Risk factors for and outcomes of detention of patients with TB in New York City: an update: 2002-2009.
BACKGROUND
One of the most controversial aspects of New York City's highly effective TB control program is the use of public health law and court-ordered detention to treat persistently recalcitrant patients with active TB. We now report on characteristics and outcomes of patients undergoing detention for completion of TB treatment due to nonadherence in New York City from 2002 through 2009.


METHODS
A retrospective cohort study was designed to compare patients undergoing court-ordered detention (n = 79) and time-matched control subjects undergoing TB treatment in outpatient directly observed therapy (DOT) at Bellevue Hospital in New York City.


RESULTS
From January 1, 2002, through December 31, 2009, 79 patients underwent court-ordered detention for TB treatment. Compared with patients completing treatment in DOT, univariate analysis found that detainees were younger; more likely to be of minority race/ethnicity; to have a history of substance abuse, tobacco use, homelessness, incarceration, HIV infection; and to be born in the United States. Multivariate analysis adjusting for other variables found smear positivity (OR = 3.93; 95% CI, 1.05-14.75; P = .04), mental illness (OR = 5.80; 95% CI, 1.18-28.51; P = .03), and substance abuse (OR = 9.25; 95% CI, 2.81-30.39; P < .01) to be the strongest independent predictors of likelihood of detention. Of those initially detained, 46 (58%) completed treatment during inpatient detention, 29(37%) completed treatment under outpatient court-ordered DOT, and four died during their hospitalization.


CONCLUSIONS
The majority of patients undergoing court-ordered detention for TB treatment (95%) successfully completed therapy. Likelihood of detention was most strongly associated with factors expected to be associated with poor adherence, including mental illness and substance abuse.
New York University School of Medicine, New York, NY; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Seema
S
Pursnani
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Sumeet
S
Srivastava
New York University School of Medicine, New York, NY.
Saleem
S
Ali
New York University School of Medicine, New York, NY.
Eric
E
Leibert
New York University School of Medicine, New York, NY. Electronic address: linda.rogers@nyumc.org.
Linda
L
Rogers
D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D015331:Cohort Studies; D023801:Directly Observed Therapy; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D006703:Ill-Housed Persons / Q000706:statistics & numerical data; D006760:Hospitalization / Q000331:legislation & jurisprudence*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000453:epidemiology*; D064424:Tobacco Use / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy / Q000453:epidemiology*; D055815:Young Adult; D016903:Drug Monitoring
D000995:Antitubercular Agents