White Mary C, Tulsky Jacqueline P, Menendez Enrique, Goldenson Joe, Kawamura L Masae
Department of Community Health Systems, University of California, School of Nursing, San Francisco, CA 94143-0608, USA.
Am J Prev Med. 2005 Nov;29(4):295-301. doi: 10.1016/j.amepre.2005.06.014.
Inmates are a high-risk population for tuberculosis (TB) control efforts, including treatment for latent tuberculosis infection (LTBI). Completion of therapy after release has been poor. The goal of this study was to evaluate therapy completion and active disease over 5 years in a cohort of inmates.
The sample was from a completed randomized trial in 1998-1999 of education or incentive versus usual care to improve therapy completion after release from the San Francisco County Jail. Records from the jail, the County Tuberculosis Clinic, and the California TB Registry were used to measure therapy completion and development of active TB. Analyses were conducted in 2005.
Of a total 527 inmates, 31.6% (n=176) completed therapy, of whom 59.7% (n=105) completed it in jail. Compared with the U.S.-born, foreign-born inmates residing in the United States for < or =5 years were less likely to complete the therapy (adjusted odds ratio [AOR]=0.49, 95% confidence interval [CI]=0.28-0.85), and those with more education were more likely to complete the therapy (AOR=1.06, 95% CI=1.01-1.12). Three subjects developed active TB in the 5 years of follow-up, resulting in an annual rate of 108 per 100,000. Compared with California rates, subjects were 59 times as likely to develop active TB (standardized morbidity ratio of 59.2, 95% CI=11.2-145.1). None had completed therapy, none were new immigrants, and two were known to be HIV-positive at diagnosis.
Completion of therapy for LTBI is a challenge, but the active TB seen in this jail cohort emphasizes the importance of continued efforts to address TB risk in this population.
在结核病（TB）防控工作中，包括潜伏性结核感染（LTBI）治疗方面，囚犯是高危人群。释放后治疗的完成情况较差。本研究的目的是评估一组囚犯在5年期间的治疗完成情况和活动性疾病情况。
样本来自1998 - 1999年一项已完成的随机试验，该试验比较了教育或激励措施与常规护理对提高从旧金山县监狱释放后治疗完成率的效果。利用监狱记录、县结核病诊所记录以及加利福尼亚结核病登记处的数据来衡量治疗完成情况和活动性结核病的发生情况。分析于20年进行。
在总共527名囚犯中，31.6%（n = 176）完成了治疗，其中59.7%（n = 105）在监狱内完成治疗。与在美国出生的囚犯相比，在美国居住≤5年的外国出生囚犯完成治疗的可能性较小（调整后的优势比[AOR]=0.49，95%置信区间[CI]=0.28 - 0.85），而受教育程度较高的囚犯完成治疗的可能性较大（AOR = 1.06，95% CI = 1.01 - 1.12）。在5年的随访中有3名受试者发生了活动性结核病，年发病率为每10万人108例。与加利福尼亚州的发病率相比，受试者发生活动性结核病的可能性高59倍（标准化发病比为……此处原文有误，应为59.2，95% CI = 11.2 - 145.1）。没有人完成治疗，没有人是新移民，且已知有两名在诊断时为HIV阳性。
LTBI治疗的完成是一项挑战，但该监狱队列中出现的活动性结核病强调了持续努力应对该人群结核病风险的重要性。
