A prevalence and risk-factor survey of active pulmonary tuberculosis in prison facilities of the Republic of Tajikistan

INTRODUCTION: High rates of pulmonary tuberculosis (TB) have been reported in prisons of the former Soviet Union. The social and biological factors placing inmates in Tajikistan at high risk for TB are poorly understood. METHODS: We administered a cross-sectional behavioral and demographic survey to 1317 inmates in two prison facilities in Sughd province, Tajikistan along with radiographic screening for pulmonary TB. Cases were confirmed bacteriologically with direct sputum microscopy and sputum culture. Inmates already undergoing TB treatment were also surveyed. In-depth interviews were conducted with former prisoners to elicit relevant social and behavioral characteristics. Crude and adjusted odds ratios of risk factors were calculated. RESULTS: We detected 47 cases of active pulmonary TB (a prevalence of 3.6%). Factors associated with a diagnosis of pulmonary TB were: HIV-infection by self-report (OR=14.58; 95% CI: 3.09-56.98), history of previous TB diagnosis (OR=10.14; 95% CI: 5.05-19.91), history of drug use (OR=2.28; 95% CI: 1.02-4.69), and infrequent supplemental nutrition beyond scheduled meals (OR=1.39; 95% CI: 1.09-1.82). In multivariate regression analysis, self-reported HIV-infection (AOR=18.60; p < 0.001) and history of previous TB (AOR=10.35; p < 0.001) were most predictive of active pulmonary TB. Self-reported HIV-infection was associated with intravenous drug use (p < 0.001). CONCLUSIONS: In prison facilities of Tajikistan, HIV-infection, drug use and insufficient nutrition were associated with an increased likelihood of developing active pulmonary TB disease. Policies and programs targeted toward reducing the spread of HIV among intravenous drug users may alleviate the TB burden in Tajikistan's prisons.