Pulmonary tuberculosis in pre-trial detentions in St.Petersburg, Russia

Abstract: During the last 15 years situation with Tuberculosis (TB) in prison system in Russia has been worsened as well as in the whole country. High TB rates in prison system reflect not only bad conditions there, but also the economical situation in the country and the health of whole population. In the beginning of 21 st century, the prisons became a mirror of political, socio-economical, and demographical changes in Russia. There is a wide gap between people living in cities and suburbs in income, level of education, and social status. Alcohol and narcotic drugs increase the number of unemployed and homeless people and raise the number of teenagers and adolescents living outside parental control. This, in turn, promotes the growth of crime in the country. According to the WHO, a tuberculosis case is defined as a patient with bacteriologically confirmed tuberculosis or clinically diagnosed with TB. In the prison system in St. Petersburg the first and quick method for early TB diagnosis is the chest x-ray. It is an obligatory procedure for all newly arrived people. The diagnosis of TB could then be confirmed by smear sputum examinations. Treatment for tuberculosis is also mandatory in prison system, using 3-4 anti-tuberculosis drugs and regular follow-up by chest x-ray control. Our studies in St.Petersburg were undertaken to analyse the epidemiology of tuberculosis in remand prisons from 2000 and to estimate risk factors which contribute to TB development during incarceration. Knowledge of the risk factors for TB development helps identify people at risk and guides prevention. Analysis of epidemiological situation in remand prisons can create prophylactic measure or could be premise for new order for TB control in country. Risk of getting TB is increasing during the first 2 years of being in remand prison (SIZO). Therefore, if according to new Federal order (2002), prisoners will be held in remand prison for no more than 6 months, the number of new TB cases will be essentially minimized. This will in turn reduce the impact of non-clinical TB infection and its transmission among prisoners. On one hand, the prisoners, who left SIZO, may contract disease (TB) later, in colony; hence the total number of people who has developed TB in Prison system will remain the same. On the other hand, since conditions of detentions in colony are essentially better one may expect the decrease of total number of people developed TB during the incarceration