LINKING RELEASED INMATES TO TB CLINIC TO CONTINUE INH

描述（改编自研究者摘要）：最近增加 在美国，结核病的发病率被归因于：艾滋病的流行， 来自结核病流行国家的移民， 在惩教设施等聚集场所传播， 公共卫生基础设施不断恶化。 大多数结核病控制项目都把重点放在 活动性疾病;预防潜伏性结核感染的激活， 对于控制结核病流行的高危人群同样至关重要。 这项随机对照试验的目的是研究在农村地区的结核病控制策略， 曾受潜伏性结核病感染的囚犯， 完成预防性治疗。 本申请提出了一种随机的 研究三种教育干预措施效果的临床试验（RCT） 两个结果：第一次出狱后访问县结核病诊所; 完成后续随访访视，以完成完整的结核病疗程 预防性治疗 在监狱中进行筛查，以确定感染者 结核病，许多人开始对异烟肼（INH）预防性治疗，而在 监狱 然而，大多数人在完成国家卫生研究所的工作之前就被释放了。 囚犯被释放时没有药物，必须去结核病诊所， 继续预防性治疗。 试点工作表明， 需要进一步INH的释放囚犯实际上向县TB报告 门诊随访。 数据表明需要测试干预措施 提高释放囚犯去结核病中心的比例的战略 诊所继续并完成结核病预防治疗。 本RCT 建议将监狱中服用INH的结核病感染囚犯随机分为 三个干预组：常规护理（标准教育和咨询， 在INH处方时提供一次）;常规护理加加强 每两周一次的教育和释放时的教育; 价值25美元的奖励（酒店代金券、公共汽车代金券或食品券） 如果第一次结核病诊所访问是在释放后两周内。 三个具体 目的是衡量：1）三种教育干预措施的效果 在两周内第一次到结核病诊所就诊的百分比 2）干预措施对完成的百分比的影响 完成INH预防性治疗的足够访视;和3）原因 完成或未完成首次结核病诊所就诊的人。 的意义 本项目是：1）随着护理工作加强以病人为中心， 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结核病的人的护理场所 其他护理来源; 3）教育和财政激励措施尚未得到 在这项研究中， （4）该项目加强了监狱与监狱之间的联系。 卫生服务和公共卫生部结核病控制服务，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.