Abstract

1
Abstract

• Problem Statement Armenia received anti-TB drugs
  from the Global Drug Facility to treat patients
  in the civil sector in January 2003, whereas the
  supply of anti-TB drugs for prisons is ensured by
  the International Committee of the Red Cross
  (ICRC) as from 2002, allowing anti-TB drugs for
  all patients. However, a high default rate in the
  civil sector results in a high transmission of TB
  infection, and therefore increases treatment
  costs for society.
• Objectives To evaluate the efficacy of active
  follow-up of released prisoners under anti-TB
  treatment to the civil sector and its impact on
  the general population and related treatment
  costs.
• Design Cross-sectional study.
• Setting and Population One central penitentiary
  hospital in Yerevan, Armenia, using TB transfer
  forms and patient records analysed from January
  2003 until November 2003.
• Intervention The study of TB cases released
  from prisons covered 2 periods from January to
  July 2003, no active follow-up of patients was
  done. From July till November 2003, patients were
  assisted by a doctor of the Ministry of Justice
  to ensure registration at TB facilities and
  completion of treatment.
• Outcome Measures TB transfer forms and patients
  treatment cards were systematically reviewed
  during the period of intervention, giving of
  defaulters, of drug intakes, and completion
  rates.
• Results In the group of patients without active
  follow-up, only 22 continued treatment, whereas
  in the group actively followed-up, 62.5
  completed treatment. This means that in the group
  without follow-up, 78 of the patients will
  infect an average of 15 persons in the civil
  sector, resulting in about 117 TB cases. In the
  group with active follow-up, only 56 TB cases
  will be produced. For society, this represents an
  increased cost of USD 9360 per 100 patients
  compared to a cost of USD 4480 per 100 patients
  if active follow-up is in place together with
  availability of drugs in the civil sectors and
  prisons.
• Conclusions Provision of anti-TB drugs in
  Armenia in the civil sector and in prisons
  combined with active tracking of released
  prisoners under treatment doubled reductions in
  anti-TB treatment costs. Therefore, we recommend
  continuing active follow-up of released prisoners
  under treatment since it improves drug use and
  treatment completion.

2
Background and setting

• In Armenia, TB cases detected in the prison
  system constitute a disproportionately large
  fraction of disease burden. The prison TB
  prevalence is estimated to be 50 times that of
  the general population.
• As from 2002, the ICRC is supporting the Ministry
  of Justice to detect promptly TB cases and treat
  them in the Central Penitentiary Hospital and the
  pre-trial detention centre through DOTS.

3
Introduction

• Anti-TB drugs are supplied from 2 sources the
  GDF for civilian and the ICRC for prisons.
• Prisoners released while under treatment are
  entitled to complete a free course of DOTS.
  However, barriers to treatment access in TB
  facilities result in a high defaulter rate for
  patients including ex-prisoners.

4
Objectives

• The MOJ supported by the ICRC follows each
  patient released from prisons to the TB
  facilities and help in basic medical/administrativ
  e steps.
• To evaluate the efficacy of active follow-up of
  released prisoners under anti-TB treatment to the
  civil sector and its impact on the general
  population and related treatment costs.

5
Method 1

• Active follow up consists on accompanying the
  released prisoners while under DOTS to civilian
  TB facilities. This is ensured by a physician of
  the MOJ.
• Completion rates during six months without active
  follow up were compared to five months with
  active follow up.

6
Method 2 future perspectives

• An individualized automatized database is under
  preparation for the civilian sector that will
  record information of TB registers (TB03, TB10,
  TB12).
• Such DB already exists in prisons.
• In the future, the two DB will be linked to
  ensure information flow between prisons and the
  civilian sector.

7
Results 1

• Completion of treatment is 22 without active
  follow-up compared to 62.5 with active
  follow-up.
• 117 additional TB cases are produced if no active
  follow-up compared to 56 if active follow-up.

8
Results 2

• For the society, this represents an increased
  cost of USD 9360 per 100 patients compared to USD
  4480 per 100 patients if active follow-up is
  carried out together with availability of anti-TB
  drugs in both sectors (civil prisons) as is as
  from January 2003.

9
Discussion

• Informal payments are a major barrier to TB
  treatment access and their reduction by medical
  services is of utmost importance.
• In the future, provision of anti-TB drugs to both
  sectors from one source (GDF in the civil sector)
  may strengthen links in between these sectors.

10
Summary

• Provision of anti-TB drugs in Armenia in the
  civil sector through the GDF and in prisons
  through the ICRC combined with active tracking of
  released prisoners while under DOTS doubled
  reduction in anti-TB treatment costs.

11
Conclusion recommendations 1

• Active follow-up of released prisoners under DOTS
  should continue.
• Barriers to TB treatment access could be
  diminished through reduction of informal payments
  by medical services. This may be done through
  fourfold measures.

12
Conclusion recommendations 2

• Increase salaries of medical professionals.
• Link salaries to performance.
• Transparent accounting and reporting of financial
  activities through clear governance of TB
  facilities.
• Publicize patients rights in facilities and
  through large media coverage.