Page 22 - Delaware Medical Journal - May 2016
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LATENT TUBERCULOSIS INFECTION (LTBI)
Annual TB skin testing for tuberculosis is performed on all offenders, staff members, and volunteers who frequently visit and work with the offenders. On average the intake screening and annual skin testing of offenders identify 45 offenders per month who have a positive skin test upon entry or have converted a previous negative skin test, with the majority of cases occurring in the Sussex County facilities. Each offender with a newly positive skin test has a chest x-ray performed and a decision
to initiate treatment is made based upon the CDC treatment recommendations.3 On average the department has 16 offenders being treated for LTBI in any one month. The difference between the number of offenders with new positive skin tests and the number of the incarcerated population have advanced liver disease and a number of offenders are released on bail after
their skin test has been read and treatment is no longer possible. Offenders being released are referred to the Division of Public Health for follow-up of their LTBI. Those offenders with liver disease and co-infections are treated in accordance with CDC recommendations.3
HEPATITIS
Hepatitis is a relatively common occurrence in the prison population and in Delaware the incidence is on average 564 alcoholic hepatitis, A, B, and C, as the department has only recently began to differentiate these types in its reporting process. In keeping with the CDC’s Opt-Out policy for infectious disease
testing4 the Department offers testing and treatment to offenders during their initial physical assessments, preventive medicine visits or whenever an offender requests a Sick Call visit for
the purpose of testing for Hepatitis infections. In addition, the Department offers Hepatitis A and B vaccines to every offender who is interested in becoming vaccinated.
Hepatitis B treatment is available and in 2014 two offenders were treated. None were treated in 2015.
Hepatitis C treatment has been available using the previous interferon-based treatment protocols5 and since the availability of the newer non-interferon protocols the Department has made these treatments available based upon the judgment of the infectious disease consultant. The inclusion criteria to recommend treatment is based upon having enough incarceration time to complete treatment, the degree of liver decompensation, and a consideration toward the risk of re-infection upon release.6 The Department has made the newer antivirals available to 27 offenders with the 12 10 months of 2015. The infectious disease consultant also monitors the success of the treatment with post-treatment viral load studies and thus far there has only been one treatment failure and he is being re-treated through an extended treatment protocol.
HUMAN IMMUNODEFICIENCY VIRUS
common diagnosis among the offender population. As noted above, the Department follows the CDC recommendation for Opt-Out testing for HIV4 disease and offenders are offered testing during their preventive medicine visits and through requesting
a Sick Call visit for testing. As HIV disease currently requires continual treatment every offender being released is referred to a community HIV clinic, every effort is made to enroll the offender in Medicaid prior to release, and the prisoner is given a 30-day supply of anti-viral medications upon release to allow time for
the offender to contact the community HIV clinic and obtain a follow-up appointment.
On average in 2014 and 2015, the Department treated 82 offenders with HIV disease per month costing $2.6 million per year or $2,660 per offender per month.
SEXUALLY TRANSMITTED DISEASES
Other sexually transmitted diseases are also common in the prison population and offenders are offered testing and treatment
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Del Med J | May 2016 | Vol. 88 | No. 5
