From 1995 to 1996, the Institute for Law and Policy Planning, Inc., Berkeley, Calif., carried out a study of tuberculosis (TB) screening and treatment procedures in jails and community-based health care facilities in two representative California counties.

Although county governments provide funding for health services for both the medically indigent and the incarcerated, there is little integration between community-based and jail health care systems.

Because of arrests and re-arrests, many individuals with serious infectious diseases move between jail and the community. The potential for cross-transmission is particularly problematic in the case of TB, which occurs at much higher rates in correctional facilities than in the general population.

Key Findings

• Rural County A demonstrated a need for administrative/clinical integration among public health, jail medical, and community clinics; coordination between jail medical, and corrections agencies; and better adherence of practice to Centers for Disease Control and Prevention (CDC) guidelines.
• Urban County B, where the reported active case rate was unexpectedly low compared to the community rate, appeared to have fewer problems, i.e., the six active cases associated with the jail completed treatment in the community. Nevertheless, the study identified some areas for improvement.
• Study of both counties demonstrated that early identification of active TB requires the development of integrated information systems or records within the jail and other health agencies, with careful system wide planning and evaluation. There is an overall need for tracking inmates with TB throughout the county public health agencies (including the jail medical system).
• In one hypothetical scenario demonstrated in the adjunct study, one "missed" case in a state prison led to costs of $1.3 million.

Key Recommendations

• Integrate information systems or share records within and between jails, and with other community-based health care providers to promote early identification of TB.
• Track active TB cases among current and released inmates throughout the county public health system to ensure completion of treatment.
• Consider jail facilities as "designated health care facilities," and make public health standards mandatory for accrediting jail medical programs.

Funding

The Robert Wood Johnson Foundation (RWJF) supported the project with a grant of $150,353 between August 1995 and November 1996.