Prevalence, Risk Factors and Social Context of Active Pulmonary Tuberculosis among Prison Inmates in Tajikistan

Daniel E Winetsky,Olga Almukhamedov,Baurzhan Zhussupov,Natalia Vezhnina,Dilshod Pulatov,Aizhan Dooronbekova,Igor Mokrousov

doi:10.1371/journal.pone.0086046

Daniel E Winetsky, Olga Almukhamedov + Show 5 more

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https://doi.org/10.1371/journal.pone.0086046

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Journal: PloS one	Publication Date: Jan 20, 2014
Citations: 75	License type: CC BY 4.0

Affiliation: University of Pennsylvania

Abstract

SettingTuberculosis (TB) is highly prevalent in prisons of the former Soviet Union.ObjectiveTo understand the behavioral, demographic and biological factors placing inmates in Tajikistan at risk for active TB.DesignWe administered a behavioral and demographic survey to 1317 inmates in two prison facilities in Sughd province, Tajikistan along with radiographic screening for pulmonary TB. Suspected cases were confirmed bacteriologically. Inmates undergoing TB treatment were also surveyed. In-depth interviews were conducted with former prisoners to elicit relevant social and behavioral characteristics.ResultsWe identified 59 cases of active pulmonary TB (prevalence 4.5%). Factors independently associated with increased prevalence of active TB were: HIV-infection by self-report (PR 7.88; 95%CI 3.40–18.28), history of previous TB (PR 10.21; 95%CI 6.27–16.63) and infrequent supplemental nutrition beyond scheduled meals (PR 3.00; 95%CI 1.67–5.62). Access to supplemental nutrition was associated with frequency of visits from friends and family and ability to rely on other inmates for help.ConclusionIn prison facilities of Tajikistan, HIV-infection, injection drug use and low access to supplemental nutrition were associated with prevalent cases of active pulmonary TB. Policies that reduce HIV transmission among injection drug users and improve the nutritional status of socially isolated inmates may alleviate the TB burden in Tajikistan’s prisons.

Highlights

Since the early 1990s, the incidence of active tuberculosis in the formerly Soviet Central Asian Republics has risen dramatically [1]
Factors independently associated with increased prevalence of active TB were: HIV-infection by self-report (PR 7.88; 95% confidence intervals (95%CI) 3.40–18.28), history of previous TB (PR 10.21; 95%CI 6.27–16.63) and infrequent supplemental nutrition beyond scheduled meals (PR 3.00; 95%CI 1.67–5.62)
We interviewed 14 former inmates, recruited from the members and clientele of a mutual assistance organization in Khudjand, Tajikistan (Sughd province), who had been released from prisons in Tajikistan within the prior 12 months

Summary

Introduction

Since the early 1990s, the incidence of active tuberculosis in the formerly Soviet Central Asian Republics has risen dramatically [1]. In the Republic of Tajikistan, where per capita GDP is among the lowest of any former Soviet republic [2], estimated TB incidence has more than doubled since 2000 (Figure 1). Because risk behaviors for HIV transmission are common among those subjected to incarceration, inmates may be susceptible to HIV/ TB co-infection [5]. The high mobility of inmates between the general population and the prison population makes correctional facilities an important social vector for disease transmission. In Eastern Europe and Central Asia, increased rates of incarceration are associated with civilian rates of multidrugresistant TB and have been implicated in increased TB incidence in the general population [4]

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