Acceptability of short-course rifampin and pyrazinamide treatment of latent tuberculosis infection among jail inmates

Study objectives: To determine whether short-course treatment of latent tub erculosis infection (LTBI) with 2 months of rifampin and pyrazinamide (2RZ) is well tolerated and leads to increased treatment completion among jail i nmates, a group who may benefit from targeted testing and treatment for LTB I but for whom completion of greater than or equal to 6 months of isoniazid treatment is difficult because of the short duration of incarceration. Design: Prospective cohort. Setting: Large, urban county jail. Patients: All inmates admitted to the Fulton County Jail who had positive t uberculin skin test results, normal findings on chest radiography, and expe cted duration of incarceration of at least 60 days. Intervention: Inmates were offered 2RZ via daily directly observed therapy for 60 doses as an alternative to isoniazid therapy. Measurements and results: We measured the completion of 2RZ treatment and t oxicity clue to 2RZ treatment during incarceration. From December 14, 1998, through December 13, 1999, 1,360 new inmates had positive tuberculin skin test results and normal findings on chest radiograph); and 168 new inmates had an expected duration of incarceration of greater than or equal to 60 da ys. One hundred sixty-six inmates (> 99%) were HIV-negative. Eighty-one inm ates (48%) completed 60 doses of 2RZ treatment while incarcerated. Seventy- four inmates (44%) were released before completion. Treatment was stopped i n 1 inmate (< 1%) for asymptomatic elevation of asparginine aminotransferas e (<greater than or equal to> 10 times normal) and in 12 inmates (7%) for m inor complaints. Twenty-one inmates had completed isoniazid treatment in th e lear before the availability of 2RZ, and 9 inmates completed isoniazid tr eatment in the year during the availability of 2RZ. Conclusions: 2RZ was acceptable to and well tolerated by inmates, and led t o a marked increase in the number of inmates completing treatment of LTBI d uring incarceration.