PIH program breaking deadly strain of TB transmission in Kazakh prisons
Posted on Dec 20, 2011
In Kazakhstan, roughly one in seven inmates living in the state’s prison system is infected with tuberculosis (TB). For years, the rampant spread of TB has put prisoners at risk of debilitating infection, with many dying from a preventable and treatable disease. At the Kazakh government’s request, PIH is working to curb that trend. Earlier this year, PIH began offering technical and medical assistance to each of the Central Asian country’s estimated 5,000 prisoners living with TB.
A prisoner living with TB is examined by his doctor.
“This is a miniature reform of the country’s penal system,” said Dr. Askar Yedilbayev,
Program Director for PIH-Kazakhstan (PIH-KZ). From training prison personnel in better techniques for treating the disease, to advocating for changing outdated laws, PIH’s project aims to prevent infection and death in the six prisons housing TB patients.
With nearly 15 percent of the prison population living with this highly contagious and potentially fatal disease, the need for an intervention could not be greater. TB spreads between people in enclosed spaces with incredible ease. A condition that primarily affects the lungs, the bacteria that cause TB move into the air when an infected person coughs or sneezes. Kazakh’s outdated prisons are ideal conditions for new TB infections.
As if these numbers were not bad enough, roughly 20 percent of the 5,000 prisoners living with TB have developed the more debilitating multidrug-resistant TB (MDR-TB) – a dangerous strain of the disease resistant to treatment. And of those patients, an unknown number are living with extremely drug-resistant TB (XDR-TB).
Chest x-rays from prisoners infected with TB dry in a room near the prison's lab.
A system needing reform
Just north of Kazakhstan in neighboring Siberia, PIH has been working to combat TB in Russia since 1998. Within a few years, PIH-Russia was seeing treatment adherence and reinfection rates significantly below international averages. Impressed by these accomplishments, Kazakh health officials invited PIH-Russia to help overhaul its own prison facilities. In late 2010, PIH-KZ was created, and began formulating a plan based on the Russian model.
In Kazakhstan, PIH found a Soviet-era prison system unequipped to fully meet the needs of patients infected with TB and MDR-TB. Fewer than half of infected prisoners were being effectively treated. Consequently, strains of TB became dangerously resistant to more and more drugs, and prisoners continued to spread the bacteria through the wards. Prison staff simply lacked the knowledge, resources, and motivation to treat the disease.
The PIH-KZ team quickly began implementing its plan.“We visit patients at each prison, we look at treatment files, go through regimens, check everything – we fix prescriptions and create consistency,” said Dr. Yedilbayev.
A patient living with TB receives medication from a trained nurse.
A simple solution: isolate infectious prisoners
After realizing the extent of the problem, PIH-KZ devised a plan. They recommended that each prison be divided into three wards, separated by levels of contagion – red for highly infectious patients, yellow for those on treatment and green for prisoners free of the disease. These stringent infection control measures curb re-infection rates by separating the sickest patients from prisoners free of the disease.
According to World Health Organization standards, all prisoners undergo careful bacteriological monitoring – receiving smears and sputum cultures. These tests detect new infections as well as monitor the treatment progress of infected patients. When prisoners fall ill, or if those in treatment respond well to their therapy, the patient is transferred to a demarcated zone.
Breaking the chain of transmission
“In addition to separation, effective treatment is one of the most important tools to break the chain of transmission,” said Dr. Yedilbayev.
Prisons with TB wards are broken into wards, a necessary step to controlling the spread of the airborne disease.
While PIH-KZ does not provide medicine directly to the prisoners, its nine clinicians and support staff are advising the government and prison officials on how to treat this vulnerable patient population. In addition, PIH-KZ is training prison staff to diagnosis TB and MDR-TB as early as possible.
“We believe in early identification of drug-resistance and timely start of treatment with aggressive and effective regimens under direct observation,” said Dr. Yedilbayev. While PIH-KZ does not provide medicine directly to patients, its 9 clinicians and support staff are advising the government and prison officials on how to separate and treat this vulnerable patient population.
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Learn more about PIH-Kazakhstan.
