Isoniazid preventive therapy in correctional facilities: a systematic review

Area of Science:

• Public Health
• Infectious Diseases
• Epidemiology

Background:

• Tuberculosis (TB) is a leading cause of death in correctional facilities, particularly in low- and middle-income countries.
• The unique environment of correctional facilities necessitates effective TB control measures.
• Isoniazid preventive therapy (IPT) is a proven, cost-effective strategy for TB control.

Purpose of the Study:

• To systematically review interventions assessing IPT initiation and completion in correctional settings.
• To identify challenges and outcomes associated with implementing IPT in jails and prisons.
• To evaluate the effectiveness and adverse effects of IPT in incarcerated populations.

Main Methods:

• Systematic review of published studies from two biomedical databases.
• Inclusion of additional relevant references, totaling 18 eligible studies.
• Analysis focused on studies reporting IPT initiation, completion, and adverse events.

Main Results:

• Most studies were from the US (72%) and focused on jails (60%), aiming to improve IPT completion.
• Initiation and completion rates for IPT in correctional facilities were generally poor.
• Adverse events, including hepatotoxicity, occurred in 1-55% of cases (median 5%); HIV status was often missing.

Conclusions:

• IPT implementation in correctional facilities faces significant challenges, leading to low success rates.
• Adverse effects and treatment interruptions are notable concerns.
• Further research is needed, especially in low- and middle-income countries and co-endemic TB/HIV settings, to optimize IPT effectiveness.