Giuseppe
Emeritus
[Source: Chest, full page: (LINK). Abstract, edited.]
Original Research | August 08, 2013
Risk factors for and outcomes of detention of tuberculosis patients in New York City: an update 2002-2009
Seema Pursnani, MD, MPH; Sumeet Srivastava, MPH, MBA; Saleem Ali, MD; Eric Leibert, MD; Linda Rogers, MD
Author and Funding Information: New York University School of Medicine, New York, NY (Pursnani, Ali, Leibert, Rogers); Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Pursnani, Srivastava)
Correspondence To: Linda Rogers, MD, E-mail: Linda.rogers@nyumc.org
Chest. 2013. doi:10.1378/chest.13-0324. Published online .
Abstract
Background:
One of the most controversial aspects of NYC's highly effective tuberculosis (TB) control program is the use of public health law and court ordered detention to treat persistently recalcitrant patients with active TB. We now report on characteristics and outcomes of patients undergoing detention for completion of TB treatment due to non-adherence in NYC from 2002-2009.
Methods:
Retrospective cohort study design comparing patients undergoing court-ordered detention (n=79) and time-matched controls undergoing TB treatment in outpatient directly observed therapy (DOT) at Bellevue Hospital in NYC.
Results:
Between 2002-2009, 79 patients underwent court ordered detention for TB treatment. Compared to patients completing treatment in DOT, univariate analysis found that detainees were younger, more likely to be of minority race-ethnicity, and to have a history of substance abuse, tobacco use, homelessness, incarceration, HIV infection, and to be U.S. born. Multivariate analysis adjusting for other variables found smear positivity (OR=3.93, 95% CI 1.05-14.75, p=0.04), mental illness (OR=5.80, 95% CI 1.18-28.51, p=.03), and substance abuse (OR=9.25, 95% CI 2.81-30.39, p< 0.01) to be the strongest independent predictors of likelihood of detention. Of those initially detained, 46 (58%) completed treatment during inpatient detention, 29(37%) completed treatment under outpatient court-ordered DOT (CoDOT), and 4 died during their hospitalization.
Conclusions:
The majority of patients undergoing court ordered detention for TB treatment successfully completed therapy (95%). Likelihood of detention was most strongly associated with factors expected to be associated with poor adherence including mental illness and substance abuse.
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Original Research | August 08, 2013
Risk factors for and outcomes of detention of tuberculosis patients in New York City: an update 2002-2009
Seema Pursnani, MD, MPH; Sumeet Srivastava, MPH, MBA; Saleem Ali, MD; Eric Leibert, MD; Linda Rogers, MD
Author and Funding Information: New York University School of Medicine, New York, NY (Pursnani, Ali, Leibert, Rogers); Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Pursnani, Srivastava)
Correspondence To: Linda Rogers, MD, E-mail: Linda.rogers@nyumc.org
Chest. 2013. doi:10.1378/chest.13-0324. Published online .
Abstract
Background:
One of the most controversial aspects of NYC's highly effective tuberculosis (TB) control program is the use of public health law and court ordered detention to treat persistently recalcitrant patients with active TB. We now report on characteristics and outcomes of patients undergoing detention for completion of TB treatment due to non-adherence in NYC from 2002-2009.
Methods:
Retrospective cohort study design comparing patients undergoing court-ordered detention (n=79) and time-matched controls undergoing TB treatment in outpatient directly observed therapy (DOT) at Bellevue Hospital in NYC.
Results:
Between 2002-2009, 79 patients underwent court ordered detention for TB treatment. Compared to patients completing treatment in DOT, univariate analysis found that detainees were younger, more likely to be of minority race-ethnicity, and to have a history of substance abuse, tobacco use, homelessness, incarceration, HIV infection, and to be U.S. born. Multivariate analysis adjusting for other variables found smear positivity (OR=3.93, 95% CI 1.05-14.75, p=0.04), mental illness (OR=5.80, 95% CI 1.18-28.51, p=.03), and substance abuse (OR=9.25, 95% CI 2.81-30.39, p< 0.01) to be the strongest independent predictors of likelihood of detention. Of those initially detained, 46 (58%) completed treatment during inpatient detention, 29(37%) completed treatment under outpatient court-ordered DOT (CoDOT), and 4 died during their hospitalization.
Conclusions:
The majority of patients undergoing court ordered detention for TB treatment successfully completed therapy (95%). Likelihood of detention was most strongly associated with factors expected to be associated with poor adherence including mental illness and substance abuse.
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