Siberian jail is champion in fight against TB

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

"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 killingprisoners here every week, but with the help of a group ofAmerican doctors, the jail near one of the world's biggestswamps has set an example to others worldwide dealing withdrug-resistant TB.

Following an initiative from the U.S. Public HealthResearch Institute which was funded by George Soros, the Tomskproject now run by Boston-based doctors' group Partners inHealth (PIH) has overturned conventional medical thinking thatdrug-resistant TB strains are extremely difficult and expensiveto treat.

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

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

Under the project, which has now extended beyond the prisonto the general population in the region, deaths from TB inTomsk have nearly halved in eight years to around 12 per100,000 people -- a third of the average in Siberia.

Its main thrust is simple: just to ensure existingtreatment is adhered to properly, rather than introducing newhigh-tech solutions or expensive drugs.

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

Drug-resistant TB emerged over the last couple of decadesmainly because patients failed to complete courses ofmedication, so the Tomsk Correction Facility is an appropriateplace for this project: one of its core weapons has beendiscipline.

The most effective response was produced by rigorouslyenforcing a series of existing measures, including improvingventilation, ensuring medical staff have proper training,paying for essential drugs and establishing a strict monitoringsystem to make sure patients complete their treatments.

Among the non-prison population, doctors do rounds andphysically watch their patients take their TB medicine. Statebenefits are withdrawn if the patient skips their treatment,while testing and education about TB have improved.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 switchpatients between treatments if they don't respond.

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

KILLER OF CHOPIN, ORWELL

Previously known as consumption, TB killed millionsincluding the 19th-century Polish composer Frederik Chopin,Scottish author Robert Louis Stevenson and 20th-century Englishwriter George Orwell.

Rising living standards and antibiotics virtually wiped outTB -- bacteria spread via droplets which commonly attack thelungs invoking a bloody cough and sapping energy -- in thedeveloped world during the second half of the 20th century.

But it still stalks poorer countries, where people infectedwith HIV are most vulnerable, and figures show there are morepeople with the disease now than ever.

The WHO estimates that nearly half a million people a yearworldwide become infected with a form of TB that is resistantto two or more of the primary drugs used to treat it.

Parts of the former Soviet Union are among the worstaffected areas: around 15 percent of new cases in Tomsk aredrug resistant, against a world average of just over 5 percent.Baku in Azerbaijan has the world's highest rate of drugresistance in new cases, at 22 percent.

But PIH says it has achieved nearly an 80 percent cure ratefor drug-resistant TB. The group, founded to provide medicalcare to the poor, is using the experience from Tomsk to set upprojects to treat drug-resistant TB in the African countries ofRwanda and Malawi, and other former Soviet states.

Since PIH took it over, the Tomsk project has also beenfunded by the Bill & Melinda Gates Foundation andpharmaceutical group Eli Lilly, and in 2004 received a grantworth $10.8 million (5.44 million pounds) over five years fromthe Global Fund to Fights AIDS, Tuberculosis and Malaria, setup by the world's wealthiest countries.

The Russian prison service now sends inmates from otherregions to the jail to receive treatment, and the regionalauthorities plan to set up a global TB research unit there thisyear.

EIGHT YEARS AND COUNTING

In a wing of the prison cordoned off from the rest of thehospital, a few dozen inmates infected with drug-resistant TBhave been locked away. People only enter wearing protectiveclothing -- plastic hats, overalls and face masks.

Before the U.S. doctors launched their project here, fewinmates could expect to leave this wing alive.

"Maybe that's why Tomsk was so receptive," said Ed Nardell,another PIH doctor. "They were literally counting the bodiesand knew that something had to be done."

Groups of men dressed in black overalls stared out frombehind high wire fences which segregate courtyards or peeredthrough mucky, barred dormitory windows. Their heads wereshaved, their expressions blank, their faces gaunt and hollow.

A prisoner who gave his name as Rakhid said life in thehospital prison has vastly improved: "I've been here eightyears," he said and then chuckled.

"And I'll be here a while longer."

(Editing by Keith Weir and Sara Ledwith)