TB Prevention and Control in Correctional Facilities

Overview

TB is a challenging disease to identify, treat, and control, especially in congregate settings like correctional facilities (e.g., prisons or jails). People in correctional facilities are from diverse backgrounds and communities and live and work in close proximity for varying periods.

A person who is 'justice system-involved' is any person who is currently or has ever been arrested or incarcerated in a detention or correctional facility. This term also includes those reentering their communities after detention or incarceration, including those on parole or probation.

Correctional facilities are critical settings to find and treat people with TB infection.

People who are justice systemA -involved may have had varying levels of medical care before entering a correctional facility1. They may not have had access to medical care to diagnose TB infection early.

People who are justice systemA-involved or work in a correctional facility have a higher risk of being exposed to Mycobacterium tuberculosis. M. tuberculosis is more likely to spread in correctional facilities due to several factors, including:

• People who may have increased risk for TB due to other health conditions,
• Environment of the facilities such as people living in close proximity, poor air flow, shared airspaces, and overcrowding, and
• Movement of people between facilities.

Effective TB prevention and control measures in correctional facilities include:

• Early identification of persons with TB disease through entry and periodic follow-up screening;
• Successful treatment of latent TB infection and TB disease;
  • Thorough and efficient contact investigations when a TB case is identified;
• Comprehensive discharge planning;
• Appropriate use of airborne precautions (e.g., airborne infection isolation, environmental controls, and respiratory protection); and
• Annual TB training and education and program evaluation.

Correctional facilities should collaborate with local or state TB programs and other key partners to implement TB prevention and control measures.

Screening for TB infection

Finding and treating people for TB disease is the best way to prevent disease transmission.

A health care provider working in a correctional facility should screen justice system-involved people for TB disease upon entry. If a person is diagnosed with TB disease, he or she should begin treatment before they are integrated into the general correctional facility population.

The screening methods for TB disease may include:

• Asking about symptoms of TB disease, including a medical history,
• Conducting a chest radiograph,
• Testing for TB infection (i.e., TB blood test or TB skin test), and
• Collaborating with the TB program to review local TB registries.

In general, people who are justice systemA-involved for longer periods of time and all employees who have a negative baseline TB blood test or TB skin test should have follow-up testing at least annually.

Diagnosis and treatment of latent TB infection and TB disease

Successful treatment of latent TB infection and TB disease can help to prevent and control TB disease in correctional facilities.

Latent TB infection

People with latent TB infection do not feel sick, do not have symptoms, and cannot spread M. tuberculosis to others. Without treatment, people with latent TB infection can develop TB disease at any time and become sick.

Ensuring that people with latent TB infection complete treatment may be challenging in a correctional facility due to movement of people from one facility to another or short-term correctional facilities.

TB disease

People with TB disease feel sick and can spread M. tuberculosis to others. TB disease can almost always be treated and cured with medicine. Without treatment, TB disease can be fatal.

Reporting cases of TB disease

All correctional facilities must report suspected and confirmed cases of TB disease to the local or state TB program. This includes even if the justice-systemA involved person has been released from the facility into the community or transferred to a different facility.

Contact investigation

Correctional facility staff should conduct a contact investigation once a person is diagnosed with TB disease. A prompt response is important to prevent the spread of TB disease within the facility and helps to avoid a potential outbreak.

A contact investigation helps to stop the spread of TB disease by

1. Identifying, isolating, and treating people with TB disease, and
2. Identifying contacts and treating them for inactive TB.

Airborne protection

Correctional facilities should implement airborne precautions for any person who:

1. Has signs or symptoms of TB disease or
2. Has documented TB disease and has not completed treatment or not been determined previously to be noninfectious.

Discharge planning

A discharge plan is crucial for effective local TB control efforts within the community.

Correctional facilities should have a discharge plan for justice-systemA involved people who

• Have confirmed or suspected TB disease
• Have latent TB infection who are at higher risk for developing TB disease.

Correctional facilities should ensure that the discharge plan is comprehensive and effective. The process should include:

1. Collaborating with public health and other community health-care professionals,
2. Ensuring continuity of case-management, and
3. Evaluating discharge-planning procedures and modifying procedures as needed to improve outcomes.

TB training and education

Correctional facilities can implement TB training and education of correctional workers and other persons associated with any correctional facility (e.g., volunteers and justice-systemA involved people). Training and education can help lower the risk for TB transmission and disease.

To ensure the training and education is effective, correctional facilities should:

1. Collaborate with local or state TB programs to have TB training specifically for the correctional facility setting.
2. Provide routine TB training for everyone who spends a significant amount of time in the facility, and additional training should be given to any employee who will interact with people at risk for TB disease.
3. Document the TB training and education efforts to evaluate the programs and update the trainings as needed.

It is also important to provide TB training and education for people who are justice-systemA involved.

Program evaluation

Correctional facilities should implement a program evaluation to assess how effective the procedures are in preventing the spread of TB disease in the facility. A program evaluation helps to improve accountability, enable ongoing learning and problem-solving, and identify opportunities for improvement.

Successful monitoring and evaluation of a TB-prevention and -control program includes:

• Identifying collaborators,
• Describing the TB control program,
• Conducting a risk assessment for TB transmission within the facility,
• Collecting and organizing data,
• Analyzing data and forming conclusions, and
• Using the information to improve the TB program.

Correctional facilities can collaborate with the local or state TB program to implement the program evaluation.

Resources