DRUG-RESISTANT TUBERCULOSIS IN PRISONS IN AZERBAIJAN - CASE-STUDY

Objectives: To document the existence of drug resistance in a tubercul osis treatment programme that adheres strictly to the DOTS principles (directly observed treatment, short course) and to determine the exten t of drug resistance in a prison setting in one of the republics of th e former Soviet Union. Design: Case study. Setting: Central Penitentia ry Hospital in Baku, the referral centre for tuberculosis patients fro m all prisons in Azerbaijan. Subjects: Prisoners with tuberculosis: 28 selected patients not responding clinically or bacteriologically to t he standard treatment (group 1) and 38 consecutive patients at admissi on to the programme (group 2). Main outcome measures: Drug resistance of Mycobacterium tuberculosis strains grown from sputum. Results: All the nan-responding patients (group 1) had strains resistant to at leas t 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 resistan t M tuberculosis strains are common in prisons in Azerbaijan. Tubercul osis problems tend to be worse in prisons, but prisoners and former pr isoners may have an important role in the transmission of tuberculosis , particularly of drug resistant forms, in the community. National pro grammes to control tuberculosis will have to take into account and add ress the problems in prisons to ensure their success.