Nolan C M, Roll L, Goldberg S V, Elarth A M
Tuberculosis Control Program, Seattle-King County Department of Public Health, Washington 98104, USA.
Am J Respir Crit Care Med. 1997 Feb;155(2):583-6. doi: 10.1164/ajrccm.155.2.9032198.
This study was designed to determine whether an integrated screening program could be implemented that identified persons with latent tuberculosis infection among jail inmates and produced a high rate of completion of isoniazid preventive therapy (IPT) in those persons after their discharge from short-term detention, by means of community-based directly observed preventive therapy (DOPT). From June 1, 1992 through December 31, 1994 inmates in the King County Jail who were from populations at high risk of tuberculosis were screened by means of the tuberculin skin test and those with latent tuberculosis infection were offered IPT. Among 262 inmates receiving IPT upon release from jail, 105 (40%) could not be located after release. Among another 105 enrolled on DOPT, 63 (60%) completed therapy. Among 52 who chose self-supervised isoniazid therapy after release, 15 (29%) completed therapy (chi-square = 13.50, p = 0.0002). Among persons with latent tuberculosis infection detected during screening at a county jail, a postrelease DOPT program resulted in a high rate of immediate loss to follow-up and a low rate of completion of therapy. Based on these results, we suggest that funds for TB control, if limited, should not be diverted to jail-based screening and postrelease DOPT.
本研究旨在确定是否可以实施一项综合筛查计划，该计划能够识别监狱囚犯中的潜伏性结核感染人群，并在这些人短期拘留释放后，通过社区直接观察预防治疗（DOPT），使异烟肼预防性治疗（IPT）的完成率较高。从1992年6月1日至1994年12月31日，对金县监狱中来自结核病高风险人群的囚犯进行结核菌素皮肤试验筛查，并为潜伏性结核感染患者提供IPT。在262名出狱时接受IPT的囚犯中，105名（40%）在出狱后无法找到。在另外105名登记接受DOPT的囚犯中，63名（60%）完成了治疗。在52名出狱后选择自我监督异烟肼治疗的囚犯中，15名（29%）完成了治疗（卡方检验=13.50，p=0.0002）。在县监狱筛查期间检测出的潜伏性结核感染人群中，出狱后DOPT计划导致随访立即失访率高，治疗完成率低。基于这些结果，我们建议，如果结核病控制资金有限，不应将其转用于基于监狱的筛查和出狱后DOPT。
