Siberian jail is champion in fight against TB

By James Kilner

TOMSK, Russia (Reuters) - Alexander Pushkarev, head doctor at the 1,000-bed hospital in a Soviet-era prison nestling at the edge of Siberia, flashed a row of metal teeth with his smile.

"Welcome to Tomsk Correction Facility No. 1," he said. "This is the best treatment for TB in Russia."

In the mid-1990s, virulent tuberculosis was killing prisoners here every week, but with the help of a group of American doctors, the jail near one of the world's biggest swamps has set an example to others worldwide dealing with drug-resistant TB.

Following an initiative from the U.S. Public Health Research Institute which was funded by George Soros, the Tomsk project now run by Boston-based doctors' group Partners in Health (PIH) has overturned conventional medical thinking that drug-resistant TB strains are extremely difficult and expensive to treat.

"Without the Tomsk project, drug-resistant TB treatment would be years behind where it is now," said Jussi Saukkonen, a doctor from Boston who was in Tomsk to inspect the project.

"It's been an important benchmark in dealing with this problem."

Under the project, which has now extended beyond the prison to the general population in the region, deaths from TB in Tomsk have nearly halved in eight years to around 12 per 100,000 people -- a third of the average in Siberia.

Its main thrust is simple: just to ensure existing treatment is adhered to properly, rather than introducing new high-tech solutions or expensive drugs.

About 2 million people die each year from TB, a rate which is accelerating, making it one of the world's biggest killers: there are around 3 million deaths a year from AIDS and 1 million from malaria.

Drug-resistant TB emerged over the last couple of decades mainly because patients failed to complete courses of medication, so the Tomsk Correction Facility is an appropriate place for this project: one of its core weapons has been discipline.

The most effective response was produced by rigorously enforcing a series of existing measures, including improving ventilation, ensuring medical staff have proper training, paying for essential drugs and establishing a strict monitoring system to make sure patients complete their treatments.

Among the non-prison population, doctors do rounds and physically watch their patients take their TB medicine. State benefits are withdrawn if the patient skips their treatment, while testing and education about TB have improved.

Doctors use a range of antibiotics and are ready to switch patients between treatments if they don't respond.

The World Health Organisation (WHO) now promotes such a strategy, called the DOTS (Directly Observed Treatment, Short-course) programme.

KILLER OF CHOPIN, ORWELL