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Tuberculosis, HIV seroprevalence and intravenous drug abuse in prisoners

¹ HPA National Mycobacterium Reference Unit, Dept of Microbiology and Infection, King's College London, London, ³ Epidemiology and Statistics Core, Wellcome Trust Clinical Research Facility, Edinburgh, UK. ² Samara TB Service, Samara Oblast Dispensary, ⁴ Samara Oblast Health Dept, ⁵ Samara City TB Service, ⁶ Samara Prison TB Service, Samara City, Russian Federation.

CORRESPONDENCE: F. A. Drobniewski, HPA MRU, Dept of Microbiology and Infection, King's College Hospital (Dulwich), East Dulwich Grove, London SE22 8QF, UK. Fax: 44 2073466477. E-mail: francis.drobniewski@kcl.ac.uk.

Keywords: HIV, intravenous drug users, prisons, Russia, tuberculosis

Received: November 29, 2004
Accepted February 28, 2005

High rates of tuberculosis (TB) and HIV are believed to exist in Russian prisons. Prisoners with TB were studied in order to identify the following: 1) prevalence of HIV, and risk factors for HIV and other blood-borne virus infections; and 2) clinical and social factors that might compromise TB treatment effectiveness and/or patient adherence and, hence, encourage treatment failure.

A 1-yr cross-sectional prevalence study of 1,345 prisoners with TB was conducted at an in-patient TB facility in Samara, Russian Federation.

HIV and hepatitis B and/or C co-infection occurred in 12.2% and 24.1% of prisoners, respectively, and rates were significantly higher than in civilians. Overall, 48.6% of prisoners used drugs, of which 88.3% were intravenous users. Prisoners were more likely to be intravenous drug users and HIV positive compared with civilians with TB, and 40.2% of prisoners shared needles. Two-thirds of prisoners (68.6%) had received previous TB drug therapy (frequently multiple, interrupted courses) and were significantly more likely than civilians to have had previous therapy consistent with the high drug-resistance rates seen.

Prisons are major drivers of the tuberculosis and HIV epidemics. Novel strategies are needed to reduce the spread of blood borne diseases, particularly in intravenous drug users.

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