TB Challenge: Partnering to Eliminate TB in African Americans

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TB Cases in Correctional Facilities

Raising the Awareness - Educating the Incarcerated Population about TB: A Nurse's Perspective

Ellen R. Murray, RN, BSN, Training Specialist/Nurse Consultant, Southeastern National TB Center and Elvin Magee, MPH, MS, Health Scientist, Surveillance, Epidemiology, and Outbreak Investigations Branch, CDC

Black or African American persons have historically had a disproportionate share of the TB cases diagnosed in correctional facilities in the United States. As shown in Figure 1, this group represented 46% of all TB cases (4276 cases) reported in correctional facilities from 1993 through 2006. Of this total, 3709 were male and 567 were female.

Correctional facilities in the United States house people of every race, ethnicity, and cultural background. Figure 2 illustrates the difference by race and ethnicity of persons with TB diagnosed in correctional facilities. Of the total TB diagnoses made from 1993 through 2006, an average of 5 to 6% were black inmates, while inmates of all other races and ethnicities, excluding Hispanics, averaged 3% or less.

Corrections, present and the future

At the end of 2006, the U. S. Department of Justice reported greater than 7.2 million people were either: (1) on probation, (2) on parole, (3) in jail, or (4) in prison. This number represented 3.2% (1 in every 31 adults) of all U.S. adult residents. ¹
It is estimated that 32% of all black males will enter state or federal prison in their lifetime. This figure is in sharp contrast to the 17% estimated for Hispanic males and 5.9% of white males.

Figure 3 shows that from 1993 through 2006, the incarcerated were more likely to have a history of the following risk factors: homelessness, excessive alcohol use, injecting drug use, or non-injecting drug use.

Education is the Key

In addition to other TB control measures, TB education in the correctional populace should be a priority to affect the rate of disease. In short, education in correctional facilities can be an intervention for TB infection control.

Education of prison inmates often occurs sporadically rather than systematically, with information about controlling and containing infectious disease not given high priority. Further, dwindling resources for public health education have resulted in cutbacks in community-wide TB programs. The higher proportion of 4276 total cases of TB in black inmates along with other health disparities present in the incarcerated population, demonstrate a need for education about TB. The development of educational programs for the incarcerated should be a priority for local health departments, working hand-in-hand with corrections administration to raise awareness and educate their medical and non-medical corrections staff about tuberculosis. Education about tuberculosis prevention and control is best done by those who are knowledgeable about the disease. Vehicles for also educating inmates about TB are prison ministries and other community-based programs that have gained inmates’ trust and respect are already in place in the facilities. There are many educational programs currently available in correctional facilities, such as General Education Diploma (GED) classes, drug and alcohol programs, and rehabilitation programs that help inmates learn a trade. Programs such as these can be used to help TB programs educate the incarcerated population.

In summary, health department and correctional facilities should work collaboratively to ensure prompt disease detection, isolation, management, and discharge planning for infectious inmates. In addition, correctional facilities should develop an infectious disease plan focused on TB and offer education for their staff. Fundamental TB prevention and control activities in correctional facilities would include: (1) screening for TB disease and testing for latent tuberculosis infection (LTBI); (2) treating persons with TB and LTBI; (3) preventing TB transmission; and (4) enhancing collaboration between corrections, public health, and community partners. ²

With public health and corrections working together, educating the incarcerated population about TB becomes a powerful tool for change.

1. U.S. Department of Justice. (2007). Bureau of Justice Statistics. Retrieved from the website on 12/19/07.
2. CDC. Prevention and control of tuberculosis in correctional and detention facilities: Recommendations from CDC. MMWR 2006: 55(RR-9), 1-44.