Prisons have to be at the centre of national TB control programmes, as they are a breeding ground for tuberculosis, and particularly for drug-resistant forms of the disease, according to the International Committee of the Red Cross (ICRC).

“It is alarming to see that multi-drug-resistant TB, and recently even the more severe extensive drug-resistant strain, have both been spreading inside and outside prison walls in the countries where we work,” says Dr Hernán Reyes of the ICRC in Geneva. Countries in Central Asia are among those with the highest TB infection rates in the world. “In Kyrgyzstan, every third new TB patient found in prisons is infected with a multi-drug-resistant form,” underlines Dr Maxim Berdnikov, who heads the ICRC programme helping the Kyrgyz authorities to combat TB in prisons.

Prisons are particularly effective breeding-grounds for tuberculosis. Overcrowding, poor hygiene, insufficient ventilation, inadequate health care, and malnutrition all help to spread the bacteria. "We need to stress that catching tuberculosis is not part of a prisoner's sentence! In some countries, catching a resistant form of TB can be equivalent to a death sentence," says Dr Reyes. When people enter, leave and re-enter detention facilities, they unwittingly spread the bacillus to the wider community, making it even more urgent to control TB in detention systems.

The ICRC has been fighting TB in the prisons of the Caucasus, Central Asia, Latin America and Africa for a decade, either directly or by supporting local programmes. In Central Asia, Kyrgyzstan is the first country to have started a programme to combat multi-drug-resistant TB in prisons. “The Kyrgyz authorities have understood the seriousness of the situation, and other affected countries should now follow their example of how to tackle this health threat,” stresses Dr Berdnikov. The ICRC is also working with the Azerbaijani authorities on a pilot project to combat multi-drug-resistant TB in that country’s prisons.

“We cannot afford to drop our guard in the fight against TB,” adds Dr Reyes. “It is of vital importance that all organizations involved in anti-TB programmes work hand in hand". The World Health Organization and the ICRC are currently reviewing their joint guidelines for the control of tuberculosis in prisons, first published in 1998. The ICRC has also contributed to a new interactive self-study course on the Internet, developed by the World Medical Association, which offers practitioners all over the world the opportunity to upgrade their knowledge on controlling multi-drug-resistant TB.