TB Education in Jail: Transferring Research to Practice

我们工作的总体目标是提高监狱囚犯出狱后对潜伏性结核病感染的预防护理的依从性。结核病（TB）在美国仍然是一个重要的问题，特别是在公认的亚群中，他们处于感染和发展活动性疾病的高风险中。监狱是一个主要的场所，在那里可以发现高危人群，并在他们入狱时开始治疗。然而，一旦被释放，他们就得靠自己在社区继续接受治疗，没有后续行动，也没有来自惩教或医疗保健系统的提醒。在之前的研究中，我们发现监狱教育是一种有效的策略，可以激励人们在出狱后继续接受治疗。然而，我们的研究结果是有意义的，只有当策略可以被监狱临床医生采用并有效时。本研究的目的是：1)向监狱医务人员传递教育协议；2)衡量协议在确保囚犯释放后预防性治疗连续性方面的有效性；3)衡量监狱医务人员对教育协议的接受程度。本前瞻性队列研究的目的是：1。衡量两个结果：从监狱释放后一个月内首次到结核病诊所就诊，以及在监狱中接受预防性治疗的潜伏结核感染囚犯队列中完成预防性治疗2。根据教育是否由监狱医务人员提供以及教育的特点（课程的次数和长度、课程的地点、语言以及是一对一还是小组授课）来分析这两项结果3。将这一队列的两个结果与历史数据进行比较，一个来自我们的研究团队在监狱开展教育课程之前的时间段，另一个来自研究人员向囚犯提供教育的时间段。描述监狱医务人员对教育计划的接受程度。本研究将回答在采用常规护理方案后试验结果的可持续性问题。这将是有用的研究人员和临床医生检查的问题，从研究过渡到临床实践。

The overall goal of our work is to improve adherence to preventive care for latent tuberculosis infection among jail inmates after they are released from jail. Tuberculosis (TB) remains an important problem in the United States, especially among recognized subgroups who are at high risk of becoming infected and developing active disease. Jails are a prime setting where high-risk populations can be identified and treatment begun while they are in jail. Once released, however, they are on their own to continue care in the community, without follow-up or reminders from either the correctional or the healthcare system. In previous work, we found that education in jail was an effective strategy in motivating persons to continue therapy after release from jail. Our study results are meaningful, however, only if the strategy can be adopted and is effective when done by jail clinicians. The purpose of this study is to: 1) transfer the educational protocol to jail medical personnel; 2) measure the effectiveness of the protocol in insuring continuity of preventive therapy after inmates are released; and 3) measure the acceptance of the educational protocol by jail medical personnel. The aims of this prospective cohort study are to: 1. measure two outcomes: the first visit to the TB Clinic within one month of release from jail and completion of preventive therapy, in a cohort of inmates with latent TB infection who are prescribed preventive therapy in jail 2. analyze the two outcomes by whether education was provided by jail medical personnel, and by the characteristics of the education (number and length of sessions, location of the session, language, and whether one-to-one or in a group) 3. compare the two outcomes in this cohort with historical data, one from the time period before our research team developed and conducted educational sessions in the jail, and the second from the time period when research personnel were providing educations to inmates 4. describe the acceptance of the educational program by jail medical personnel This study will answer questions about the sustainability of trial results after adoption of protocols as usual care. It will be useful to researchers and clinicians examining the question of the transition from research to clinical practice.