Russian prisons to free 100,000 as TB stopgap
Russian prisons to free 100,000 as TB stopgap
Experts say plan will slow pace of TB in prisons
More than 100,000 inmates crowded into Russia’s TB-infested prisons are about to be released into the civilian population, according to terms of an amnesty recently approved by the Russian Duma.
The rationale for the release — besides decreasing the overcrowding that exacerbates TB transmission in the prison system — is to make room to isolate patients with TB and to make more food available for remaining prisoners, Russian prison and health authorities say.
Up to 200,000 more prisoners may receive amnesty if additional pending legislation is passed, says Russia’s Justice Minister Yury Chaika. The first release, which equals about 10% of the existing prison population, is due to start immediately and will be carried over the next six months.
Some TB experts say the move is a good plan, at least as a stopgap measure. "It will slow the pace of the epidemic inside the prisons without contributing to the spread of the disease outside prisons," says Alexander Goldfarb, PhD, associate director of the Public Health Research Institute in New York City.
Given the constant back-and-forth movement between the penal and civilian sectors — estimated at about 25% of the prison population per year — the amnesty probably won’t add to the spread of TB in the civilian population, says Vinciane Sizaire, MD, medical coordinator for Doctors Without Borders (DWB) in Moscow.
The prison system could initiate other measures that would help as much, or more, than an amnesty, adds Sizaire. Such changes could include reducing the rate of incarceration by imposing fines or setting bail instead of subjecting the accused to long stays in pre-trial detention.
More stress on public health system?
Other TB experts here say they worry the releases may stress the already overburdened community public health systems. That’s partly because it’s hard to predict when a release at a given prison will occur, making it possible that prisoners who, in the middle of treatment for TB, will have their therapy interrupted, says Michael Kimerling, MD, MPH, a medical consultant to DWB and an assistant professor of medicine and public health at the University of Alabama in Birmingham. "The release may just shift some of the burden of TB management to the community, which has very limited resources," he says.
For the long run, the real solution is to get the prison system and the public health system to collaborate better than they do now, say Sizaire and Kimerling. For example, the national TB dispensary should be collecting data for a given region from both the civilian and prison sectors, says Sizaire. In practice, the two systems function independently.
No common policy on TB control
Likewise, rules regulating the management of TB control vary between the Ministry of Justice and the Ministry of Health, says Sizaire. "There is no common national policy," she says. Rather, each system adheres to its own policies and methods of diagnosis, and each relies on its own supply of medications.
For example, in the Kemerovo region of Siberia, there is an excellent program of directly observed therapy-short course (DOTS) in place in the prison system, but it has yet to become active among the civilian sector, says Sizaire.
In a handful of places, officials are working toward integrative programs, says Kimerling. "It’s so hard and too early to know where these projects will end up," he notes. "The prognosis is poor, unless we get a coordinated, concerted effort between the civilian and prison sectors. They have to be linked, because the constant flow of people in and out of prison will continue."
DWB has DOTS programs under way in several institutions in the Kemerovo region of Siberia, including prisons, two TB hospitals, and three pre-detention centers. The organization also is developing a network of microscopy laboratories in other colonies to improve diagnosis and has undertaken a plan to train doctors, nurses, and lab technicians in TB diagnosis and treatment. DWB also continually surveys several other regions of Russia to evaluate the severity of multidrug-resistant TB.
The agency plans to begin a DOTS program at Colony 33, a referral prison for patients with multi-drug resistant TB — but not until a DOTS program also is operating in the region, says Sizaire.
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