Just came across this 2002 article; I had mentioned
that I thought there were mandatory programs re: TB
treatment. Excerpts:
"We describe the implementation of a mandatory
tuberculosis (TB) screening program that uses symptom
screening and tuberculin skin testing in homeless
shelters. We used the results of DNA fingerprinting of
Mycobacterium tuberculosis isolates to evaluate the
effect of the program on TB incidence and
transmission. After the program was implemented, the
proportion of cases among homeless persons detected by
screening activities increased, and the estimated TB
incidence decreased from 510 to 121 cases per 100,000
population per year. Recent transmission, defined by
DNA fingerprinting analysis as clustered patterns
occurring within 2 years, decreased from 49% to 14%
(p=0.03). Our results suggest that the shelter-based
screening program decreased the incidence of TB by
decreasing its transmission among the homeless.
"Homelessness is one of the greatest risk factors for
contracting tuberculosis (TB) in the United States.
The incidence in the general population is extremely
low; however, the incidence among the homeless,
particularly among minority ethnic groups, can be as
high as 450 cases per 100,000 population. In a
previous study, homelessness was the key factor
associated with DNA fingerprint clustering, suggesting
that ongoing transmission of TB in Denver, Colorado,
occurs primarily among the homeless...
"The Denver Metro TB Clinic of Denver Public Health
Department provides TB control activities for
metropolitan Denver, Colorado... Active TB is treated
by use of directly observed therapy in the clinic or
in the community; outside the clinic, outreach workers
deliver the therapy using incentives and enablers
(i.e., transport, food coupons, temporary housing, and
treatment for substance abuse or mental illness).
Temporary housing for the homeless in Denver is
available in large communal shelters, through
residential drug and alcohol treatment programs, and
in individual or family transitional housing. Our
program focused on the large communal shelters and the
drug and alcohol treatment programs because these
settings were the likely loci of TB transmission.
The screening program included a simple symptom
assessment and a tuberculin skin test for persons who
had no history of a positive skin test. The symptom
assessment was a brief interview to detect TB symptoms
such as chronic cough, weight loss, night sweats, and
hemoptysis {coughing up bloody sputum}...
"To stay in a homeless shelter or residential
substance abuse treatment program for more than 3 to 5
days, patients were required to complete the
screening. All persons with active TB were treated
with directly observed therapy, and persons with
latent TB infection who met criteria for treatment
were offered directly observed preventive treatment.
After completion of screening, homeless persons were
given a card from the clinic that allowed them to
remain in one of the shelters for up to 6 months...
"The institution of a TB-screening program for the
homeless population in congregate settings in Denver
in 1995 was associated with a substantial decrease in
the incidence of active TB in this high-risk
population...The estimated number of active TB cases
decreased despite an increasing population of homeless
persons, leading to a drop in the annual incidence
rate from 510 to 121 per 100,000 persons...
(The current rate for the Denver non-homeless is 8.2
per 100,000 population.)
<scratching forehead>
I don't remember how the subject came up, but thought
this was an interesting article.
Debbi
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