LINKING RELEASED INMATES TO TB CLINIC TO CONTINUE INH

描述(改编自《调查者摘要》)：最近的增长 美国的结核病归因于：艾滋病毒的流行， 从结核病流行国家移民，便利 在教养设施等聚集环境中传播，以及 不断恶化的公共卫生基础设施。大多数结核病控制方案将重点放在 关于活动性疾病；预防潜伏性结核病感染的激活是 在控制结核病流行的高危人群中同样至关重要。 这项随机对照研究的目的是研究结核病控制的战略。 之前获释的潜伏结核病感染者入狱人员 完成预防性治疗。这个应用程序提出了一个随机化的 临床试验(RCT)研究三种教育干预措施的效果 关于两个结果：入狱后第一次到县结核病诊所就诊； 完成后续的后续随访，以完成整个结核病疗程 预防性治疗。在监狱中进行筛查以识别感染者 患有结核病，许多人开始接受异烟肼(INH)的预防性治疗 在监狱里。然而，大多数人在INH完成之前就从监狱获释。 囚犯在没有药物治疗的情况下被释放，必须去结核病诊所 继续预防性治疗。试点工作表明，只有不到4%的 需要进一步感染的获释囚犯实际上向县结核病部门报告 门诊进行随访。数据证明了测试干预的必要性 提高被释放囚犯去结核病治疗的百分比的策略 诊所继续并完成结核病的预防治疗。本RCT 建议将监狱中感染结核病的INH囚犯随机分成以下一组 三个干预组：常规护理(标准教育和咨询， 在开INH处方时提供一次)；通常护理加上加强 每两周一次的教育和释放；以及平时的照顾和照顾 提供价值25美元的奖励(酒店代金券、公交车代金券或食品券) 如果第一次去结核病诊所就诊是在出院后两周内。三个具体的 目的是衡量：1)三种教育干预措施的效果 第一次去结核病诊所就诊的百分比 释放；2)干预措施对完成率的影响 足够的就诊次数以完成INH预防治疗；以及3)原因 完成或不完成第一次结核病诊所就诊的人。的重要意义。 本项目是：1)加强以病人为中心的护理工作 关爱，监狱中的人越来越被认为是一个弱势群体 结核病的高风险；2)监狱是那些可能没有 其他护理来源；3)教育和财政奖励没有 在这项研究中，研究作为坚持预防性结核病治疗的预测因素 4)这个项目加强了监狱和监狱之间的联系 卫生服务和公共卫生署结核病控制服务，以及 可以作为其他监狱系统和公共卫生系统的典范 美国

DESCRIPTION (Adapted from the Investigator's Abstract): The recent increase in tuberculosis in the U.S. has been attributed to: the HIV epidemic, immigration of persons from countries where TB is endemic, facilitation of spread in congregate settings such as correctional facilities, and a deteriorating public health infrastructure. Most TB control programs focus on active disease; prevention of activation of latent TB infection is equally critical in high risk populations for control of the TB epidemic. The purpose of this RCT is to investigate strategies for TB control among jailed persons with latent TB infection who are released from jail before completing preventive therapy. This application proposes a randomized clinical trial (RCT) to study the effects of three educational interventions on two outcomes: the first post-jail visit to the county TB Clinic; and the completion of subsequent follow-up visits to complete a full course of TB preventive therapy. Screening in jail identifies persons who are infected with TB, and many are begun on isoniazid (INH) preventive therapy while in jail. Most, however, are released from jail prior to INH completion. Inmates are released without medication, and must go to the TB clinic to continue preventive therapy. Pilot work has shown that less than 4% of released inmates who need further INH actually report to the county TB clinic for follow-up. Data demonstrate the need to test intervention strategies to increase the percent of released inmates who go to the TB Clinic to continue and complete preventive therapy for TB. This RCT proposes to randomize TB-infected inmates on INH in the jail into one of three intervention groups: usual care (standard education and counseling, provided once at the time of INH prescription); usual care plus reinforced education at two-weekly intervals and at release; and usual care plus incentive valued at $25 (hotel vouchers, bus tokens, or food coupons) given if the first TB Clinic visit is within two weeks of release. Three specific aims are to measure: 1) the effects of the three educational interventions on the percent who make a first visit to the TB Clinic within two weeks of release; 2) the effects of the interventions on the percent who complete enough visits to finish INH preventive therapy; and 3) the reasons why persons do or do not complete a first TB Clinic visit. The significance of this project is: 1) as nursing strengthens its focus on patient-centered care, persons in jail are increasingly recognized as a vulnerable group at high risk for TB; 2) the jail is a venue of care for those who may not have other sources of care; 3) education and financial incentives have not been studied as predictors of adherence to preventive TB therapy in this population; and 4) this project strengthens the link between the jail's health services and the Public Health Department TB control services, and may serve as a model for other jail systems and public health systems in the U.S.