Date of Degree


Document Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)




Holly A. DiLeo


Sue Doty


Purpose: The purpose of this Doctor of Nursing Practice project was to update an existing tuberculosis policy for screening HIV-positive individuals entering a south Texas jail to meet current evidence-based guidelines and increase the adherence of jail staff to the updated screening process.

Background and Significance: In 2015, over 700,000 people were jailed in the United States with over 20,000 being HIV-positive. Tuberculosis is highly contagious and spreads through the air. HIV is a virus that targets the immune system. HIV-positive people are 17-22 times more likely to contract tuberculosis. The current screening process at the jail showed a low adherence among staff for placing a purified protein derivative and performing a chest x-ray in the HIV population.

Method: A retrospective chart review of pre-intervention and post-intervention HIV-positive inmate charts was conducted. The implementation of an updated tuberculosis policy and staff education provided a new TB screening process. The addition of a clinical reminder sticker affixed to the computer monitors in the screening area was a component of the intervention.

Results: Results showed an increase in purified protein placement, chest x-rays and documentation post intervention with a significant correlation.

Conclusion: Policy revision and the use of a clinical reminder sticker can increase staff adherence to process change. Evidence supports that chest x-ray is a valuable adjunct when used with purified protein derivative to screen HIV-positive inmates for tuberculosis in a correctional facility. Strengthening the tuberculosis screening process to include both purified protein derivative and chest x-ray protects other inmates and the community. Jails are expected to provide care consistent with community standards and evidence-based practice.