Article 12 : Who Fails to Complete Tuberculosis Treatment in Haiti ’ s National Prison , and What Innovations Might Improve Success ?
time to complete treatment ( P < 0.0001 ). Cox regression was then limited to newly diagnosed cases . Age , TB type , HIV status , housing location , and pre-treatment weight were not significantly associated with time to complete treatment in prison .
Treatment after prison Of the 52 persons in the study cohort who were released before treatment completion , we identified seven ( 1.1 % of entire cohort ) who finished TB treatment in the transition clinic . This brought the total number of persons identified by HtW as treatment completers to 563 ( 85.2 %) patients . No additional treatment completers were found , in spite of efforts to submit names to the National TB Registry .
Discussion
From 2016-2018 , the National Penitentiary facility achieved 84.1 % treatment completion with the assistance of HtW . This level of treatment completion is commendable , given Haiti ’ s national average of 79 % ( WHO , 2019 ). Although impressive , we believe that there is room for improvement to reach the WHO ’ s and TB target of successfully treating 90 % of incarcerated people with TB ( STP , 2015 ).
The results of the regression analysis indicate that the individuals who are less likely to complete treatment in prison are EPTB cases and persons living with HIV . The statistically significant difference in mortality rates by TB case category and HIV status indicates that these individuals are also more likely to die due to the advanced disease , which explains much of their failure to complete treatment . Retreatment cases are significantly likely to take longer to complete treatment than new cases , an expected result since regimens have more doses ; however , treatment completion rates do not differ significantly based on retreatment status . Interventions targeting persons living with HIV and / or EPTB cases may improve the prison ’ s TB treatment completion rate and help achieve the WHO ’ s 90 % target .
Possible interventions could involve additional patient education to improve treatment adherence and ensure that interruptions in care are minimized ( Basu , Stuckler , & McKee , 2011 ; CDC , 2006 ). As noted above , treatment is often challenging in provincial prisons . Transporting TB patients faring poorly to the National Penitentiary may improve regular access to care . Nonetheless , waiting until the transfer before treatment is routinized may be an unnecessary delay if care in remote prisons could be improved . Interventions to enhance monitoring of adherence if released from confinement prior to treatment completion could also improve outcomes .
We recommend improving linkage systems to ensure continuity of care . Linkage systems would ideally notify prison staff when a person undergoing treatment is transferred , therefore preventing disruptions in their treatment . Another important facet of care continuity is discharge planning , which is linking formed incarcerated people living with TB disease to health care upon release ( CDC , 2006 ). In this regard , the presence of Klinik Soliderite has ameliorated continuity of care issues , however , there is still no record for a substantial number of released subjects .
After completion of this baseline study , HtW implemented a TB-Reach funded project that explored a digital Directly Observed Therapy solution : Video Directly Observed Therapy ( VDOT ) for TB patients who are incarcerated in the provincial prisons or who are about to be released from the
183