Southern Caucasus: Combating tuberculosis in prisons - a challenge for the 21st century

Geneva (ICRC) - Prisoners are more prone to communicable diseases than the general population, mostly because of poor living conditions and limited access to health care. Many governments today are confronted with tuberculosis (TB) in prisons and a growing number of humanitarian agencies are helping the authorities tackle this major public health problem. The countries of the Commonwealth of Independent States in particular are finding it difficult to bring TB under control, especially in prisons, where the disease – often appearing in extremely drug-resistant strains – has taken on epidemic proportions.

In Georgia, the ICRC is supporting the government's national TB programme, which is implementing comprehensive control measures in prisons. These include following the World Health Organization's strategy known as DOTS ( " Directly Observed Treatment, Short course " , which requires medical staff to ensure the daily intake of medicines by each patient for the full course of treatment), screening the prison population to detect those infected with TB as early as possible, and organizing health education for the prisoners. Measures to reduce the spread of TB by improving living conditions have also been introduced.

The programme in Georgia has made significant progress over the past year thanks to improved treatment and screening of prisoners. Systematic screening added to the DOTS approach has clearly helped to reduce the number of established TB cases and curb the spread of multi-drug-resistant strains.

A total of 800 patients have been treated since the current programme was launched in 1998. The cure rate is now close to 75%. High levels of drug r esistance meant poor results in the initial groups of patients, which included many chronic cases. But the spread of the disease among inmates is expected to decrease further with careful screening and strict adherence to the course of medicines prescribed by the DOTS programme.

In Armenia, negotiations with the government are under way to launch a similar TB-control programme in prisons, in conjunction with the Ministry of Internal Affairs and the Ministry of Health. This programme is expected to start in the second half of 2000.

In Azerbaijan, a total of 1,800 prisoners have been treated for TB by the ICRC, but with a cure rate of only 55% the results remain unsatisfactory. In the absence of systematic screening of the prison population, patients often start treatment when they are already seriously ill. To make matters worse, random or incomplete treatment remains a prime factor in the spread of drug-resistant strains. Poor coordination between ministries and failure on the part of the Ministry of Health to accept the DOTS strategy and other international recommendations for TB diagnosis and treatment have obliged the ICRC to put its participation in the project on hold. Resumption on the basis of recognized international standards is presently under discussion.

The ICRC's experience shows that it is possible to control TB in prisons by ensuring early diagnosis and prompt treatment, providing health education and better living conditions, and securing a firm commitment on the part of the authorities to acknowledging TB as a public health priority.  If interministerial cooperation is lacking, TB control in prisons is doomed to fail. Places of detention are never closed communities, and governments should be aware that the impact of effective TB programmes for prisoners will inevitably be felt well beyond the prison walls.