When institutional transitions interrupt prevention: 3HP tuberculosis preventive treatment continuity in a Paraguayan...

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Implementation Science

Background:

• Tuberculosis preventive treatment (TPT) is crucial for incarcerated populations.
• Challenges exist in completing TPT within correctional facilities due to patient movement.

Purpose of the Study:

• To assess the adherence, completion, safety, and influencing factors of once-weekly isoniazid plus rifapentine for 12 weeks (3HP) TPT in a Paraguayan prison.
• To identify institutional transitions as drivers of non-completion.

Main Methods:

• A longitudinal implementation cohort study was conducted at Coronel Oviedo Penitentiary Center, Paraguay.
• Participants with latent tuberculosis infection received directly observed 3HP therapy, with weekly monitoring of adherence, missed doses, and adverse reactions.

Main Results:

• Of 170 individuals with latent tuberculosis infection, 120 initiated 3HP. Acceptable adherence (≥11/12 doses) was achieved by 75.0% (90/120), and 68.3% (82/120) completed all 12 doses.
• Medication administration success was 83.0% (1,195/1,440 scheduled person-weeks). Non-completion (n=30) was primarily due to release or transfer (93.3%).
• Adverse reactions were reported by 47.5% (57/120) of participants, mostly mild to moderate.

Conclusions:

• Once-weekly 3HP demonstrated high adherence in this prison cohort.
• Institutional transitions (release/transfer) significantly interrupted treatment completion.
• Continuity mechanisms are needed to ensure successful TPT completion after incarceration.