Tuberculosis, or TB, as it’s commonly known, is a curable
disease and yet it continues to spread across the globe. The vast majority of TB
deaths are in the developing world but the airborne illness is also making a
comeback in Europe and North America. The former Soviet Union is currently
seeing some of the highest numbers of multi-drug resistant TB cases ever
recorded. The ICRC’s Nikoloz Sadradze has followed the situation in Georgia for
many years and is now working with the authorities in Azerbaijan to stem the
spread of TB in prisons. He warns that efforts must be stepped up to stop this
Nikoloz Sadradze, ICRC medical delegate
in Baku, Azerbaijan.
general, why is TB spreading at such an alarming rate?
TB is an airborne disease. It spreads comparatively more easily than other
infectious illnesses. You only need to inhale a small amount of bacilli to
become infected. A lot of people may be shocked to realize that more than two
billion people, or around one in three on the planet, carry the microbes that
Luckily, only around one in 10 of those who have the bacilli
will actually become sick in their lifetime. The microbes can lie dormant for
weeks, years or even decades, waiting for the day when a person’s immune system
is down, for instance if they have to have chemotherapy or if they get the human
immunodeficiency virus or diabetes. Then, TB can suddenly flare up and become
life threatening as well as contagious.
If left untreated, each person
with active TB will infect 10 to 15 other people per year, on average.
We hear about different types of TB, such as multi-drug resistant or
extensively-drug resistant kinds. What’s the difference?
speaking, TB is a curable disease if people get the right medicine at the right
time and stay on it. But it can be incurable as well. This is the case with
extensively-drug resistant TB, or XDR-TB. There are some types of mycobacterium
that can’t be killed by antibiotics because they become resistant.
of people think you can’t catch drug-resistant TB right away. There’s a common
misconception that only people who stop taking their treatment wind up with
multi-drug resistant TB, known as MD-RTB, or XDR-TB. In fact, you can catch
either strain directly and then you wind up with the kind of TB that is very
difficult to treat and cure. It’s not a question of being a bad patient or
getting a bad prescription... it’s a question of bad luck.
Unfortunately, the number of drug resistant cases is on the rise in more
and more places around the world, from Baku to Beijing and from Lima to London.
According to the World Health Organization (WHO), as of last September, 57
countries had reported at least one XDR-TB case.
The Stop TB
Partnership’s slogan for World TB Day this year is "On the Move Against TB –
Innovate to Accelerate Action”. What gear would you say the international
community is currently in when it comes to tackling this disease?
think we’re currently in third gear and we definitely need to step on the gas.
We need to do more and move faster to put this disease higher on everybody’s
agenda in order to stop it from spreading further. It should be a public health
priority in all countries, not just poor ones.
Illnesses like H1N1,
Alzheimer's or heart disease often make the headlines but we don’t see that much
about TB. It’s quietly stalking millions of people around the globe, yet there’s
no real sense of alarm. Why is that and what challenges do health professionals
face in dealing with it?
It’s a combination of a lot of things.
First, there’s a lack of awareness among the public and often, among
decision-makers. It’s also an incredibly difficult disease to treat. If you get
regular TB, you’re looking at being on medicine for six to eight months. You
have to stay off alcohol, improve your diet and take a daily dose of medication.
But this form is relatively cheap and easy to treat.
It’s a different
story if you catch a drug resistant strain, which requires a combination of
pills, powders and jabs for 24 to 36 months or even longer, depending on how
effective it is. It’s very long, hard and expensive, sometimes costing tens of
thousands of dollars. In Georgia and Azerbaijan, the authorities are footing the
bill for treatment in the hope of getting it under control, but they still face
It’s been said that prisons, in particular, provide
a perfect storm for TB to thrive and spread due to overcrowding, poor nutrition
and a lack of health services. How are you tackling the spread of TB in Georgian
and Azerbaijani jails?
Indeed, prisons are an ideal breeding ground
for TB because of the close quarters. Prevalence in prisons is almost always
higher than in the civilian population – sometimes 10 times more – owing to
living conditions, nutrition and cross-contamination.
But while you can
confine people to a cell, you can’t keep TB behind bars. It spreads no matter
what – whether it’s the prison guard who catches it and takes it home to his
unsuspecting family or the detainee who is released and finds it too difficult
to stay on his medication once he’s on the outside.
When the Soviet
Union collapsed, so did medical infrastructures. As a result, ex-Soviet
countries saw a sharp increase in TB cases and drug resistance during the 1990s.
As part of our humanitarian work in countries affected by armed conflict, the
ICRC visits prisons to monitor the conditions of detention. When we started
visiting prisoners in Azerbaijan and Georgia in 1995, we discovered that TB was
rampant among inmates, so we began working with the authorities to improve
screening, treatment and follow-up.
How do you stop a killer that
can't be kept behind bars?
Well, you start by making sure the right
tools and resources are in place to identify and deal with the problem. In
Georgia, we helped develop an early detection system and encouraged the
implementation of the WHO’s Directly Observed Treatment Short Course, or DOTS,
strategy, which means patients have to take their medicine under medical
supervision. As a result, more than 200,000 detainees were screened for TB
between 1998 and 2009. Around 7,000 patients have been diagnosed with the
disease and started treatment.
In addition, we made major improvements
to 90 per cent of medical units in Georgia’s prisons and penitentiary
facilities, including the Ksani TB prison hospital near Tbilisi. The ICRC also
constructed and equipped the TB National Reference Laboratory and helped train
This month, we're handing over our detention-related TB
activities to the Georgian authorities, but we'll continue to provide technical
expertise and support.
What about Azerbaijan, which has seen a sharp
increase in MDR-TB in recent years?
In Azerbaijan, we’ve been
assisting prison authorities in carrying out an anti-TB programme for the past
15 years. Today, all prisoners in the country have access to modern diagnosis
and high quality drugs, free-of-charge. As a result, the number of TB-related
deaths at the country’s Special Treatment Institution for prisoners near Baku
plummeted from almost 300 in 1999 to 20 last year.
Almost three years
ago, we supported the Ministry of Justice in implementing a pilot programme to
treat MDR-TB patients. So far, over 220 prisoners have enrolled. We’re also
working with the Ministry of Health to provide MDR-TB treatment for people who
have been released. We cover the transport expenses for the patients and provide
them with food and hygiene items every month. There are currently 13
ex-detainees receiving treatment and I’m happy to report that another is now
That said, while we’ve seen successes in terms of
dealing with TB in a detention setting, Azerbaijan, like many other countries,
still faces challenges in addressing it among civilian populations, from
properly identifying new cases and ensuring access to treatment to tackling the
stigma and isolation faced by many sufferers.
There’s still a lot to be
done in these areas, but I remain hopeful that with each passing year, the
international community, aid agencies and local authorities will get one step
closer to making TB a thing of the past, once and for all.