28 September 2000
MSF teams approach the prevention of TB in several ways.
detection and treatment of active cases (This is essential, as these people are spreading the bacillus to others. Paradoxically, in the early stages of a TB project we may not go out actively seeking cases - rather, during the first months we concentrate on training the local national health workers to handle according to the DOTS strategy the cases that come to the clinics of their own accord. To go out finding too many new cases too quickly risks overwhelming the health services and compromising quality of care and supervision.);
setting up laboratory facilities in district hospitals so as to allow adequate diagnosis of TB;
education of the population and of community health workers on the symptoms and signs of TB, so that affected people come forward to be treated once the programme is set up and running;
advocacy in refugee situations for adequate shelter and living space, since crowded conditions favour contagion;
setting up of control programmes among disadvantaged groups such as prisoners, slum dwellers and street people, who would not otherwise have access to care.
An example - DOTS in action in Siberia.
In Russia the prevalence of TB is high and still rising, and Siberia is the region that is most
severely affected. The prevalence there is double the rate in the rest of country. This is due in
part to the inadequacies of the Siberian prison system. More than one million prisoners are
housed in conditions so crowded that the transmission of an airborne disease like TB is almost
The MSF teams work in the prisons of Mariinsk and Novokuzniets. The hospital prisons there
were heavily overburdened with patients and ill-equipped to deal with a complex condition
such as TB. We set up the DOTS strategy and trained the prison medical staff. Patients with
active smear-positive TB are targeted as they are the ones who are contagious.
Advocacy is an important element of this project in order to raise public awareness about the
prison TB epidemic and its consequences for the country as a whole. MSF is working with the
local authorities to ensure that the epidemic is managed.