TB Challenge: Partnering to Eliminate TB in African Americans
TB Cases in Correctional Facilities
Raising the Awareness - Educating the
Incarcerated Population about TB: A Nurse's Perspective
Ellen R. Murray, RN, BSN, Training
Specialist/Nurse Consultant, Southeastern National TB Center and
Elvin Magee, MPH, MS, Health Scientist, Surveillance, Epidemiology,
and Outbreak Investigations Branch, CDC
Black or African American persons have historically had a
disproportionate share of the TB cases diagnosed in correctional
facilities in the United States. As shown in Figure 1, this group
represented 46% of all TB cases (4276 cases) reported in
correctional facilities from 1993 through 2006. Of this total, 3709
were male and 567 were female.
Correctional facilities in the United States house people of every
race, ethnicity, and cultural background. Figure 2 illustrates the
difference by race and ethnicity of persons with TB diagnosed in
correctional facilities. Of the total TB diagnoses made from 1993
through 2006, an average of 5 to 6% were black inmates, while
inmates of all other races and ethnicities, excluding Hispanics,
averaged 3% or less.
Corrections, present and the future
At the end of 2006, the U. S. Department of Justice reported greater
than 7.2 million people were either: (1) on probation, (2) on
parole, (3) in jail, or (4) in prison. This number represented 3.2%
(1 in every 31 adults) of all U.S. adult residents. 1
It is estimated that 32% of all black males will enter state or
federal prison in their lifetime. This figure is in sharp contrast
to the 17% estimated for Hispanic males and 5.9% of white males.
Figure 3 shows that from 1993 through 2006, the incarcerated were
more likely to have a history of the following risk factors:
homelessness, excessive alcohol use, inject-ing drug use, or
non-injecting drug use.
Education is the Key
In addition to other TB control measures, TB education in the
correctional populace should be a priority to affect the rate of
disease. In short, education in correctional facilities can be an
intervention for TB infection control.
Education of prison inmates often occurs sporadically rather than
systematically, with information about controlling and containing
infectious disease not given high priority. Further, dwindling
resources for public health education have resulted in cutbacks in
community-wide TB programs. The higher proportion of 4276 total
cases of TB in black inmates along with other health disparities
present in the incarcerated population, demonstrate a need for
education about TB. The development of educational programs for the
incarcerated should be a priority for local health departments,
working hand-in-hand with corrections administration to raise
awareness and educate their medical and non-medical corrections
staff about tuberculosis. Education about tuberculosis prevention
and control is best done by those who are knowledgeable about the
disease. Vehicles for also educating inmates about TB are prison
ministries and other community-based programs that have gained
inmates’ trust and respect are already in place in the facilities.
There are many educational programs currently available in
correctional facilities, such as General Education Diploma (GED)
classes, drug and alcohol programs, and rehabilitation programs that
help inmates learn a trade. Programs such as these can be used to
help TB programs educate the incarcerated population.
In summary, health department and correctional facilities should
work collaboratively to ensure prompt disease detection, isolation,
management, and discharge planning for infectious inmates. In
addition, correctional facilities should develop an infectious
disease plan focused on TB and offer education for their staff.
Fundamental TB prevention and control activities in correctional
facilities would include: (1) screening for TB disease and testing
for latent tuberculosis infection (LTBI); (2) treating persons with
TB and LTBI; (3) preventing TB transmission; and (4) enhancing
collaboration between corrections, public health, and community
With public health and corrections working together, educating
the incarcerated population about TB becomes a powerful tool for
- U.S. Department of Justice. (2007).
Bureau of Justice
Statistics. Retrieved from the website on 12/19/07.
- CDC. Prevention and control of tuberculosis in correctional
and detention facilities: Recommendations from CDC. MMWR
2006: 55(RR-9), 1-44.
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