<P> Comorbidity of HIV within prison populations has also been shown to worsen health outcomes . Nachega & Chaisson articulate that while HIV - infected prisoners are not more susceptible MDR - TB infection, they are more likely to progress to serious clinical illness if infected . According to Stern, HIV infection is 75 times more prevalent in Russian prison populations than in the civilian population . Therefore, prison inmates are both more likely to become infected with MDR - TB initially and to experience severe symptoms because of previous exposure to HIV . </P> <P> Shin et al. emphasize another factor in MDR - TB prevalence in Russian prisons: alcohol and substance use . Ruddy et al. showed that risk for MDR - TB is three times higher among recreational drug users than non-users . Shin et al.'s study demonstrated that alcohol usage was linked to poorer outcomes in MDR - TB treatment; they also noted that a majority of subjects within their study (many of whom regularly used alcohol) were nevertheless cured by their aggressive treatment regimen . </P> <P> Non-compliance with treatment plans is often cited as a contributor to MDR - TB transmission and mortality . Indeed, of the 80 newly - released TB - infected inmates in Fry et al.'s study, 73.8% did not report visiting a community dispensary for further treatment . Ruddy et al. cite release from facilities as one of the main causes of interruption in prisoner's TB treatment, in addition to non-compliance within the prison and upon reintegration into civilian life . Fry et al.'s study also listed side effects of TB treatment medications (especially in HIV positive individuals), financial worries, housing insecurities, family problems, and fear of arrest as factors that prevented some prisoners from properly adhering to TB treatment . They also note that some researchers have argued that the short - term gains TB - positive prisoners receive, such as better food or work exclusion, may dis - incentivize becoming cured . In their World Health Organization article, Gelmanova et al. posit that non-adherence to TB treatment indirectly contributes to bacterial resistance . Although ineffective or inconsistent treatment does not "create" resistant strains, mutations within the high bacterial load in non-adherent prisoners can cause resistance . </P> <P> Nachega & Chaisson argue that inadequate TB control programs are the strongest driver of MDR - TB incidence . They note that prevalence of MDR - TB is 2.5 times higher in areas of poorly controlled TB . Russian - based therapy (i.e., not DOTS) has been criticized by Kimerling et al. as "inadequate" in properly controlling TB incidence and transmission . Bobrik et al. note that treatment for MDR - TB is equally inconsistent; the second - line drugs used to treat the prisoners lack specific treatment guidelines, infrastructure, training, or follow - up protocols for prisoners reentering civilian life . </P>

Mdr-tb is resistant to which of the following drugs