A prevalence survey for smear-positive tuberculosis in Thai prisons

SETTINGS

Twenty-seven prisons in Thailand.

OBJECTIVES

To measure the prevalence of smear-positive tuberculosis (TB) and to compare its detection using the World Health Organization (WHO) guidelines for prisons or the International Standards for Tuberculosis Care (ISTC) criteria.

METHOD

Prisoners who were not on TB medications and who had not been treated for TB in the previous 6 months were enrolled in the survey. Prison nurses conducted a one-time mass screening using the WHO questionnaire, with follow-up sputum collection in TB suspects.

RESULTS

Of 71594 prisoners, 22132 (30.9%) were identified as TB suspects, and 254 were confirmed by sputum smear, for a prevalence of 354.8/100000. Males were most likely to be diagnosed with TB disease (OR 2.6), as were those transferring in from another prison versus new prisoners (OR 3.0). The positive predictive value of the WHO criteria was 1.2%, and that of the ISTC standard was 5.9%.

CONCLUSION

TB prevalence in this survey remained high. WHO guidelines, recognised as a standard, require health workers to question prisoners and measure height and weight. The ISTC standard, a single question about cough >or=2 weeks, is simple, may be asked by non-health personnel and may be a better alternative.

Implementation of the DOTS strategy in prisons at provincial level, Thailand

SETTINGS

Sixteen prisons located in four geographic regions in Thailand.

OBJECTIVES

To assess treatment outcomes of tuberculosis (TB) patients under the DOTS strategy in a prison programme.

METHOD

The programme prospectively included 1412 consecutive TB patients registered during Year 1 (June 1999-May 2000), Year 2 (June 2000-May 2001) and Year 3 (June 2001-May 2002). DOTS implementation consisted of government commitment; passive detection by sputum smear microscopy; standardised short-course chemotherapy, including directly observed treatment by prison nurses; maintenance of drug stocks at provincial health offices; and a recording and reporting system. Data were collected using prison TB registers.

RESULTS

The number of TB patients increased from 348 in Year 1 to 490 in Year 2 and to 574 in Year 3. New smear-positive patients accounted for 82.0% of the total. Of the 1158 new smear-positive cases, 68.7% were cured, 17.6% died, 10.6% were transferred out, 2.6% failed, and 0.5% completed treatment.

CONCLUSIONS

DOTS implementation in these prisons could not achieve the national target to cure 85% of new smear-positive cases. More interventions are needed to help reduce the deaths and transferred cases that mainly affected the treatment outcomes in these settings.

Resistance to anti-tuberculosis drugs among smear-positive cases in Thai prisons 2 years after the implementation of the DOTS strategy

SETTING

Three prisons in Bangkok and vicinity, Thailand.

OBJECTIVE

To examine the prevalence of drug-resistant tuberculosis among smear-positive cases in Thai prisons 2 years after the implementation of the DOTS strategy, and to identify factors associated with resistance to anti-tuberculosis drugs.

METHODS

In a cross-sectional study, 154 consecutive tuberculosis patients with at least one positive sputum smear and at least one positive sputum culture registered between 1 May and 31 October 2000 were enrolled. Drug susceptibility testing was performed by the Ministry of Public Health Tuberculosis Division. Patient characteristics were obtained by face-to-face interview.

RESULTS

Resistance to at least one drug was found in 50.6% of the subjects, including multidrug-resistant tuberculosis (MDR-TB) in 19.5%. The proportion of resistance to any anti-tuberculosis drug in prisons A, B and C was respectively 52.7%, 37.8% and 61.5%. The only factor significantly associated with resistance to at least one drug (P = 0.011) and MDR-TB (P < 0.001) was a history of previous tuberculosis treatment.

CONCLUSION

After 2 years of the DOTS strategy, resistance to anti-tuberculosis drugs, an indicator of the quality of tuberculosis treatment, was found to be high. The DOTS strategy currently used in Thai prisons should be reviewed, in order to reduce and prevent drug-resistant tuberculosis.