Legal intervention for non-adherent patients in the treatment of tuberculosis.
BACKGROUND
The Philadelphia Department of Public Health Tuberculosis (TB) Control Program has a progressively severe, stepwise legal process for managing non-adherent TB patients, potentially culminating in incarceration.


OBJECTIVE
To review the application of legal procedures and to evaluate their effectiveness in the management of non-adherent TB patients.


METHODS
We evaluated this process by reviewing patients' records from 2001 to 2005 to identify all non-adherent patients and determine their treatment outcomes.


RESULTS
In this period, we initiated the legal process for 39 non-adherent patients. One patient died, and nine patients were lost. Twenty-nine patients became adherent after the use of a legal intervention. Our final completion percentage was 76.3%.


CONCLUSIONS
Our legal process improved the treatment completion rate for patients who would otherwise have been non-adherent. Increasing treatment completion rates reduce the risk of relapse and disease transmission as well as the growing rate of anti-tuberculosis drug resistance.
Pritchett
E N
EN
Philadelphia Department of Public Health, Philadelphia, Pennsylvania 19146, USA. nikki.pritchette@phila.gov
Schlossberg
D
D
Lovett-Glenn
G
G
Beck
J
J
Dickman
B
B
D001741:Black or African American / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007603:Jurisprudence; D008297:Male; D010349:Patient Compliance / Q000706:statistics & numerical data; D015143:Philadelphia; D012189:Retrospective Studies; D014376:Tuberculosis / Q000188:drug therapy* / Q000517:prevention & control; D055815:Young Adult