of care for LTBI
• Identify barriers to those links

Keywords: Tuberculosis, 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.