Short-term incarceration for the management of noncompliance with tuberculosis treatment.
OBJECTIVE
To review the use of incarceration for noncompliance with tuberculosis treatment.


METHODS
Retrospective review.


METHODS
An urban tuberculosis control program.


METHODS
Patients treated for active tuberculosis.


RESULTS
We reviewed the legal basis and practical application of quarantine for active tuberculosis, including the use of incarceration for noncompliance. The records of patients treated at the Denver Metro Tuberculosis Clinic during 1984 to 1994 were reviewed to identify patients who were incarcerated and to evaluate the effectiveness of this intervention. Of 424 cases of tuberculosis, 20 patients (4.7%) were incarcerated for noncompliance; an additional 21 patients (5.0%) were lost to follow-up prior to completing therapy. Incarcerated patients were predominantly men who were born in the United States and had a history of homelessness and alcohol abuse. The median duration of the initial incarceration was 20 days (range, 7 to 51 days). Of the 17 patients released prior to completing therapy, 13 (76%) were compliant with outpatient, directly observed therapy after one or two short-term incarcerations (<60 days); only three patients were incarcerated for the duration of treatment. Overall, 18 of 20 incarcerated patients (90%) were successfully treated.


CONCLUSIONS
Approximately 5% of the patients treated through our program were incarcerated for noncompliance; an additional 5% were unavailable for follow-up and would have been candidates for incarceration if found. Homelessness and alcoholism were closely associated with the use of incarceration. Short-term incarceration followed by outpatient, directly observed therapy was relatively successful in the management of this difficult patient population.
Burman
W J
WJ
Department of Public Health, Denver Health and Hospitals, University of Colorado Health Sciences Center, 80204, USA. william.burman@uchsc.edu
Cohn
D L
DL
Rietmeijer
C A
CA
Judson
F N
FN
Sbarbaro
J A
JA
Reves
R R
RR
D000328:Adult; D000437:Alcoholism / Q000453:epidemiology; D000553:Ambulatory Care; D000995:Antitubercular Agents / Q000627:therapeutic use*; D003120:Colorado / Q000453:epidemiology; D005260:Female; D006703:Ill-Housed Persons; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011790:Quarantine / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D013997:Time Factors; D016312:Treatment Refusal / Q000331:legislation & jurisprudence*; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control
D000995:Antitubercular Agents