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The Status of TB Prevention and Control Measures in Large City and County Jails in the U.S.

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Executive Summary

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Provide More Comprehensive and Timely Screening and Diagnostic Evaluations

Although most jail systems had adequate policies for TB screening, most still need to strengthen their screening practices. First, there was a lack of information in the medical records about TB history and risk factors, including HIV status. Second, at least one quarter of the jail systems did not have policies requiring chest radiographs for all known HIV-positive inmates. Third, the study found routine lengthy delays in obtaining chest radiograph results for inmates who were symptomatic, skin test positive, or HIV positive. In the intervening time, potentially contagious inmates were housed with the general population.

In terms of diagnostic practices, TB symptoms and abnormal chest radiographs did not always trigger an evaluation for TB. According to medical records reviewed, several cases of active TB were initially misdiagnosed or missed.

Specific Recommendations

  • Screen inmates for TB symptoms in a timely manner after entry and ask about key symptoms, such as persistent cough.

  • Systematically gather data about TB risk factors during the initial medical screening and evaluation.

  • Routinely administer chest radiographs to all known HIV-positive inmates and to inmates who are at risk for HIV but whose status is unknown.

  • Periodically assess the timeliness of chest radiograph results so that jail medical staff have a chest radiograph interpretation within 24 hours of symptoms and within 72 hours of a positive skin-test result.


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