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Azerbaijan: fighting drug-resistant tuberculosis in prisons pays off
URL: http://www.icrc.org/web/eng/siteeng0.nsf/html/azerbaijan-feature-210310
International Committee of the Red Cross 22-03-2010  Feature  

In Azerbaijan, tuberculosis remains a serious threat to public health. The situation is made much worse by a drug-resistant form of the disease. The ICRC is working with the Azerbaijani government and other organizations to address the problem.
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Teymur is 32 and the first ex-detainee to have successfully completed a new follow-up programme for released prisoners run by Azerbaijani officials and supported by the ICRC.
©ICRC / Zalmaï /V-P-AZ-E-00376

Teymur Huseynov, 32, learned that he had tuberculosis when he was in prison in 2000. What he thought was a simple fever got gradually worse. "I was coughing day and night and couldn’t sleep. I lost 20 kilos in six months. But it was only when I started coughing up blood that I sought medical help."

Teymur received treatment and was later discharged. But his symptoms returned in 2005. Still in jail, he was sent to the prison tuberculosis (TB) hospital, the Specialized Treatment Institution, for screening and treatment. Test results revealed that he had tuberculosis.

Joining forces to fight tuberculosis


In Azerbaijan, where tuberculosis continues to pose a serious threat to public health, a drug-resistant form of the disease (MDR-TB) has been identified as a major health problem. The government, supported by the ICRC and other organizations, has taken steps to curb the spread of MDR-TB in the country.


Since 1995 the Azerbaijani prison authorities, assisted by the ICRC, have been carrying out an anti-TB programme in prisons. The programme is based on the Directly Observed Treatment Short Course (DOTS) strategy recommended by the World Health Organization (WHO).


In 2004 the ICRC helped the authorities to submit, to the Global Fund to fight TB, AIDS and Malaria, an application to launch in Azerbaijani prisons a pilot project based on the WHO strategy called "DOTS-Plus". The application was approved. The ICRC provides technical assistance for the implementation of the programme, whose goal is to treat detainees with MDR-TB, a specific form of TB caused by a bacillus resistant to at least two of the most powerful anti-TB drugs.


"Entirely man-made, drug-resistant strains of TB represent a significant threat to the management of the disease. DOTS is the most effective strategy in preventing the development of MDR-TB," says Nickoloz Sadradze, head of ICRC's programme of support to the anti-TB strategy in the prisons.

©ICRC / Zalmaï /V-P-AZ-E-00377
"It was very difficult to be sick in prison,” says Teymur. "I had no family around and every day I thought I was going to die, but then I started treatment. The medication made me quite sick but the doctors convinced me to stick with it and I’m glad I did because now I’m cured.”
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"It was very difficult to be sick in prison,” says Teymur. "I had no family around and every day I thought I was going to die, but then I started treatment. The medication made me quite sick but the doctors convinced me to stick with it and I’m glad I did because now I’m cured.”
©ICRC / Zalmaï /V-P-AZ-E-00377

He adds, "Prisons are not entirely cut off from the civilian population, and when detainees go back and forth between prisons and the outside world they bring all their infectious diseases with them, including TB strains. As such it is vital to include prisoners in efforts to control the spread of MDR-TB”

Thanks to the anti-TB programme, today all prisoners in Azerbaijan have access to high quality modern diagnosis and TB treatment, free-of-charge. As of December, 2009, the DOTS strategy had been used as a basis for over 10,000 TB-treatments administered to detainees infected with tuberculosis.


Teymur’s story


A beneficiary of the anti-TB programme, Teymur was put on the DOTS treatment in August 2005 for a nine-month period. Every morning he would go to the nurses' room and take his pills in front of his nurse. However, six to seven months later, his health no showed improvement. After nine months of treatment, he was still infected with the TB bacilli and his health was worsening by the day.


"I was coughing constantly. I lost weight drastically and was too weak to walk. I had to stop every two steps to take a breath. I was told that my treatment had not helped and I became worse," – Teymur recalls.


He was tested for drug sensitivity. The results showed that he was resistant to four out of five anti-TB drugs. He had contracted a multi-drug-resistant form of the disease.


His doctor stopped the treatment because first-line drugs for TB were ineffective in treating him. He needed second-line drugs to treat MDR-TB. He was put in a special ward for TB-resistant patients, to await the launch of the DOTS-Plus programme in prisons.


"In 2007, my health was really very bad. My life was slipping away. But I heard about a new treatment programme and pinned my hopes for recovery on it," Teymur says.

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Wardens check on the prisoners who are serving life sentences and suffering from TB. Each detainee is allowed to spend two hours per day outside their cell in a cage-like courtyard.
©ICRC / Zalmaï /V-P-AZ-E-00312

A glimmer of hope

In April 2007, Azerbaijan's Ministry of Justice, with the technical support of the ICRC, started implementing the pilot DOTS-Plus programme for the treatment of patients suffering from drug-resistant tuberculosis. So far, over 220 patients have enrolled in the MDR-TB project.


An MDR-TB treatment takes at least two years and this could have jeopardized Teymur's chances of joining the programme as he had less than two years to go in his prison term.. Doctors agreed to enrol him for the treatment only after he promised to continue with it after his release. He just told them, "I want to live."


Teymur was put on a course of treatment with second line anti-TB drugs. "From the first week of treatment I felt an improvement. I had no more symptoms of TB, no coughing. I became cheerful and felt a surge of energy. I was even able to run, whereas in the past I could hardly walk," he recalls.


After one month and a half though, he felt pains in his arms, shoulders and joints. It was a reaction to the strong drugs. He continued with his treatment.


In March 2009, Teymur was pardoned by the country’s president, but he had not yet completed his treatment.


Released but not abandoned


In order to address all aspects of the MDR-TB problem, the ministries of justice and health and the ICRC signed a memorandum of understanding in March 2007 to provide MDR-TB patients released from prison with the necessary treatment in civilian anti-TB dispensaries. As soon as a person is released, the justice ministry delivers the necessary quantity of medicines to the health ministry to ensure he continues with his treatment.


The ICRC covers transport expenses of patients, released from prison, and provides them with a food ration and hygiene every month. At the same time, the ICRC provides financial incentives to the doctors in charge of the patients and even rewards the patients for a successful completion of the treatment.

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Thanks to support from the ICRC over the past 15 years, the diagnostics capacity of the prison lab in Baku has increased dramatically, helping to save lives.
©ICRC / Zalmaï /V-P-AZ-E-00326

Representatives of the national TB programme and the ICRC jointly visit the patients every month to monitor their recovery.
As of December 2009, 15 MDR-TB patients who had been released from prison were continuing with their treatment in civilian TB dispensaries.

Living proof


An ambulance brought Teymur Huseynov from the Specialized Treatment Institution to the TB dispensary in his native city, Sumgait. Here the National TB programme and the ICRC followed up his treatment. Every day Teymur visited the civilian TB dispensary to take pills and after four months he was eventually cured of TB.


Today, Teymur is more optimistic. "I was very happy when I finally tested negative for tuberculosis. Today the days of persistent coughing are well and truly behind me. I am living proof that TB patients who respect their treatment regimes and are careful about what they eat can be cured. It is tough but necessary for those who want to stay alive."

Copyright © 2010  International Committee of the Red Cross 22-03-2010
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