The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #67097

Cheryl A Roberts, MPA¹, Mark N. Lobato, MD², Lauri B. Bazerman, MS², Theodore M. Hammett, PhD¹, and Ryan N. Kling, MA¹. (1) Abt Associates Inc., 55 Wheeler Street, Cambridge, MA 02138, 617-482-2520, croberts@crjustice.org, (2) Division of Tuberculosis Elimination (DTBE), Centers for Disease Control and Prevention, 1600 Clifton Rd., NE, Mailstop E10, Atlanta, GA 30333

Background: A disproportionate percentage of TB cases in the U.S. occur among jail inmates. This study assessed the extent to which jail systems follow the CDC’s guidelines for TB prevention and control in correctional facilities, including screening, containment, and program assessment, and collaboration between jail systems and public health departments.

Methods: The study randomly selected 20 of the 46 cities/counties with large jail systems (average daily census > 1,500) and TB case rates at least the national average. Data were collected through questionnaires, mailed to jail medical directors and local health department TB controllers, on-site interviews, and medical records abstraction.

Results: Over half of inmates evaluated for TB disease were diagnosed in jail, presenting an important public health opportunity. Improvement is needed in all major areas of TB prevention and control. Just over one third of jails and health departments reported having effective collaboration in TB prevention and control activities, and only 15% reported having effective discharge planning collaboration. Most jail systems had inadequate medical information systems, and medical records lacked information about TB history and risk factors.

Conclusions: To improve TB prevention and control, jails and health departments need to increase the scope and levels of collaboration and establish organizational mechanisms that were associated with effective collaboration. Jails also need to develop electronic information systems to monitor patient management and evaluate TB control activities. Other areas for improvement include environmental controls and isolation, comprehensiveness and timeliness of screening and diagnostic evaluations, and contact investigation protocols.

Cheryl Roberts current affiliation: Crime and Justice Institute, 355 Boylston St., Boston, MA 02116, croberts@crjustice.org.

Learning Objectives:

At the conclusion of this session, participants will be able to:
• Identify areas for improvement for TB prevention and control among jail populations;
• Describe areas of collaboration between large city/county jail systems and local or state health departments and identify deficiencies in TB program collaboration; and
• Identify and apply strategies to improve TB control in jails and strengthen collaborations between jail systems and health departments to reduce TB in both jails and the larger communities.

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.