Incidence of TB in inmates with latent TB infection: 5-year follow-up.
Incidence of TB in inmates with latent TB infection: 5-year follow-up.
复制标题
潜伏性结核感染囚犯的结核发病率：5 年随访。
DOI：
10.1016/j.amepre.2005.06.014
复制
发表时间：
2005
期刊：
影响因子：
--
通讯作者：
Kawamura,LMasae
中科院分区：
文献类型：
--
作者：
White,MaryC;Tulsky,JacquelineP;Menendez,Enrique;Goldenson,Joe;Kawamura,LMasae
背景囚犯是结核病控制工作的高危人群，包括治疗潜在的结核病感染(LTBI)。出院后完成治疗的情况一直很差。这项研究的目的是评估一组囚犯在5年内的治疗完成率和活动性疾病。方法样本来自1998-1999年间完成的一项随机试验，研究对象是教育或激励措施与常规护理，以提高旧金山县监狱出狱后的治疗完成率。监狱、县结核病诊所和加州结核病登记处的记录被用来衡量活动性结核病的治疗完成和发展情况。结果共调查527名服刑人员，31.6%(n=176)完成治疗，其中59.7%(n=105)在狱中完成治疗。与在美国出生的囚犯相比，在美国居住5年的外国出生的囚犯完成治疗的可能性较小(调整后的优势比[≤]=0.49，95%可信区间[CI]=0.28~0.85)，而受教育程度较高的人更有可能完成治疗(调整后的优势比=1.06，95%CI=1.01~1.12)。三名受试者在5年的随访中患上了活动性结核病，结果是年发病率为108/10万。与加州的发病率相比，受试者患活动性结核病的可能性是加州的59倍(标准化发病率为59.2%，95%CI=11.2-145.1)。没有人完成治疗，没有新移民，有两人确诊为HIV阳性。结论完成LTBI的治疗是一个挑战，但在这个监狱队列中看到的活动性结核病强调了继续努力解决该人群结核病风险的重要性。
BACKGROUNDInmates are a high-risk population for tuberculosis (TB) control efforts, including treatment for latent tuberculosis infection (LTBI). Completion of therapy after release has been poor. The goal of this study was to evaluate therapy completion and active disease over 5 years in a cohort of inmates.METHODSThe sample was from a completed randomized trial in 1998–1999 of education or incentive versus usual care to improve therapy completion after release from the San Francisco County Jail. Records from the jail, the County Tuberculosis Clinic, and the California TB Registry were used to measure therapy completion and development of active TB. Analyses were conducted in 2005.RESULTSOf a total 527 inmates, 31.6% (n=176) completed therapy, of whom 59.7% (n=105) completed it in jail. Compared with the U.S.-born, foreign-born inmates residing in the United States for ≤5 years were less likely to complete the therapy (adjusted odds ratio [AOR]=0.49, 95% confidence interval [CI]=0.28–0.85), and those with more education were more likely to complete the therapy (AOR=1.06, 95% CI=1.01–1.12). Three subjects developed active TB in the 5 years of follow-up, resulting in an annual rate of 108 per 100,000. Compared with California rates, subjects were 59 times as likely to develop active TB (standardized morbidity ratio of 59.2, 95% CI=11.2–145.1). None had completed therapy, none were new immigrants, and two were known to be HIV-positive at diagnosis.CONCLUSIONSCompletion of therapy for LTBI is a challenge, but the active TB seen in this jail cohort emphasizes the importance of continued efforts to address TB risk in this population.