Risk factors for tuberculosis and homelessness often overlap in US

some southern states. "Most homeless persons with TB were male (87 percent) and aged 30 to 59 years. Black individuals represented the highest proportion of TB cases among the homeless and nonhomeless. The proportion of homeless persons with TB who were born outside the United States (18 percent) was lower than that for nonhomeless persons with TB (44 percent). At the time of TB diagnosis, nine percent of homeless persons were incarcerated." The authors continue, "Compared with nonhomeless persons, homeless persons with TB had a higher prevalence of substance use (54 percent alcohol abuse, 29.5 percent noninjected drug use, and 14 percent injected drug use), and 34 percent of those tested had coinfection with human immunodeficiency virus." Most of the TB cases in homeless persons were managed by health departments (81 percent) and 86 percent of those cases used directly observed therapy where healthcare professionals watched the patients take their medications.

"The most urgent priority for controlling TB in the United States is interrupting new transmission of M tuberculosis. Opportunities for transmission arise when homeless persons with infectious TB frequent homeless shelters, emergency departments, and jails," the authors write. "Once diagnosed, however, homeless TB patients received good case management, including laboratory diagnostic evaluation, appropriate use of a 4-drug regimen, and excellent treatment outcomes for persons given DOT [directly observed therapy] (recommended for all TB patients). Controlling this public health problem demands considerable resources but is integral to responding to the Institute of Medicine's call to eliminate TB in the United States," the authors conclude.


Contact: Jessica Frickey
JAMA and Archives Journals

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