Management of Tuberculosis in the Texas Prison System

Abstract

Prison inmates are at increased risk of tuberculosis (TB) compared to the general population. A number of TB outbreaks have been reported in correctional settings, some of which have spread to the general community. The purpose of the present study was to describe the incidence of TB and the patterns of treatment in the Texas prison system. The incidence of TB in the Texas Department of Criminal Justice (TDCJ) prison population during a 12-month period was 27 cases per 100,000 inmates. In general, this rate persisted across each of the sociodemographic groups under study, but was 15-fold greater among HIV-infected inmates (395 cases per 100,000). Overall, 59% of the sample were prescribed antitubercular therapy for at least the defined standard duration; 45% were prescribed anti-TB therapy for longer than the standard duration; ethambutol was included in the initial therapy among 95% of inmates treated with anti-TB therapy; and approximately 33% were prescribed pyrazinamide for a period of less than 56 days. Approximately 36% of the study sample began antitubercular pharmacotherapy prior to incarceration, while 7% were released from prison prior to completion of their therapy. In view of previously reported prison-to-general-community TB transmission, understanding TB prevalence and treatment patterns in correctional settings holds clinical and public health relevance beyond the prison setting.