Drug resistant tuberculosis in prisons in Azerbaijan: case study.
OBJECTIVE
To document the existence of drug resistance in a tuberculosis treatment programme that adheres strictly to the DOTS principles (directly observed treatment, short course) and to determine the extent of drug resistance in a prison setting in one of the republics of the former Soviet Union.


METHODS
Case study.


METHODS
Central Penitentiary Hospital in Baku, the referral centre for tuberculosis patients from all prisons in Azerbaijan.


METHODS
Prisoners with tuberculosis: 28 selected patients not responding clinically or bacteriologically to the standard treatment (group 1) and 38 consecutive patients at admission to the programme (group 2).


METHODS
Drug resistance of Mycobacterium tuberculosis strains grown from sputum.


RESULTS
All the non-responding patients (group 1) had strains resistant to at least one drug. 25 (89%) of the non-responding patients and nine (24%) of the consecutive patients had M tuberculosis strains resistant to both rifampicin and isoniazid. A further 17 patients in group 2 had strains resistant to one or more first line drugs.


CONCLUSIONS
Drug resistant M tuberculosis strains are common in prisons in Azerbaijan. Tuberculosis problems tend to be worse in prisons, but prisoners and former prisoners may have an important role in the transmission of tuberculosis, particularly of drug resistant forms, in the community. National programmes to control tuberculosis will have to take into account and address the problems in prisons to ensure their success.
Coninx
R
R
International Committee of the Red Cross, CH-1202 Geneva, Switzerland. rconinx@icrc.org
Pfyffer
G E
GE
Mathieu
C
C
Savina
D
D
Debacker
M
M
Jafarov
F
F
Jabrailov
I
I
Ismailov
A
A
Mirzoev
F
F
de Haller
R
R
Portaels
F
F
D000904:Antibiotics, Antitubercular / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use*; D001382:Azerbaijan / Q000453:epidemiology; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D011329:Prisoners; D011718:Pyrazinamide / Q000627:therapeutic use; D012293:Rifampin / Q000627:therapeutic use; D013183:Sputum / Q000382:microbiology; D013307:Streptomycin / Q000627:therapeutic use; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology*
D000904:Antibiotics, Antitubercular; D000995:Antitubercular Agents; D011718:Pyrazinamide; D007538:Isoniazid; D012293:Rifampin; D013307:Streptomycin