Tuberculosis in socially maladjusted individuals (BOMGE): causes, symptoms, diagnosis, treatment

To socially maladjusted groups of the population include persons without a definite place of residence (BOMJ) migrating both within the country and from countries of near and far abroad, refugees from zones of interethnic and local military conflicts, unemployed persons, patients with chronic alcoholism (and drug addiction), prisoners , persons living in shelters for the disabled and the elderly.

A significant proportion of socially maladjusted individuals are not "permanent residents", formally outside the responsibility of health facilities, but among them, a complex of anti-tuberculosis activities is needed (social support for the tuberculosis control program, the establishment of rehabilitation centers, and the provision of health education).

In most cases, tuberculosis among homeless people and migratory populations is "on the order of treatment", so diagnose common acute current, poorly treatable forms. Such patients are potential sources of tuberculosis, including multidrug-resistant tuberculosis.

To identify and diagnose tuberculosis among migrants and homeless people, the brigade method and mobile fluorography are used. Methods allow to identify tuberculosis in the majority of adult migrants in places of their greatest concentration - temporary accommodation centers (hotels, sanatoriums, rest homes, schools), places of their work (studies), points of charitable societies, labor exchanges, refugee committees. For the treatment of the migratory population and persons of the BOMJ, they organize specialized hospitals (departments), rehabilitation centers and boarding homes for the transferred tuberculosis or for patients with chronic forms.

Services dealing with refugee affairs often do not pay enough attention to the fight against tuberculosis. Employees of the services take care of providing refugees with food, clothing and shelter. Medical workers should pay special attention to the fight against tuberculosis, promptly identify and treat patients. In the treatment of refugees and homeless people, permanent monitoring is necessary.

The reasons for the increase in the number of patients with non-treatable forms of tuberculosis are diverse. Increasing the effectiveness of treatment of tuberculosis in socially maladjusted individuals depends not so much on therapeutic tactics in hospitals or outpatient settings, as on the conditions of the socioeconomic situation and the factors of tuberculosis transmission. An important condition is the patient's desire to be cured. For patients from socially maladaptive groups, individual monitoring of the patient's behavior at different stages of treatment is developed. As a rule, men are refused treatment (90%) under the age of 45, single, with a low level of education, unemployed and without a permanent residence, who suffer from alcoholism and who were previously imprisoned.

To reduce the frequency of refusals from treatment and cases of violation of the regime, it is necessary to provide social assistance to patients: the issuance of food or hygiene kits, reimbursement of transportation costs, the organization of food stations, the rehabilitation of former prisoners.

When tuberculosis is detected in shelters, homes for people with disabilities and the elderly, it is necessary to examine all persons who have been in contact with a sick person and to conduct controlled preventive chemotherapy.

Prisoners and prisoners are also at risk of tuberculosis. Persons detained in places of deprivation of liberty are poorly educated and in disadvantaged socio-economic conditions. The spread of HIV infection complicates the control over the incidence of tuberculosis in the institutions of the penitentiary system.

Prisoners are often transferred within the correctional facility, between various institutions of the law enforcement system and the enforcement service. In contact with inmates serving prison come and with etiteli, so tuberculosis in prison tank poses a risk to society. Effective control of the spread of tuberculosis in prisons is necessary to protect the health of prisoners and society as a whole.

To identify patients with tuberculosis, prisoners under investigation are undergoing X-ray fluorography of the chest organs. The inmate is given an x-ray inspection every six months. However, in some regions of Ukraine, most infectious forms of pulmonary tuberculosis are detected 2-3 months after the next control. Therefore, when a prisoner experiences symptoms of pulmonary tuberculosis (cough with sputum, chest pain, subfebrile temperature, hemoptysis), sputum is examined for mycobacterium tuberculosis (at least three samples). This makes it possible to identify infectious patients, to examine contact persons and to prevent a group disease with tuberculosis.

The regional tuberculosis control program should be unified for both civil society and penitentiary institutions. It is necessary to provide prisoners with complete anti-tuberculosis treatment and follow-up after release.

However, the form and content of tuberculosis control programs in penitentiary institutions and in institutions of the municipal network differ. It is necessary to monitor not only the treatment process (ensuring strict control over the intake of drugs and preventing their entry to the "black market"), but also strict monitoring of tuberculosis diagnostics, especially when obtaining sputum specimens from prisoners, as both simulation and concealment of the disease are possible tuberculosis.

Particular attention should be paid to prisoners who are transferred within the prison or between prisons. If the patient is treated in the same medical institution, the process is easier to control. When transferring a patient to another correctional institution, it is necessary to ensure the completion of the full course of treatment in the institution where the prisoner is transferred.

Due to increased control of diagnosis and treatment of tuberculosis, improvement of drug provision, the share of cases of tuberculosis detected in penitentiary institutions among all newly registered patients in the last 4-5 years decreased from 22-25% to 11-13%.

Carrying out antituberculous activities among the entire population of the administrative territory undoubtedly improves control over the incidence of tuberculosis and can lead to stabilization of morbidity and mortality rates from tuberculosis and to their reduction.