A/HRC/41/34/Add.1 between policymakers and specialists, with educational programmes to help specialists to move in the same direction. IV. Health in detention: tuberculosis and drug use 66. Before 2014, persons in temporary detention centres in Kyrgyzstan could only receive emergency medical assistance, until the International Committee of the Red Cross (ICRC), together with the Ministry of the Interior and the Ministry of Health, agreed that detainees should have regular access to doctors from civilian hospitals. As at April 2018, approximately 70 per cent of detainees in temporary detention facilities had access to regular medical care.24 67. The Special Rapporteur visited health facilities at pretrial detention centres and various prisons with the initial aim of following up on recommendations made by previous special procedure mandate holders and to observe how tuberculosis is treated. During the visits, he was impressed by the effort made to provide additional care for drug users. 68. Tuberculosis in detention centres must be addressed, precisely because the risk of transmission is higher in centres and the disease could potentially have a harmful effect on the wider community. It is estimated that a person with tuberculosis who has not been treated will transmit the disease to an average of 15–20 people per year. This rate increases significantly in detention centres owing to a combination of factors, such as overcrowding, unsanitary conditions, including poor ventilation and poor air exchange, and restricted access to adequate medical care. 69. Tuberculosis is a curable but potentially fatal disease if not treated correctly. Multidrug resistant tuberculosis is a strain of the disease that is highly resistant to two or more of the common drugs that are used in combination to treat the infection. Kyrgyzstan is among the 30 States with the highest rate of multi-drug resistant tuberculosis. 70. Treatment for persons with multi-drug resistant tuberculosis can take up to two years, as those affected must be monitored from diagnosis to cure. Since 2007, ICRC has supported Kyrgyzstan in addressing the disease, mainly in two of its prisons: Colony 31 (since 2013) and SIZO-1 (since the beginning of 2015).25 The focus has been on infection control through early detection and treatment to prevent transmission. Infrastructure has been created or renovated and the capacity of health-care services and personnel and of prison authorities has been strengthened to improve diagnosis, treatment and care. Care may also include psychological and social support, as necessary. Detainees have access to diagnosis and rapid treatment in ad hoc facilities through standard bacteriology laboratory diagnostic services. Detainees with tuberculosis are separated according to their infectiousness to avoid transmission. 71. Following his visit to the hospital at Colony 31, the Special Rapporteur was able to confirm that its practices, developed with international cooperation, were exemplary in terms of control and treatment of tuberculosis. He also learned, however, that ICRC was planning to withdraw its support by 2020 as Kyrgyzstan is now a middle-income country. Sustainability has therefore become an issue of concern; the Government must continue its efforts and investments to control and treat the disease. The Special Rapporteur learned that other international bodies were also planning to withdraw their support; he therefore stresses that the authorities must take ownership of the projects implemented through international cooperation to ensure their sustainability, and that any results achieved are not reversed. 72. During his visit to Colony 31, the Special Rapporteur also learned about the treatment and rehabilitation available to drug users through the Atlantis programme. This prison-based programme follows the “clean zone” 12-step model developed by Pawel Moczydlowski, a Polish criminal justice expert. In accordance with the model, methadone 24 25 See ICRC, “Kyrgyzstan: improving access to health-care for detainees”, 16 April 2018. See ICRC, “Combating tuberculosis in detention”, 24 March 2015. 13