SHORT-TERM INCARCERATION FOR THE MANAGEMENT OF NONCOMPLIANCE WITH TUBERCULOSIS TREATMENT

Study objectives: To review the use of incarceration for noncompliance with tuberculosis treatment. Design: Retrospective review. Setting: A n urban tuberculosis control program. Patients: Patients treated for a ctive tuberculosis. Measurements and results: We reviewed the legal ba sis and practical application of quarantine for active tuberculosis, i ncluding the use of incarceration for noncompliance, The records of pa tients treated at the Denver Metro Tuberculosis Clinic during 1984 to 1994 were reviewed to identify patients who were incarcerated and to e valuate the effectiveness of this intervention, Of 424 cases of tuberc ulosis, 20 patients (4.7%) were incarcerated for noncompliance; an add itional 21 patients (5.0%) were lost to follow-up prior to completing therapy. Incarcerated patients were predominantly men who were born in the United States and had a history of homelessness and alcohol abuse , The median duration of the initial incarceration was 20 days (range, 7 to 51 da)a). Of the 17 patients released prior to completing therap y, 13 (76%) were compliant with outpatient, directly observed therapy after one or two short-tern incarcerations (<60 days); only three pati ents were incarcerated for the duration of treatment, Overall, 18 of 2 0 incarcerated patients (90%) were successfully treated. Conclusions: Approximately 5% of the patients treated through our program were inca rcerated for noncompliance; an additional 5% were unavailable for foll ow-up and would have been candidates for incarceration if found, Homel essness and alcoholism were closely associated with the use of incarce ration. Short-term incarceration followed by outpatient, directly obse rved therapy was relatively successful in the management of this diffi cult patient population.