Decentralization of the DOTS programme within a Russian penitentiary system. How to ensure the continuity of tuberculosis treatment in pre-trial detention centres.
BACKGROUND
In Kemerovo region (Siberia), three pre-trial detention centres (SIZO; Ministry of Justice) serve as the gateway to the penitentiary system, comprised of 23 prisons and 30,000 detainees. The follow-up for tuberculosis (TB) patients released into civil society is unreliable. Due to varying detention times and frequent transfers to temporary detention centres (IVS; Ministry of Internal Affairs) for investigation and trial, and concerns about continuity of treatment, SIZOs were not included in the revised TB control programme initiated during 1996.


METHODS
To investigate the feasibility of DOTS (Directly Observed Therapy, Short-Course) expansion into SIZOs, general detainee release was studied by examining 10% of files from detainees admitted during 1998 (SIZOs 1,2,3). Then, 5% of general files from SIZO 1 were examined to determine SIZO-IVS flow; 224 TB patient files from SIZO 3 were evaluated to determine the pattern of release/transfer.


RESULTS
TB patients in SIZO 3 have less chance of release before six months of detention than non-TB detainees (14/224, 6.3% versus 774/2276, 34%; p < 0.001). Among detainees not released, 60% are not moved during the first six months of detention. For those who move, the mean stay in IVS was 9.5 (+/- 6) days. The incidence of active disease detected upon entry to SIZO 3 was 4,560/100,000, the subsequent rate during the same year of detention 880/100,000.


CONCLUSIONS
Despite frequent detainee movements between institutions, DOTS should be introduced into the earliest stages of detention to prevent case mismanagement, and links to the civilian programme should be developed.
Slavuckij
Andrei
A
Department of Epidemiology and International Health, School of Public Health, University of Alabama at Birmingham, USA.
Sizaire
Vinciane
V
Lobera
Laura
L
Matthys
Francine
F
Kimerling
Michael E
ME
D000995:Antitubercular Agents / Q000008:administration & dosage*; D003140:Communicable Disease Control / Q000379:methods*; D016001:Confidence Intervals; D004334:Drug Administration Schedule; D006801:Humans; D016017:Odds Ratio; D011330:Prisons / Q000706:statistics & numerical data*; D012800:Siberia / Q000453:epidemiology; D012926:Social Control, Formal; D014376:Tuberculosis / Q000188:drug therapy* / Q000453:epidemiology
D000995:Antitubercular Agents