Term Paper on "Tuberculosis (TB) Prevention and a TB-Treatment Intervention"

Term Paper 22 pages (6084 words) Sources: 3 Style: APA

[EXCERPT] . . . .

Tuberculosis (TB) Prevention and a TB-Treatment Intervention for Males Newly Released from New York City Prison/Correctional Facility (Riker's Island)

Despite significant progress in detecting and treating tuberculosis (TB) in recent years, TB remains a significant health threat, especially among institutionalized populations such as prisons. While the experts remain divided as to the precise causes for the inordinately high incidence of TB in the nation's prisons, the reasons typically cited include the fact that prisons house higher percentages of lower socioeconomic individuals that have not had access to healthcare or that have ignored their healthcare needs prior to incarceration, including alcoholism, substance abuse patterns and a higher rate of HIV infection, all of which can promote the contraction and spread of tuberculosis. The purpose of the proposed study will be to evaluate the effectiveness of tuberculosis (TB) prevention and a TB-treatment intervention on males who have been newly released from New York City Prison/Correctional Facility (Riker's Island) and who have been diagnosed with latent TB infection (LTBI) or active TB disease. To this end, a community intervention trial study is proposed, together with supporting background and rationale for the study. A summary of the research and salient findings are presented in the conclusion.

Introduction

Purpose of the Proposed Study

Specific Aims

Background and Significance

Understanding of the Problem

Rationale of the Proposed Study

Conceptual Framework

Research Methodology

Overview of Proposed Study

Study Design

Summary

Tuberculosis (TB) Prevention and a TB-Treatment Intervention for Males Newly Released from New York City Prison/Correctional Facility (Riker's Island)

This proposal will be for funding purposes for a future intervention. The proposal will follow the guidelines established by the National Institute of Health for such grant proposals (PHS 398), but will utilize the community intervention trial as its primary study design. The purpose and specific aims of the proposed study, as well as relevant background information and the significance of the proposal, are followed by a review of the peer-reviewed and scholarly literature concerning tuberculosis in general and its impact on prison populations in particular in the Understanding of the Problem segment. A presentation of the rationale of the proposed study is followed by a discussion of the conceptual framework to be used in the proposed study and a description of the community intervention trial study research methodology to be employed. An overview of the proposed study is followed by a description of the study design, and concludes with a summary of the introductory chapter.

Purpose of the Proposed Study

The purpose of the proposed study will be to evaluate the effectiveness of tuberculosis (TB) prevention and a TB-treatment intervention on males who have been newly released from New York City Prison/Correctional Facility (Riker's Island) and who have been diagnosed with latent TB infection (LTBI) or active TB disease (TB).

Specific Aims

The specific aims of the proposed study are represented by its respective goals and objectives, to-wit, the development of relevant data needed to confirm or refute the following null and alternative hypotheses.

Null Hypothesis (#1): A tuberculosis (TB) prevention and TB treatment intervention on males whom have been diagnosed with latent TB infection (LTBI) or active TB disease (TB) and are newly released from Correctional facilities will not make a difference in their knowledge of TB and their communities.

Null Hypothesis (#2): A tuberculosis (TB) prevention and TB treatment intervention on males whom have been diagnosed with latent TB infection (LTBI) or active TB disease (TB) and are newly released from New York City Correctional facilities will not reduce the rates of infection.

Alternate Hypothesis (#1): A tuberculosis (TB) prevention and TB treatment intervention on males whom have been diagnosed with latent TB infection (LTBI) or active TB disease (TB) and are newly released from Correctional facilities will make a difference in their knowledge of TB and their communities.

Alternate Hypothesis (#2): A tuberculosis (TB) prevention and TB treatment intervention on males whom have been diagnosed with latent TB infection (LTBI) or active TB disease (TB) and are newly released from New York City Correctional facilities will reduce the rates of infection.

Background and Significance

The United States incarcerates more of its citizens than any other country in the world today with some concomitant implications for healthcare providers responsible for this population (Stanko, Gillespie & Crews, 2004). In this regard, Braithwaite, Braithwaite and Poulson emphasize that, "Traditionally associated with high-risk sexual activity, drug use, poverty, disenfranchised status, population density, homelessness and poor access to preventive and primary health care, the health problems of the inmate population pose difficult programmatic and fiscal challenges for correctional policy-makers and personnel" (p. 108). Not surprisingly, infection rates for tuberculosis among inmates in federal and state prisons are far greater than for the American population as a whole (Smith, 2006; Louis, 2002). According to Smith, there are a variety of causes for this increased incidence of TB among prisons populations, but behind-bar-sex represents one of the most significant: "The high incidence of prison rape increases health care expenditures, both inside and outside of prison systems, and reduces the effectiveness of disease prevention programs by substantially increasing the incidence and spread of HIV, AIDS, tuberculosis, hepatitis B and C, and other diseases" (p. 185). As Mueller emphasizes, people with both HIV and TB are much more likely to develop active TB than others that have the TB organism alone: "When an inmate's immune system is not working well, he or she is much more likely to get TB. Health care workers consistently have to track inmates who test HIV positive because of their vulnerability to TB" (p. 101).

As with a number of other infectious diseases, though, there are a variety of causes or combinations of causes that can contribute to such higher incidence of TB among prison populations. For example, prisoners are especially susceptible to infection tuberculosis than other members of the community (Wilcox, Hammett, Widom & Epstein, 1996) and this higher rate of tuberculosis infection is consistent with the fact that prisoners typically come from lower socio-economic backgrounds and because TB is an airborne infection, overcrowded housing conditions associated with poverty facilitate its spread (Coyle, Campbell & Neufeld, 2003). Whatever its source, medical experts recommend swift and accurate diagnoses for TB in these institutionalized populations because early diagnosis can literally mean the difference between life and death (Mueller, 1996).

According to its organizational Web site, the New York City Department of Correction (NY DOC) reports that its average daily inmate population varies between 13,000 and 18,000, an amount which is more than the prison population of many state correctional systems (an overview, 2008). The site adds that, "On a typical weekday, the Department logs more than 3,000 miles transporting inmates to courts in the five boroughs and to medical and other jail or prison facilities throughout the city and state" (an overview, p. 2).

Today, Rikers Island has been enlarged to more than 400 acres and contains 10 major jails with a combined capacity of almost 17,000 inmates; among the Rikers' facilities are a jail for sentenced males, another for sentenced and detainee females, and a detention center for adolescent males (ages 16 to 18) and seven jails for adult male detainees (an overview). The Rikers' complex also features include a bakery, central laundry, tailor shop, print shop, maintenance and transportation divisions, K-9 unit and a power plant (an overview).

Understanding of the Problem

Just as many institutional settings have experienced an increase in the incidence of staphylococcus resistant methicillin strains in recent years, prisons and jails are also high-risk settings for the spread of TB infection. According to Braithwaite and his colleagues, "Living conditions are invariably crowded, and many facilities have extremely poor ventilation and air circulation. Moreover, many inmates already have elevated risk for TB because of their lifestyles, inadequate prior health care and increased prevalence of HIV / AIDS" (p. 108). In fact, a study of the New York City jail system showed that TB infection and progression to active TB disease take place at higher rates in individuals with more frequent incarceration and longer total time spent in jail (Braithwaite et al.). As these authors point out, though, "TB is not a new problem in prisons and jails. Several studies undertaken in correctional facilities in New York City, New Orleans and Arkansas between the mid-1940s and the late 1970s revealed higher rates of TB infection and disease among inmates than in the outside population. Several of these studies also documented the transmission of TB infection among inmates and from recently released offenders to people in the community" (emphasis added) (Braithwaite et al., p. 109).

There problem of TB in correctional facilities across the country is well documented, and there have been dramatic increases in TB cases reported in correctional facilities in some geographic areas of the United States in recent years (Braithwaite et al.). Among inmates in the New York state correctional system, the incidence has been staggering. In fact, the incidence of TB among this population increased from 15.4 per 100,000 in 1976 and… READ MORE

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