Prevalence, risk factors and social context of active pulmonary tuberculosis among prison inmates in Tajikistan.

SETTING: Tuberculosis (TB) is highly prevalent in prisons of the former Soviet Union. OBJECTIVE: To understand the behavioral, demographic and biological factors placing inmates in Tajikistan at risk for active TB. DESIGN: We 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. RESULTS: We 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. CONCLUSION: In 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

Social context and nutrition.

<p>Frequency of supplemental nutrition is correlated with both A) number of visits from friends and family, and B) number of other inmates respondents felt they could rely on for help if necessary, representing social networks outside of and within the prison facilities.</p

Demographic characteristics of inmates and risk factors for active pulmonary TB.

<p>Demographic characteristics of inmates and risk factors for active TB in univariate and multivariate analysis. Prevalence ratios (PR) and 95% confidence intervals (95%CI) were weighted using random effects modeling. Adjusted prevalence ratios (aPR) and their respective 95% confidence intervals (95%CI) were derived from multivariate regression analysis. * p<0.05.</p

Social characteristics of inmates surveyed and prevalence of risk behaviors among respondents.

<p>IQR = interquartile range.</p

Prevalence of HIV (registered cases per 100,000 population) and WHO notification rates for TB (cases per 100,000 person-years) in the republic of Tajikistan from 1998–2008 [1][41].

<p>Prevalence of HIV (registered cases per 100,000 population) and WHO notification rates for TB (cases per 100,000 person-years) in the republic of Tajikistan from 1998–2008 <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0086046#pone.0086046-World1" target="_blank">[1]</a><a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0086046#pone.0086046-Republican1" target="_blank">[41]</a>.</p

Clinical and microbiological characteristics of prevalent TB cases.

<p>Radiographic findings were defined as any features determined to be suspicious for TB after reading of MMR films by two independent radiologists. In this table, presence of symptoms refers to report by respondents of having any of the following symptoms at the time of the survey: “cough,” “sputum with or without blood,” “weight loss in the last three months,” “loss of appetite,” “chest pain,” “night sweats,” “generalized weakness or fatigue,” “shortness of breath.”</p