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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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Strengthen Collaboration Between Health Departments and Jails

Close collaboration between jail systems and their corresponding public health departments in TB screening, containment, and assessment activities is integral to effective TB prevention and control in jails and the communities they serve. The study found that increasing the breadth and intensity of collaboration between jails and health departments could significantly strengthen TB control. All of the 20 jail systems surveyed collaborated with their local or state health departments in at least some areas of TB prevention and control, but the scope and effectiveness of collaboration were generally limited.

Increase Collaboration in Major Areas of TB Control

Most jail systems collaborated with their health departments on TB treatment (85%) and contact investigations (80%) but, for most other recommended activities, collaboration was relatively limited. For example, only about half of the jail systems collaborated in screening and diagnosis, TB policies and protocols, and prerelease discharge planning. A minority of jail systems collaborated in staff training (40%), quality assurance/improvement (25%), and TB education for inmates (20%). Areas in which collaboration needs to be strengthened include

  • Discharge planning and continuity of care for inmates undergoing treatment;


  • Use of TB information systems and program assessment (including quality improvement);


  • Development and review of TB policies and protocols;


  • Use of environmental controls (e.g., ventilation systems and isolation rooms); and


  • Staff training.

Increase the Effectiveness of Collaboration

Sixty-five percent of the jail systems rated their overall collaboration with the health department as effective or highly effective. However, health department respondents generally rated collaboration as less effective in all areas than did jail respondents, with the most dramatic rating difference centering on discharge planning. Within jurisdictions, jails and health departments often differed in their perceptions of the effectiveness of collaboration. In just over one third of the jurisdictions, both parties agreed that overall collaboration was highly effective. Jurisdictions collaborating in more areas of TB control were more likely to rate overall collaboration as effective. Having organizational mechanisms in place was the best predictor for both collaborating in more areas and for more effective overall collaborations.

Specific Recommendations

  • Increase formal organizational mechanisms of collaboration, including
    • designating one person at the jail system to be responsible for TB control;


    • designating liaisons from the public health department TB program and from the jail system;


    • arranging for TB program staff to provide on-site services at the jail; and


    • holding periodic management and staff-level meetings.

Dramatically Increase Collaboration on Discharge Planning and Continuity of Care

The study found that discharge planning and continuity of care are among the least effective areas of collaboration—only 15 percent of jurisdictions reported having effective collaboration in these areas. Barriers to effective collaboration included lack of advance notification of release (less than one third of jail medical departments were usually notified in advance of release of inmates with TB disease), lack of coordination by the jail with the health department, and limited health department resources for field follow-up. For inmates undergoing treatment for latent LTBI, there was generally no organized system for continuity of care.

Specific Recommendations

  • Consider administrative procedures, such as medical clearance or medical holds, to allow jail medical staff to coordinate postrelease care.


  • Provide inmates with a medical discharge card so that continuity-of-care information is available to inmates who are released without notification of the medical staff.


  • Visit patients before release from jail by health department TB program staff.


  • Set up specific appointments for medical follow-up.


  • Develop a coordinated effort for continuity of care for high-risk patients with LTBI

 

 
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