Randomized controlled trial of interventions to improve follow-up for latent tuberculosis infection after release from jail.
BACKGROUND
Adherence to treatment of persons with latent tuberculosis infection after release from jail has been poor.


METHODS
A randomized controlled trial was conducted at the San Francisco City and County Jail, San Francisco, Calif. Subjects undergoing therapy for latent tuberculosis infection who spoke either English or Spanish were randomly allocated to receive education every 2 weeks while in jail; an incentive if they went to the San Francisco County Tuberculosis Clinic within 1 month of release; or usual care. The main outcome measures were completion of a visit to the tuberculosis clinic within 1 month of release and completion of therapy.


RESULTS
Of 558 inmates enrolled, 325 were released before completion of therapy. Subjects in either intervention group were significantly more likely to complete a first visit than were control subjects (education group, 37%; incentive group, 37%; and controls, 24%) (adjusted odds ratio based on pooled results for the education and incentive groups, 1.85; 95% confidence interval, 1.04-3.28; P =.02). Those in the education group were twice as likely to complete therapy compared with controls (adjusted odds ratio, 2.2; 95% confidence interval, 1.04-4.72; P =.04). Of those who went to the tuberculosis clinic after release, subjects in the education group were more likely to complete therapy (education group, 65% [24/37]; incentive group, 33% [14/42]; and control group, 48% [12/25]; P =.02).


CONCLUSIONS
Education or the promise of an incentive improved initial follow-up. Education was superior to an incentive for the completion of therapy. Fairly modest strategies provided in jail can improve adherence. Further links between jail health services and community care should be explored.
White
Mary Castle
MC
Department of Community Health Systems, School of Nursing, The University of California, San Francisco, 2 Koret Way, Campus Box 0608, San Francisco, CA 94143-0608, USA. mcwhite@itsa.ucsf.edu
Tulsky
Jacqueline P
JP
Goldenson
Joe
J
Portillo
Carmen J
CJ
Kawamura
Masae
M
Menendez
Enrique
E
D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use*; D008297:Male; D010044:Outpatient Clinics, Hospital; D010349:Patient Compliance; D010353:Patient Education as Topic; D011329:Prisoners; D013997:Time Factors; D014376:Tuberculosis / Q000188:drug therapy* / Q000517:prevention & control*
D000995:Antitubercular Agents; D007538:Isoniazid