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Randomized Controlled Trial of Interventions to Improve Follow-up for Latent Tuberculosis Infection After Release From Jail
Mary Castle White, MPH, PhD, FAAN;
Jacqueline P. Tulsky, MD;
Joe Goldenson, MD;
Carmen J. Portillo, RN, PhD, FAAN;
Masae Kawamura, MD;
Enrique Menendez, MD
Arch Intern Med. 2002;162:1044-1050.
Background Adherence to treatment of persons with latent tuberculosis infection
after release from jail has been poor.
Methods A randomized controlled trial was conducted at the San Francisco City
and County Jail, San Francisco, Calif. Subjects undergoing therapy for latent
tuberculosis infection who spoke either English or Spanish were randomly allocated
to receive education every 2 weeks while in jail; an incentive if they went
to the San Francisco County Tuberculosis Clinic within 1 month of release;
or usual care. The main outcome measures were completion of a visit to the
tuberculosis clinic within 1 month of release and completion of therapy.
Results Of 558 inmates enrolled, 325 were released before completion of therapy.
Subjects in either intervention group were significantly more likely to complete
a first visit than were control subjects (education group, 37%; incentive
group, 37%; and controls, 24%) (adjusted odds ratio based on pooled results
for the education and incentive groups, 1.85; 95% confidence interval, 1.04-3.28; P = .02). Those in the education group were twice as likely
to complete therapy compared with controls (adjusted odds ratio, 2.2; 95%
confidence interval, 1.04-4.72; P = .04). Of those
who went to the tuberculosis clinic after release, subjects in the education
group were more likely to complete therapy (education group, 65% [24/37];
incentive group, 33% [14/42]; and control group, 48% [12/25]; P = .02).
Conclusions Education or the promise of an incentive improved initial follow-up.
Education was superior to an incentive for the completion of therapy. Fairly
modest strategies provided in jail can improve adherence. Further links between
jail health services and community care should be explored.
From the Department of Community Health Systems, School of Nursing
(Drs White, Portillo, and Menendez), and the Department of Medicine, School
of Medicine, Positive Health Program (Dr Tulsky), The University of California,
San Francisco; Jail Health Services, San Francisco City and County Department
of Public Health, San Francisco, Calif (Dr Goldenson); and Tuberculosis Clinic
and the Department of Public Health, San Francisco General Hospital Medical
Center, San Francisco (Dr Kawamura).
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