WHO research: awareness of imprisoned persons of TB.

At its annual conference on the "Stop TB" Strategy implementation in Foros, Crimea, on 1-3 November 2007, the WHO Country Office in Ukraine presented outcome of research on an awareness level of imprisoned persons of TB prevention and treatment.

The research was commissioned by the WHO Country Office in Ukraine and the State Department of Ukraine on penalty execution and was carried out by the Coalition of HIV-service organizations in the SIZO (investigation and temporary detention center), prisons and TB hospitals of Kharkiv and Kherson regions.

The research aimed at identifying contents, channels and sources of information on TB for imprisoned persons and looking into factors that could motivate individuals with TB to reveal themselves for medical care. The following groups have been surveyed: imprisoned and detained individuals, among whom persons with TB made a special sub-group; and medical staff of the penitentiary system. The research methods included semi-structured interview and focus-groups.

All in all, the respondents are aware of the TB problem, however this knowledge is often inaccurate. Detained/imprisoned persons often are not fully aware of how TB is communicated and what are the factors, often mixing it up with the knowledge of other diseases, such as HIV and hepatitis. The awareness level of individuals who had TB the past or are currently diagnosed with TB is higher than of those who have not had such an experience.

In general, the respondents are familiarized with TB symptoms, yet not sufficiently, having named some of the main symptoms, e.g. coughing for over 2 weeks (66,7 per cent), fatigue (64,5 per cent), etc. Mostly, the surveyed individuals know at least one diagnostics method, more often - an X-ray.

Great discrepancies have been noted in the knowledge of treatment duration: the term named varies from 1 to 5 years. On the whole, the surveyed individuals consider TB as incurable. 1/3 of the total selection considers diagnostics expensive, ½ of the selection attributes it to treatment.

75 per cent of respondents believe they can get infected while in prison or denetion. ¾ of respondents think it is possible to protect oneself from TB while in an penitentiary institution, however only 2/3 of them take respective measures.

The respondents are rather responsible towards their surrounding and the majority of them tend to inform the people around should they develop TB,irregardless of whether they are in prison/detention or have been released.      

With regard to getting information on TB within the period of detention/imprisonment, around 85 per cent indicated that they receive information from printed sources (79,6 per cent) and during individual communication (76,3 per cent). The main source of information is medical staff (66,7 per cent).

Among information channels that are trusted on the first place are posters, followed by booklets, brochures, newspapers, as well as TV and lectures. Yet, the most trusted information is the one obtained during individual communication, in particular from the medical staff (over 70 per cent).

Over 80 per cent of respondents indicated that they have access to information about TB, however only slightly over 30 per cent asked for such information if they had a chance. Nevertheless, almost 70 per cent feel the need for additional information on TB.

Obstacles in information flow, that also demotivate detained/imprisoned persons from getting information, are fear before the disease, lack of information materials, limited information channels, scarcity of and lack of trust to the staff who could carry out information and motivation activities, and difficult access to information placed in medical units for individuals with physical or other disabilities.

The respondents also indicated factors that negatively influence the decision to ask for medical help after the release. These are financial expenses for the diagnostics and/or treatment, lack of possibility to work during the treatment, duration and isolation during the in-patient treatment which is perceived as repeated imprisonment, distrust to quality of medical care, and expectations of anti-TB drugs side-effects.

The research gives recommendations as to principles on which the information activities with imprisoned and detained individuals should base, as well as channels and sources of information, contents of messages and ways of their presentation.

An important role in this process is given to medical personnel of the penitentiary system as the most trusted information source. Medical staff should be put on a special training programme for carrying out information and awareness work with imprisoned individuals, which should include prevention of professional burnout and raising the level of their skills on TB issues.

It would have also been useful to engage NGO representatives in the information and motivation work with imprisoned persons.

Based on the research materials and outcome the WHO Country Office in Ukraine will prepare detailed suggestions for possibilities of carrying out information and awareness activities in penitentiary institutions and submit them to the State Department of Ukraine for penalty execution.

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For further information please contact Ms. Myroslava Korenevych, Advocacy and Social Mobilization Officer, WHO CO in Ukraine, at tel.:  425 8828 ext. 78417