Prisons conference stresses TB opportunities

Captive audience available for isoniazid therapy

Jails and prisons offer a unique opportunity for practicing preventive medicine, says one of the speakers scheduled for a Feb. 24 satellite conference on TB in correctional facilities. "The prison is a great place to practice public health," says Stephen Weis, DO, medical director of the TB clinic in Tarrant County, TX, and professor of medicine at the University of North Texas Health Science Center at Fort Worth.

"TB rates are going down in prisons, but this population still has an incredible number of individuals with TB infection," he notes. Inmates often are members of groups at especially high risk for TB infection — injecting-drug users or alcohol and crack cocaine abusers, for example. Yet in the free world, it’s nearly impossible to get them through a course of isoniazid prophylaxis, Weis adds. In a correctional facility, on the other hand, "we’ve got them," he says.

At the jail in Tarrant County (with an inmate population of about 3,500), Weis takes advantage of the opportunity, placing as many as 35 people on preventive therapy every other week. Critics of his aggressive approach toward isoniazid preventive therapy say he’s not assured of getting everyone through an entire six-month course of isoniazid. "But the way I look at it, every dose counts," he says. "The day I see them is the day we start them on therapy. We have a bottle of pills right there," so every incoming inmate under age 35 get his first biweekly dose on the spot.

There’s more good news on the TB front in correctional facilities. In a study that looked at skin-test positivity rates of the more than 27,000 correctional officers who work in Texas state prisons, the results were found to be lower than rates for the general population, says Mike Kelley, MD, chief of preventive medicine for the state’s criminal justice department. Kelley also is a scheduled speaker at the satellite broadcast.

"Even though the rates for TB are still much higher among the inmate population than among the general population, TB is dropping faster among prison populations than among the general population," he says. With TB and HIV disease finally under control, hepatitis C is likely to be the next infectious disease prison authorities will find themselves grappling with, he adds.

The three-hour, national satellite broadcast is co-sponsored by the Texas departments of health and criminal justice, says Ray Silva, corrections program coordinator with the state health department. There will be no charge for sites wishing to receive the broadcast. (See editor’s note, below.)

Live presentations are included

The program will consist of live presentations from Austin, TX, with a few pre-taped sections to illustrate some points. The broadcast will include information on:
• the status of TB in correctional facilities;
• transmission of TB;
• diagnosis and treatment of TB;
• the basics of a screening program;
• transportation of persons with TB;
• intake issues;
• training correctional staff to "think TB"
• contact investigations.

Other scheduled speakers include John Weisbuch, MD, board chair of the National Commission on Correctional Health Care; Newton Kendig, MD, TB controller for Maricopa County (AZ); Orlando H. Pile, MD, chief of infectious diseases at the Los Angeles County jail; and Brian Smith, MD, MPH, the Texas health department’s regional director.

(Editor’s note: For more information on the broadcast, contact Ray Silva or Ann Tyree by phone at (512) 458-7447 or send e-mail to ray.silva@tdh.state.tx.us or ann.tyree@tdh.state.tx.us.)