Article 12 : Who Fails to Complete Tuberculosis Treatment in Haiti ’ s National Prison , and What Innovations Might Improve Success ?
WHO FAILS TO COMPLETE TUBERCULOSIS TREATMENT IN HAITI ’ S NATIONAL PRISON , AND WHAT INNOVATIONS MIGHT IMPROVE SUCCESS ?
Haley Kehus , Rollins School of Public Health , Epidemiology Atlanta , GA , USA Dr . Margaret Bury , Health through Walls , Rue Marcadieu , Port-au-Prince , HT Dr . Edwin Prophete , Health through Walls , Rue Marcadieu , Port-au-Prince , HT Laura Dirks , Rollins School of Public Health , Epidemiology Atlanta , GA , USA
Dr . Anne Spaulding , Rollins School of Public Health , Epidemiology Atlanta , GA , USA
Abstract
Background : This baseline study aims to characterize tuberculosis patients in Haiti ’ s National Penitentiary facility who did not demonstrate timely treatment completion .
Methods : Data were collected for every person in Haiti ’ s flagship correctional facility identified with tuberculosis disease from 2016-2018 . Logistic regression was used to identify factors associated with not completing tuberculosis treatment while in prison .
Results : From 2016-2018 , the in-prison treatment completion rate was 556 / 661 ( 84.1 %). Extrapulmonary TB ( EPTB ) patients were twice as likely to not complete treatment in prison as pulmonary cases ( aOR 1.96 , 95 % CI 1.08-3.52 ). Patients living with HIV were three times as likely to not complete treatment as HIV-negative patients ( aOR 3.31 , 95 % CI 1.82-6.02 ). A subsequent review of records from a community transitional clinic showed that an additional 7 patients ( 1.1 %) from the cohort completed treatment after prison .
Conclusions : Tuberculosis treatment completion of 85.2 % while in custody for the period 2016-2018 exceeds Haiti ’ s national average of 79 %, but falls short of the World Health Organization ’ s target of 90 % for correctional services . Targeting patients with HIV and / or EPTB for closer monitoring , plus interventions to finish treatment after release , may push the overall TB treatment completion rate towards the WHO ’ s target . To help improve TB treatment completion , this study justified a trial of Video Direct Observed Therapy .
Keywords : Prison , epidemiology , Tuberculosis , drug treatment , VDOT
175