Prevention and Control of Tuberculosis in Correctional and Detention Facilities: Recommendations from CDC

Endorsed by the Advisory Council for the Elimination of Tuberculosis, the National Commission on Correctional Health Care, and the American Correctional Association

Disclosures

Morbidity and Mortality Weekly Report. 2006;55(27):1-44. 

In This Article

Collaboration and Responsibilities

The management of TB from the time an inmate is suspected of having the disease until treatment is complete presents multiple opportunities for collaboration between correctional facilities and the public health department. For example, public health agencies can partner with correctional facilities in TB screening and treatment activities. In a study of 20 urban jail systems and their respective public health departments, only 35% reported having collaborated effectively when conducting TB-prevention and -control activities.[38] Formal organizational mechanisms (e.g., designated liaisons, regular meetings, health department TB program staff providing on-site services, and written agreements) are associated with more effective collaboration between correctional facilities and health departments.[37]

Correctional facilities and health departments should each designate liaisons for TB-associated efforts. Liaisons should serve as a familiar and accessible communication link between collaborating entities. The duty of liaison at the correctional facility should be assigned to the person responsible for TB control or to another staff member familiar with TB control and patient management at the facility. Regular meetings between correctional facilities and health departments are important to establish communication and collaboration on TB-related issues.[37,171] Jurisdictions with regularly scheduled meetings between jails and public health staff are 13 times more likely to report having highly effective collaboration than jurisdictions that have not established such meetings.[37] For example, in Florida, the state TB-control program and corrections health officials hold quarterly coordination meetings on TB issues and regularly scheduled collaborative TB case-review conferences,[171] activities that have encouraged communication between facilities and local health departments.

The presence of health department staff in correctional facilities can help promote more effective collaboration.[37,171] Functions provided by such personnel within the correctional facility setting include screening, surveillance, education and training, contact investigation, and follow-up after release.[171] For example, New York City Department of Health and Mental Hygiene personnel assigned to the Rikers Island jail interview inmates, monitor their care, suggest interventions or changes, and work with the jail to determine discharge planning needs for continuity of care in the community. Data access links are available on site that enable health department personnel to promptly inform corrections staff regarding previous completed therapy, incomplete work-up or therapy, sputum-smear results, culture and drug-susceptibility data, and ongoing treatment for TB cases and suspects. These on-site access links diminish the time spent in AII rooms and decrease the time required for patient work-up by providing confirmatory historical documentation.

Correctional facilities and health departments should work together to agree on and delineate their respective roles and responsibilities. Establishing clear roles and responsibilities helps avoid duplication, confusion, the potential for breaching patient confidentiality, excess expenditures, and missed opportunities.

Roles and responsibilities should be clearly defined for all TB-control activities that might require collaboration between correctional facilities and health departments, including

  • screening and treatment of inmates for LTBI and TB disease,

  • reporting of TB disease,

  • follow-up of inmates with symptoms or abnormal chest radiographs,

  • medical consultation regarding persons with confirmed and suspected TB disease,

  • contact investigations for reported TB cases,

  • continuity of treatment and discharge planning for persons with TB disease and LTBI,

  • training and education of correctional facility staff,

  • evaluation of screening and case management, and

  • facility risk assessment.

Agreements about roles and responsibilities may be formal or informal, but they should be recorded in writing. Formal agreements include memoranda of understanding and written policies or plans. Informal agreements may be as simple as an e-mail summary of a verbal discussion or meeting. The format for recording and communicating agreements (e.g., checklists, flow charts, algorithms, and lists of steps) may vary depending on the need. Once agreements are made, they should be reassessed periodically (see Program Evaluation).

Correctional facilities and health departments should work together to formulate agreements that specify the information to be shared in a particular time frame, who will have access to specific information or databases, and how patient confidentiality will be protected. Information systems provide the framework for recording and accessing pertinent information (see Program Evaluation). Health departments should provide correctional facilities with pertinent TB surveillance information (e.g., local rates of drug resistance, the number of TB cases occurring in correctional facilities relative to the community, and the number of TB cases identified in the community among recently incarcerated persons), which can bolster support for TB-screening activities within these facilities.

Legislation or policy statements can effectively encourage or mandate collaboration on issues (e.g., disease reporting, contact investigation, and discharge planning) when institutional barriers (e.g., time and resources) inhibit collaboration. For example, California has improved discharge planning by prohibiting the release or transfer of inmates with confirmed or suspected TB unless a written treatment plan has been received and accepted by the local health officer.[172] Arizona's state administrative code places responsibility for contact investigations of TB exposures in correctional facilities on the correctional facility but requires consultation with (and reporting to) the local health department. ICE also has developed a policy memorandum requesting that ICE field office directors grant a short-term hold on the deportation of patients with TB disease to allow time for the ICE health services program to facilitate continuity of care.

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