Predictors of adherence to tuberculosis treatment in a supervised therapy programme for prisoners before and after release. Study Group of Adherence to Tuberculosis Treatment of Prisoners

Abstract

The prison population is a high-risk group for tuberculosis (TB). This investigation aimed to study predictive factors of treatment adherence among prisoners involved in a pilot programme of supervised treatment. The study included TB patients from the Men's Penitentiary Center of Barcelona (MPCB) in 1995. Directly observed therapy (DOT) was carried out in the infirmary or in a methadone programme. Released prisoners were referred to the municipal maintenance methadone programmes (MMP) and other social resources. Incentives and enablers were used to improve compliance (economic aid for nutritional and housing needs, methadone programmes and admittance to a sociosanitary centre). The outcome of the patients' adherence was classified as follows: completed, defaulted, dead or transferred out. Factors associated with adherence were investigated through logistic regression. The programme included 62 patients, 43 of whom were intravenous drug users (IVDU) and 46 were infected with the human immunodeficiency virus (HIV). Nineteen had previously had TB and 32 were released from prison during TB treatment. Overall adherence was 89%; 97% among those who completed treatment in prison, and 79% among those who completed treatment outside prison (p=0.05). Ninety-five per cent of IVDU in an MMP completed treatment. Homeless or alcoholic exprisoners completed treatment only if they were admitted to sociosanitary centres. DOT throughout treatment resulted in better adherence (odds ratio (OR)= 16.80; confidence interval (CI): 2.42-116.2)). Those who were incarcerated throughout treatment also showed better adherence (OR= 7.36; CI: 0.79-48.16). Antituberculosis treatment adherence in prisoners was high even after release with adequate co-ordination among intrapenitentiary and extrapenitentiary programmes. Maintenance methadone programmes proved very useful in intravenous drug users, as did admittance to sociosanitary centres for indigent or alcoholic exprisoners undergoing treatment.

Injection Drug Use and the Hepatitis C Virus: Considerations for a Targeted Treatment Approach--The Case Study of Canada

“…140 Although there are widespread assumptions that illicit drug users are not capable of adherence to long-term pharmacotherapeutic treatment regimes, experience regarding treatment of other infectious diseases of drug users (e.g., HIV and tuberculosis) has demonstrated the possibility of comparably "normal" or good compliance rates. 141,142 For the most marginalized injection drug use patients, the possibility of peginterferon monotherapy (no ribavirin) may be considered. This treatment regime does not require the daily ribavirin component and may be considered especially in patients with genotypes 2 and 3, for which response rates are as high as 40%, although it is still not as effective as pegylated interferon/ribavirin treatment.…”

Is It Justifiable to Withhold Treatment for Hepatitis C from Illicit-Drug Users?

“…In some studies, drug users were less likely than other persons to adhere to medical therapy, 12-14 whereas in other studies, the adherence of drug users was similar to that of other patients. [15][16][17] It is difficult to make generalizations about drug users because they differ with regard to the drugs they use, the extent and frequency of use, the degree of their dependence, the stability of their lives, and many other factors. For example, regular users may be more impaired than occasional users, and persons who use stimulant drugs or who binge may have more chaotic lives and poorer adherence than those who have used opiates consistently for many years.…”

A controlled trial of methadone treatment combined with directly observed isoniazid for tuberculosis prevention in injection drug users

“…including IDUs (Pablos-Maendez et al, 1997;Marco et al, 1998;). In a Spanish study of TB treatment that required only twice weekly visits, injection drug use was the main predictor of noncompletion (Caminero et al, 1996).…”

“…While DOPT is provided in some methadone treatment programs, such services are not universally available. Methadone programs have been shown to be an effective platform for the delivery of a number of health services including primary medical care for conditions such as active TB (Marco et al, 1998;Elk et al, 1993), and HIV disease (Batki, 1988;Sorensen, 1991;Goosby et al, 1992;Selwyn et al, 1993;Umbricht-Schneiter et al, 1994;Selwyn, 1996). Because methadone programs treat large numbers of atrisk patients who attend the clinic daily or almost daily, they are a logical nexus for providing tuberculosis prevention services (Brown and Felton, 1989;Haverkos and Lange, 1990).…”