Studies have documented that a high proportion of reported tuberculosis (TB) cases (up to 40%) have a history of incarceration. However, TB prevention efforts in jails are hampered by the short length of stay and the poor completion of therapy among inmates released prior to completing recommended treatment for latent TB infection (LTBI). This study assesses the degree to which recommendations for tuberculin skin testing (TST) and treatment of LTBI are being carried out among long–term inmates (incarcerated more than 90 days) in a jail facility. Through a retrospective review of medical records, the authors found that most inmates (86%) received a TST and that most inmates(85%) with a positive TST received a chest x–ray. By including inmates with a documented or oral history of a prior TST, 22% (20/91) were positive and considered to have LTBI. However, only one inmate with a positive TST was placed on treatment for LTBI. All 19 inmates not placed on treatment had a length of stay sufficient to have completed therapy prior to release, and 7 of these had medical risk factors for developing active TB. The authors discuss obstacles to full implementation of current recommendations and suggest potential approaches to addressing these obstacles.
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