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* From the Research and Evaluation Branch (Dr. Bock), Centers for Disease Control and Prevention; Fulton County Sheriff’s Department (Mr. Herron), Fulton County Health and Wellness Program (Mss. Rogers and Tapia); Georgia Division of Public Health (Ms. DeVoe), Atlanta, GA; and Sequella, Inc. (Dr. Geiter), Washington, DC.
Correspondence to: Naomi N. Bock, MD, Division of TB Elimination, Centers for Disease Control and Prevention, Mailstop E-10, 1600 Clifton Rd, N.E., Atlanta, GA 30333; e-mail: neb2{at}cdc.gov
Study objectives: To determine whether short-course
treatment of latent tuberculosis infection (LTBI) with 2 months of
rifampin and pyrazinamide (2RZ) is well tolerated and leads to
increased treatment completion among jail inmates, a group who may
benefit from targeted testing and treatment for LTBI but for whom
completion of 
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 tuberculin skin test results, normal findings on chest radiography, and expected 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 toxicity
due 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 radiography, and 168 new
inmates had an expected duration of incarceration of 60 days. One
hundred sixty-six inmates (> 99%) were HIV-negative. Eighty-one
inmates (48%) completed 60 doses of 2RZ treatment while incarcerated.
Seventy-four inmates (44%) were released before completion. Treatment
was stopped in 1 inmate (< 1%) for asymptomatic elevation of
asparginine aminotransferase ( 10 times normal) and in 12 inmates
(7%) for minor complaints. Twenty-one inmates had completed isoniazid
treatment in the year before the availability of 2RZ, and 9 inmates
completed isoniazid treatment in the year during the availability of
2RZ.
Conclusions: 2RZ was acceptable to and well tolerated by inmates, and led to a marked increase in the number of inmates completing treatment of LTBI during incarceration.
Key Words: correctional institutions • treatment of latent tuberculosis infection
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