Controlling Tuberculosis: Understanding the Effects of Incarceration on Tuberculosis Treatment Outcomes In Brazil
Abstract/Contents
- Abstract
- Prisoners bear a disproportionate and increasing burden of tuberculosis (TB) in Brazil. They make up only 0.4% of Brazil’s total population yet represent 8.7% of Brazil’s total TB cases. Prior research has demonstrated that TB in prisons acts like a reservoir for the surrounding communities and is responsible for a sizeable percentage of TB cases in the general population. TB treatment success in Brazil is among the lowest in the world for high burden countries with only 72% of cases who begin treatment successfully completing it. However, given the substantial burden little is known about incarceration’s relationship to TB treatment outcomes and care gaps in this population. The goal of this study was to assess the relationship between incarceration and treatment outcomes within Brazil. We obtained data on sociodemographic and clinical characteristics and TB treatment outcomes using Brazil’s national disease registry from 2009 to 2017.We conducted multivariable logistic regression and propensity score analysis to quantify the effect of incarceration on the probability of treatment success among new adult TB cases, controlling for sex, age, self-reported race, education status, diagnosis year, HIV status, and reported use of alcohol and tobacco. TB treatment outcomes were reported for 97.3 % of non-incarcerated and 94.4 % of prisoners. Among these, the treatment success was 71.1% among non-incarcerated individuals and 77.4% among prisoners. In multivariable regression, prisoners were more likely to have treatment success (adjusted odds ratio [AOR] 1.24 % CI 1.2-1.29). Among prisoners, self-reported black (AOR 0.74, 95% CI 0.67-0.81) or mixed-race individuals (AOR 0.91, 95% CI 0.84-0.98), HIV-coinfected (AOR 0.40, 95% CI 0.36-0.44), and those reporting alcohol use (AOR 0.64, 95% CI 0.58-0.71) were less likely to have treatment success. However, prisoners enrolled on Directly Observed Therapy (DOT) seemed to have improved treatment outcomes with DOT being associated with treatment success (AOR 1.87, 95 % CI 1.73-2.02). Access to DOT was significantly higher among prisoners (77.0%) compared to those outside prison (56.1%) (p<.0001), and this partially explained the superior outcomes among prisoners as an effect modification was observed when our cohort was stratified on DOT enrollment (DOT+ 1.61 (1.54-1.68) vs. DOT- 0.97 (0.91-1.03)). Prisoners have a greater odds of treatment success than those outside prisoners, an effect mediated in part by an increased exposure to DOT. Treatment success among both incarcerated and non-incarcerated populations is below international targets. Expanding access to DOT and other interventions to improve outcomes is needed, particularly in populations with poorer outcomes such as black or mixed- race inmates, HIV co-infected individuals and those reporting alcohol use.
Description
| Type of resource | text |
|---|---|
| Date created | May 31, 2019 |
Creators/Contributors
| Author | O'Marr, Jamieson |
|---|---|
| Primary advisor | Andrews, Jason |
| Advisor | Popat, Rita |
| Degree granting institution | Stanford University, Department of Health Research & Policy |
Subjects
| Subject | Tuberculosis |
|---|---|
| Subject | Treatment Outcomes |
| Subject | Incarceration |
| Subject | Prisons |
| Subject | Brazil |
| Subject | Department of Health Research & Policy |
| Genre | Thesis |
Bibliographic information
Access conditions
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- User agrees that, where applicable, content will not be used to identify or to otherwise infringe the privacy or confidentiality rights of individuals. Content distributed via the Stanford Digital Repository may be subject to additional license and use restrictions applied by the depositor.
- License
- This work is licensed under a Creative Commons Attribution 3.0 Unported license (CC BY).
Preferred citation
- Preferred Citation
- O'Marr, Jamieson (2019). Controlling Tuberculosis: Understanding the Effects of Incarceration on Tuberculosis Treatment Outcomes In Brazil. Stanford Digital Repository. Available at: https://purl.stanford.edu/dx956tj1917
Collection
Epidemiology & Clinical Research Masters Theses
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- Contact
- jamiesonomarr@gmail.com
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