Advancing Corrections Journal : Edition # 12-2021
Study purpose In 2018 , HtW recruited Emory researchers to assist with an evaluation of their TB program in the National Penitentiary facility . As a part of a larger evaluation ongoing in Haitian prisons , HtW provided data for this baseline analysis with the intention that this analysis may inform the next phase of a TB intervention project . All authors have physically traveled to the National Penitentiary facility .
Methods
Retrospective collection of health data HtW staff maintain a hand-written registry of all patients with active TB in the prison . Cases are discovered through the routine screening of people conducted by HtW staff . Every presumptive and confirmed TB case in the prison is tracked on the registry from the time the person is diagnosed until they stop their treatment , are released / transferred , die , or are lost to follow-up . HtW staff sent the registry pages from January 2016 to December 2018 to the Emory-based researchers , who led the analysis of de-identified data .
The outcome of interest for this analysis is completing or failing to complete the WHO-recommended TB treatment while in the prison : a ) A six-month treatment course that includes isoniazid , rifampin , ethambutol and pyrazinamide is standard for pulmonary or extrapulmonary TB ( EPTB ) if drug resistance is not suspected ( WHO , 2010 ), and b ) An eight-month treatment for recurrent TB without evidence of resistance ( WHO , 2010 ).
Patients were classified as “ treated ” if they demonstrated a positive smear result prior to starting treatment and tested negative after treatment . Patients who did not have smear-positive bacilli before starting treatment , per WHO guidelines ( WHO , 2010 ) were considered presumptive TB cases as they were diagnosed based on clinical criteria alone . Since these patients could not show a change in smear post-treatment , their treatment outcome was classified as “ treatment terminated ” instead of “ treated .” For the purposes of this analysis , both “ treated ” and “ treatment terminated ” patients were considered successfully treated .
Patients who failed to complete treatment included treatment failures , deaths , prison releases , prison transfers , and unknown / not evaluated outcomes . If a patient was transferred to another correctional facility , a rare occurrence , or released before completing their regimen , the treatment outcome was initially classified as unknown . These patients are typically lost to follow-up as there is no formal mechanism to ensure continuity of care . The Haitian-based investigators , nonetheless , checked logs of the Klinik Solidarite transition clinic to match the names of released TB patients . If still information on treatment completion was not found , the names were then submitted to the national TB registry , Program National de Lutte contre TB Haiti , for possible confirmation of treatment completion .
Possible covariates ( i . e ., factors influencing the outcome ) were identified based on a literature review but were limited to those available in the national TB registry . For each patient , the registry included : age , pre-treatment housing location , treatment start date , TB case category ( new or retreatment case ), TB type ( pulmonary or EPTB ), pre-treatment GeneXpert , pre-treatment weight , smear at 2 , 3 and 5 months , weight at 2 months , smear post-treatment , weight post-treatment , HIV status , date of HIV test , and treatment outcome .
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