The Impact of Prison Amnesties on Tuberculosis Control in Russia

Despite advances in methods of detection and pharmacological therapies, the global burden of tuberculosis (TB) remains staggeringly high, with approximately one third of the world’s population estimated to be infected with the mycobacterium that causes TB.1 The explosive epidemic of TB has been particularly acute in the correctional institutions of the Russian Federation, where extraordinary levels of penal overcrowding have facilitated the rapid transmission of TB infection. In an attempt to alleviate the negative health consequences arising from massive prisoner overcrowding, particularly in pre-trial detention centers, the Russian government has authorized a series of sweeping prisoner amnesties that have released several thousand convicts into civil society. Due to poor surveillance and treatment, however, many of these amnestied individuals are infected with latent and active TB, including multi-drug resistant strains of TB (MDR-TB). Although the impact of these amnesties on TB incidence in the general population remains unclear, it appears likely that TB exposure in the general population has increased considerably since these amnesties have been enacted. This paper focuses on the relationship between penal overcrowding and increased TB transmission, and evaluates the utility of large-scale amnesties in reducing the prisoner population against the public health consequences of releasing potentially infectious TB-positive prisoners into the general public.