Drug resistant tuberculosis in prisons in Azerbaijan: case study

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Abstract
Objectives: 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. Design: Case study. Setting: Central Penitentiary Hospital in Baku, the referral centre for tuberculosis patients from all prisons in Azerbaijan. Subjects: 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). Main outcome measures: 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. Tuberculosis is an important problem in prisons in Azerbaijan Multidrug resistant tuberculosis was common and an important cause of non-response to standard treatment National tuberculosis control programmes must include prisons and take account of drug resistance Unless WHO recommended treatment protocols are followed the problem of multidrug resistant tuberculosis may result in untreatable tuberculosis which will spread to the general community