?From 1993 through 2003, the percentage of TB cases among local inmates increased from 42.8% to 53.5%? The rate among federal prisoners ?increased from 2.9% to 11.8%,? and the state prisoner rate ?decreased from 52.3 in 1993, to 6.6 in 2003, a decline of 87.4%.
California and Texas ?accounted for 42.7% of the 7,820 reported TB cases among inmates from 1993 to 2003, and another 4 states (Florida, Georgia, Illinois and New York) accounted for an additional 28.6% of reported TB cases. These same 6 states accounted for 56.9% of the 200,648 reported TB cases among non-inmates.?
Researchers found that one ?notable reason for the high rates of TB in correctional institutions is the greater proportion of TB in correctional institutions is the greater proportion of persons who are at high risk for TB but who cannot access standard public health interventions.?
Prisoners with TB are more likely than non-prisoners to be co-infected with the Human Immunodeficiency Virus (HIV), with co-infection among prisoners at 25.2% versus 18% for the general public. Co-infection is highest among state prisoners, at 35.8%. Contrary to CDC recommendations, ?the majority of correctional systems currently do not offer universal HIV testing, a critical limitation for effective TB prevention and control and for the medical management of individual patients.?
Prisoners outpaced non-prisoner with respect to pulmonary TB, at 90.3% versus 84.4%. Prisoners were also ?more likely to have multiple risk factors for infection? and to have drug-resistant TB.? While prisoners were ?more likely to receive directly observed therapy? they ?were less likely to complete therapy.? Researchers found these ?unacceptably low rates for...therapy completion...disturbing because of the possibility that these individuals may be the cause of future TB outbreaks in a given community.
Finally, researchers recommended enhanced tracking of ?TB patients diagnosed or treated in correctional systems.? Additionally, ?public health and corrections officials are obliged to develop policies that optimize discharge planning and case management for inmates released during TB evaluation or treatment.? See: An Unanswered Health Disparity: Tuberculosis Among Correctional Inmates, 1993 Through 2003, American Journal of Public Health, October 2005, Vol. 95, No. 10.
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