First-line tuberculosis therapy and drug-resistant Mycobacterium tuberculosis in prisons

Area of Science:

• Public Health
• Infectious Diseases
• Clinical Medicine

Background:

• Assessed a tuberculosis control program in a Baku, Azerbaijan prison.
• Utilized first-line therapy and directly observed treatment, short course (DOTS).

Purpose of the Study:

• Evaluate the effectiveness of a DOTS program for tuberculosis control in a high-resistance setting.
• Identify factors associated with treatment failure.

Main Methods:

• Studied 467 patients with sputum-positive tuberculosis.
• Monitored treatment regimens per WHO guidelines, including clinical exams and supplements.
• Tested isolates for drug resistance (isoniazid, rifampicin, ethambutol, streptomycin).
• Defined treatment success as three consecutive negative sputum smears.
• Used logistic regression to identify factors linked to treatment failure.

Main Results:

• 55% of tested patients had Mycobacterium tuberculosis resistant to two or more antibiotics.
• Treatment success was 54% overall, and 71% among those completing treatment.
• Mortality was 11%, and 13% of patients defaulted.
• Treatment failure was associated with multidrug resistance, positive sputum post-treatment, cavitary disease, and poor compliance.

Conclusions:

• The DOTS program's effectiveness (54%) fell short of the WHO target (85%).
• First-line therapy may be insufficient in areas with high antibiotic resistance.
• Prison settings require tailored strategies to combat tuberculosis effectively.