Article 12 : Who Fails to Complete Tuberculosis Treatment in Haiti ’ s National Prison , and What Innovations Might Improve Success ?
Preliminary results of the VDOT project , presented at a scientific conference ( Spaulding , 2021 ), are promising . The VDOT project helped with documenting treatment completion when healthcare workers were not on site at remote prisons . We found this to be the case not just when facilities had insufficient staff assigned to oversee treatment , but also during times of political unrest , when associated road closures led to assigned staff not able to travel to work . An analysis of final outcomes is pending . Other tragedies have now unfolded in Haiti — the assassination of the president and another devastating earthquake . These have led to continued challenges with transportation . Having ways to monitor patient treatment remotely remains important .
The analysis of baseline data in this report demonstrates the impact of non-governmental organizations , like HtW , that work with prisons to achieve the WHO ’ s end TB targets ( WHO , 2010 ). Since this analysis found that individuals living with HIV were less likely to complete treatment in prison , these results emphasize the importance of HIV testing in prisons , an intervention that HtW has sustained . With a higher treatment completion rate , the risk of TB transmission is lowered and the potential for MDR TB is lessened , thereby improving the safety for all incarcerated individuals at this facility and for the communities into which they are released .
Limitations There are several limitations to this analysis and its findings . First , the data available for analysis was limited to covariates collected in the national TB registry . Additionally , there was no baseline assessment of knowledge , attitudes , or behavior of participants and , furthermore , there was no available adherence data .
Patient outcomes may have been misclassified as the data were extracted from a hand-written registry susceptible to human error . Patients who were released or lost to follow-up may also have been misclassified if they completed their TB treatment , but the outcome could not be evaluated by the investigators . The registry failed to list the year of entry for the patients , and thus time since entry was unavailable for analysis , even though it could have been a predictor of treatment completion . Without the date of prison entry , it is not possible to determine if TB cases were diagnosed during entry or at some other time during their confinement . Most health assessment occurs during entry procedures , so individuals with under-treated TB may pass through intake screening but later develop active TB disease . Additionally , comorbidities such as HIV or malnutrition may also lead to TB activation during a prison stay . A delay in diagnosis after TB activation could explain why individuals with HIV were less likely to complete treatment in prison .
Conclusions
• The completion rate for TB treatment in the main prison of this low-resource nation exceeded that in the community .
• This rate , nonetheless , falls short of the World Health Organization ’ s target of successfully treating 90 % of TB cases .
• Interventions such as VDOT could improve a prison ’ s TB treatment completion rate , especially if targeted to those at higher likelihood of non-completion due to early release or death : persons living with HIV and / or those with EPTB .
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