The Status of TB Prevention and Control Measures
in Large City and County Jails in the U.S.
Strengthen Collaboration Between Health Departments
Close collaboration between jail systems and their
corresponding public health departments in TB screening, containment,
and assessment activities is integral to effective TB prevention
and control in jails and the communities they serve. The study found
that increasing the breadth and intensity of collaboration between
jails and health departments could significantly strengthen TB control.
All of the 20 jail systems surveyed collaborated with their local
or state health departments in at least some areas of TB prevention
and control, but the scope and effectiveness of collaboration were
Increase Collaboration in Major Areas of TB Control
Most jail systems collaborated with their health departments on
TB treatment (85%) and contact investigations (80%) but, for most
other recommended activities, collaboration was relatively limited.
For example, only about half of the jail systems collaborated in
screening and diagnosis, TB policies and protocols, and prerelease
discharge planning. A minority of jail systems collaborated in staff
training (40%), quality assurance/improvement (25%), and TB education
for inmates (20%). Areas in which collaboration needs to be strengthened
- Discharge planning and continuity of care for inmates undergoing
- Use of TB information systems and program assessment (including
- Development and review of TB policies and protocols;
- Use of environmental controls (e.g., ventilation systems and
isolation rooms); and
- Staff training.
Increase the Effectiveness of Collaboration
Sixty-five percent of the jail systems rated their overall collaboration
with the health department as effective or highly effective. However,
health department respondents generally rated collaboration as less
effective in all areas than did jail respondents, with the most
dramatic rating difference centering on discharge planning. Within
jurisdictions, jails and health departments often differed in their
perceptions of the effectiveness of collaboration. In just over
one third of the jurisdictions, both parties agreed that overall
collaboration was highly effective. Jurisdictions collaborating
in more areas of TB control were more likely to rate overall collaboration
as effective. Having organizational mechanisms in place was the
best predictor for both collaborating in more areas and for more
effective overall collaborations.
- Increase formal organizational mechanisms of collaboration,
- designating one person at the jail system to be responsible
for TB control;
- designating liaisons from the public health department
TB program and from the jail system;
- arranging for TB program staff to provide on-site services
at the jail; and
- holding periodic management and staff-level meetings.
Dramatically Increase Collaboration on Discharge Planning
and Continuity of Care
The study found that discharge planning and continuity of care are
among the least effective areas of collaboration—only 15 percent
of jurisdictions reported having effective collaboration in these
areas. Barriers to effective collaboration included lack of advance
notification of release (less than one third of jail medical departments
were usually notified in advance of release of inmates with TB disease),
lack of coordination by the jail with the health department, and
limited health department resources for field follow-up. For inmates
undergoing treatment for latent LTBI, there was generally no organized
system for continuity of care.
- Consider administrative procedures, such as medical clearance
or medical holds, to allow jail medical staff to coordinate postrelease
- Provide inmates with a medical discharge card so that continuity-of-care
information is available to inmates who are released without notification
of the medical staff.
- Visit patients before release from jail by health department
TB program staff.
- Set up specific appointments for medical follow-up.
- Develop a coordinated effort for continuity of care for high-risk
patients with LTBI
Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination - http://www.cdc.gov/tb
Please send comments/suggestions/requests
CDC/Division of Tuberculosis Elimination
Communications, Education, and Behavioral Studies Branch
1600 Clifton Rd., NE - Mailstop E-10, Atlanta, GA 30333