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APHA Scientific Session and Event Listing

Mary Castle White, MPH, PhD, Sasha Cuttler, RN, MS, and Xin Zhao, MA. Community Health Systems, University of California, San Francisco, 2 Koret Way, Box 0608, N511R, San Francisco, CA 94143, 415-476-5213, mary.white@nursing.ucsf.edu

Inmates are a focus for TB control efforts. Therapy completion for latent tuberculosis infection (LTBI) after release has been poor. In a randomized trial, education improved both follow-up at TB clinic and therapy completion. But only one third ultimately completed and three developed TB in five year follow-up (108/100,000/year). Our goal was to examine reasons subjects provided for adherence, to further elucidate strategies that might improve the poor outcomes of care. Methods. The sample was from the trial to improve therapy completion after release from the San Francisco County Jail. During the trial subjects were asked to anticipate barriers and facilitators to follow-up, and after the trial ended they were located and asked post-release status and reasons for their actions. This descriptive analysis was conducted in 2006. Results. Of 325, 230 (71%) were found, 86.9% (93/107) of subjects who followed up at TB Clinic, and 63.3% (137/218) of subjects who did not; these comprise the analytic sample. Of those employed before jail, half were unemployed at follow-up after jail (p= 0.001, MacNemar test). For those who went to clinic, 41% who reported having a person who would provide support for taking INH at baseline reported no such support at follow-up (p<0.001, MacNemar test); for those who did not go to clinic, 68% reported a change to no support after release. Of those who followed up, only 13% said it was difficult to come to the clinic, but 73% came by bus, taxi, or foot. On average it took 29 minutes to get to the clinic in this 7-mile square county, and the clinic visit on average took 67 minutes. Subjects cited the waiting period and hours the clinic was open as major barriers. For those who didn't go to clinic, half cited being too busy as reasons. Transportation was the primary clinic issue cited. Conclusions. Despite initial perceptions, in follow-up many subjects had lost their jobs or now perceived no support for continuing therapy. Jail itself influences both predictors and outcomes; researchers should be cognizant of the effect of this disruption and cautious in interpreting self-reports of social status. Also, traditional system enablers (incentives, stable relationship with provider, directly observed therapy) may not be as important as operating hours, transportation, and waiting time for this population. Such factors warrant further study and may be particularly important in persons trying to get back on their feet after a jail term.

Learning Objectives:

• describe barriers and facilitators to continuity of care among released inmates; list three reasons why released inmates did, and three reasons why they did not, complete a post-release clinic visit; recognize the role of jail as a disruption in the lives of inmates asked to continue medical regimens after release

Keywords: Inmates, Tuberculosis

Presenting author's disclosure statement:

Not Answered