Lobato Mark N, Leary Linda S, Simone Patricia M
Division of Tuberculosis Elimination, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Am J Prev Med. 2003 Apr;24(3):249-53. doi: 10.1016/s0749-3797(02)00583-4.
To eliminate tuberculosis (TB) in the United States, more information is needed on how to gain access to difficult-to-reach, high-risk populations to evaluate people who would benefit from treatment for latent TB infection (LTBI).
A field study was conducted of people at risk for co-infection with TB and the human immunodeficiency virus (HIV) and to demonstrate that treating LTBI in inmates is feasible. Inmates were tested for LTBI using the Mantoux tuberculin skin test (TST). Outcomes measured were skin test results and the start and completion of treatment for LTBI.
In 49 correctional facilities in 12 states, 198102 inmates had a skin test read. The mean skin test positivity rate among inmates was 17.0%. Of those who had a known HIV test result, 14.5% tested HIV positive. Inmates with a positive TST were 4.2 times more likely than those with a negative TST to be HIV infected (95% confidence interval [CI]=3.9-4.4). Therapy for LTBI was completed in 55.9% of patients started on treatment. Patients who were HIV positive and started on a 12-month treatment regimen were less likely than HIV-negative patients (40.0% vs 68.1%, respectively) to complete treatment (odds ratio [OR]=0.24, 95% CI=0.20-0.28). Patients treated in jails were less likely than those treated in prisons (33.6% vs 57.7%, respectively) to complete treatment (OR=0.29, 95% CI=0.26-0.32).
Correctional facilities offer a venue for identifying and treating high-risk individuals for LTBI. However, completing treatment is more problematic in jails than in prisons.
为了在美国消除结核病（TB），需要更多关于如何接触难以触及的高风险人群以评估哪些人会从潜伏性结核感染（LTBI）治疗中受益的信息。
对有结核与人类免疫缺陷病毒（HIV）合并感染风险的人群进行了一项现场研究，以证明在囚犯中治疗LTBI是可行的。使用结核菌素皮肤试验（TST）对囚犯进行LTBI检测。测量的结果包括皮肤试验结果以及LTBI治疗的开始和完成情况。
在12个州的49个惩教设施中，198102名囚犯进行了皮肤试验读数。囚犯中的平均皮肤试验阳性率为17.0%。在已知HIV检测结果的人中，14.5%检测为HIV阳性。TST阳性的囚犯感染HIV的可能性是TST阴性囚犯的4.2倍（95%置信区间[CI]=3.9-4.4）。开始治疗的患者中有55.9%完成了LTBI治疗。开始接受12个月治疗方案的HIV阳性患者比HIV阴性患者完成治疗的可能性更小（分别为40.0%和68.1%）（优势比[OR]=0.24，95%CI=0.20-0.28）。在监狱接受治疗的患者比在监狱接受治疗的患者完成治疗的可能性更小（分别为33.6%和57.7%）（OR=0.29，95%CI=0.26-0.32）。
惩教设施为识别和治疗LTBI的高风险个体提供了一个场所。然而，在监狱中完成治疗比在监狱中更成问题。
