Sarang Anya, Platt Lucy, Vyshemirskaya Inna, Rhodes Tim
Andrey Rylkov Foundation for health and Social Justice, Moscow, Russia.
Int J Prison Health. 2016;12(1):45-56. doi: 10.1108/IJPH-07-2014-0022.
The purpose of this paper is to analyze poor management of tuberculosis (TB) prevention and treatment and explore parameters and causes of this problem drawing on qualitative interviews with former prisoners and medical specialists in Kaliningrad Oblast in Russia.
DESIGN/METHODOLOGY/APPROACH: The authors undertook a qualitative study, to explore access to HIV and TB treatment for people who inject drugs in Kaliningrad. The authors interviewed (outside of prisons) 15 patients and eight health specialists using a semi-structured guide. The authors analyzed the accounts thematically and health consequences of imprisonment emerged as a major theme.
Prisons are overcrowded and lack basic hygiene and infection control. Demand for medical services outstrip supply, HIV and TB prevention lacking, HIV and TB treatment is patchy, with no second-line drugs available for resistant forms. The prison conditions are generally degrading and unhealthy and many respondents perceived surviving prisons as a miracle. Cooperation with medical services in the community is poor.
RESEARCH LIMITATIONS/IMPLICATIONS: The authors used qualitative research methods, which do not rely on a representative sample. However, many of the structural barriers preventing effective TB treatment and prevention highlighted in this paper have been noted elsewhere, suggesting that findings are likely to reflect conditions elsewhere in Russia. The authors tried to include all possible points of view, as of the medical staff and the patients. However, due to resistance of the officials the authors were unable to conduct interviews with employees of the FCS. Since all the interviews are recalling past experience, the situation may have changed. This does not undermine importance of the findings, as they shed light on particular treatment experiences, and development of prison health system.
ORIGINALITY/VALUE: The paper contributes to the literature on prisons as a contributor to TB epidemic, including drug resistant forms. An urgent penitentiary reform in Russia should focus on HIV and TB prevention, case detection, availability of medications and effective treatments. Key to decreasing prison population and improving health is political reform aimed at introduction of effective drug treatment, de-penalization and de-criminalization of drug users and application of alternatives to incarceration.
本文旨在分析结核病预防与治疗管理不善的情况，并通过对俄罗斯加里宁格勒州的前囚犯和医学专家进行定性访谈，探究这一问题的相关因素及成因。
设计/方法/途径：作者开展了一项定性研究，以探究加里宁格勒地区注射吸毒者获取艾滋病毒和结核病治疗的情况。作者使用半结构化指南（在监狱外）采访了15名患者和8名卫生专家。作者对访谈内容进行了主题分析，监禁的健康后果成为一个主要主题。
监狱过度拥挤，缺乏基本卫生条件和感染控制措施。医疗服务需求超过供给，艾滋病毒和结核病预防工作缺失，艾滋病毒和结核病治疗不全面，没有二线药物可用于耐药形式。监狱条件普遍恶化且不健康，许多受访者认为能在监狱中存活是个奇迹。与社区医疗服务的合作不佳。
研究局限/影响：作者采用了定性研究方法，不依赖于具有代表性的样本。然而，本文所强调的许多阻碍有效结核病治疗和预防的结构性障碍在其他地方也有提及，这表明研究结果可能反映了俄罗斯其他地区的情况。作者试图纳入所有可能的观点，如医务人员和患者的观点。然而，由于官员的抵制，作者无法对联邦安全局的员工进行访谈。由于所有访谈都是对过去经历的回忆，情况可能已经发生了变化。但这并不影响研究结果的重要性，因为它们揭示了特定的治疗经历以及监狱卫生系统的发展情况。
原创性/价值：本文为有关监狱成为结核病流行（包括耐药形式）促成因素的文献做出了贡献。俄罗斯迫切需要进行监狱改革，应侧重于艾滋病毒和结核病预防、病例发现、药物供应及有效治疗。减少监狱人口并改善健康状况的关键在于政治改革，旨在引入有效的药物治疗、对吸毒者实行非刑罚化和非刑事化以及采用监禁替代措施。
