Treating Tuberculosis in Haiti’s National Prison: A Retrospective Analysis of Who is Less Likely to Complete Treatment in Prison Público
Kehus, Haley (Spring 2019)
Published
Abstract
Introduction: Tuberculosis remains one of the leading causes of death from an infectious disease worldwide, especially for people who experience incarceration in developing countries. The living conditions in correctional facilities and the overlapping risk factors for tuberculosis and incarceration lead to a concentration of this disease in this setting. Managing tuberculosis within correctional facilities can be difficult due to the resources required compared to what is available, unpredictable lengths of confinement, and largely insufficient tracking systems.
Methods: Data were collected for each tuberculosis patient in Haiti’s national prison from January 2016 to December 2018. Each man had been followed from the time of their diagnosis until they completed treatment. Cox regression analysis was conducted to provide insights on who takes longer to complete treatment. Univariate and multivariate logistic regression was conducted to determine factors associated with not completing tuberculosis treatment while in prison.
Results: The overall treatment completion rate was 84.1% for men incarcerated in Haiti’s national prison from January 2016 to December 2018. Retreatment cases were significantly likely to take longer to complete treatment than new cases (HR 0.29, 95% CI 0.22-0.36). Extra-pulmonary tuberculosis patients were almost twice as likely to not complete treatment as pulmonary cases (aOR 1.96, 95% CI 1.08-3.52). Patients who were HIV-positive were about three times as likely to not complete treatment as HIV-negative patients (aOR 3.31, 95% CI 1.82-6.02).
Conclusions: Completing treatment for 5 out of 6 patients is an achievement, especially given the setting, and is higher than Haiti’s national average of 79%. Nonetheless, this falls short of the World Health Organization’s (WHO) TB target of successfully treating 90% of TB cases. Extra-pulmonary and HIV-positive cases are usually the more severe cases that require extra attention, therefore it is foreseeable that these cases are less likely to complete treatment. One limitation of this analysis was the final status of men who were released before completing treatment. Interventions targeting HIV-positive, extra-pulmonary, and/or retreatment cases may improve the prison’s TB treatment completion rate and help achieve the WHO’s 90% target.
Table of Contents
INTRODUCTION.. 1
BACKGROUND.. 2
PATHOGENESIS. 2
TRANSMISSION.. 3
TESTING AND DIAGNOSIS. 4
TREATMENT.. 5
DIRECTLY OBSERVED TREATMENT, SHORT COURSE.. 6
VIDEO DIRECTLY OBSERVED THERAPY.. 7
TREATMENT ADHERENCE.. 8
MULTI-DRUG-RESISTANT TUBERCULOSIS. 10
TUBERCULOSIS-RELATED STIGMA.. 11
TUBERCULOSIS IN HAITI 11
TUBERCULOSIS IN CORRECTIONAL FACILITIES. 12
INFECTION CONTROL IN CORRECTIONAL FACILITIES. 13
THE NATIONAL PENITENITARY.. 14
STOP TB PARTNERSHIP. 16
HEALTH THROUGH WALLS. 16
METHODS. 18
DATA SOURCE. 18
DATA SECURITY.. 18
DATA CLEANING AND ANALYSIS. 19
INSTITUTIONAL REVIEW BOARD.. 22
RESULTS. 23
GENERAL RESULTS. 23
UNIVARIATE LOGISTIC REGRESSION.. 24
MULITVARIATE LOGISTIC REGRESSION.. 24
COX REGRESSION ANALYSIS. 25
DISCUSSION.. 26
LIMITATIONS. 27
RECOMMENDATIONS. 27
PUBLIC HEALTH IMPACT. 29
REFERENCES. 38
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