Tuberculosis among the homeless: should we change the strategy?

• Published in: The international journal of tuberculosis and lung disease Vol. 21; no. 3; pp. 327 - 332
• Main Authors: Dias, M., Gaio, R., Sousa, P., Abranches, M., Gomes, M., Oliveira, O., Correia-Neves, M., Ferreira, E., Duarte, R.
• Format: Journal Article
• Language: English
• Published: France International Union Against Tuberculosis and Lung Disease 01-03-2017
• Subjects: Adult; Aged; Alcohol Drinking - epidemiology; Antitubercular Agents - administration & dosage; Cohort Studies; Coinfection; Female; HIV Infections - epidemiology; Homeless Persons - statistics & numerical data; Homelessness; Human immunodeficiency virus; Humans; Incidence; Lentivirus; Logistic Models; Male; Middle Aged; Mycobacterium; Portugal - epidemiology; Predictors; Prevalence; Retrospective Studies; Retroviridae; Risk Factors; Substance-Related Disorders - epidemiology; Treatment Outcome; Treatment Success; Tuberculosis - drug therapy; Tuberculosis - epidemiology
• ISSN: 1027-3719; 1815-7920
• DOI: 10.5588/ijtld.16.0597

BACKGROUND: Tuberculosis (TB) is a major concern among high-risk populations such as the homeless.OBJECTIVES: To evaluate TB incidence and treatment outcomes among homeless patients in Portugal and to identify predictors of unsuccessful TB treatment outcomes among the homeless.DESIGN:
This was a retrospective cohort study of all TB patients notified in Portugal from 2008 to 2014. Characteristics of homeless TB patients were assessed and predictors of unsuccessful TB treatment were determined using logistic regression.RESULTS: TB incidence among the homeless was 122/100 000
homeless persons and was positively correlated with TB incidence among non-homeless persons. Homeless TB patients had a higher prevalence of alcohol and/or drug use, human immunodeficiency virus (HIV) co-infection, cavitary TB and smear positivity. The rate of unsuccessful treatment outcomes
among the homeless was 28.6%, and was significantly associated with increased age, injection drug use (IDU) and HIV co-infection.CONCLUSION: TB incidence among homeless persons was five times that among the non-homeless, and higher in regions with greater TB incidence among non-homeless
persons. The successful treatment outcome rate was lower. Predictors of unsuccessful treatment were age, IDU and HIV co-infection. Integrated TB programmes targeting homeless and non-homeless patients, with measures targeting specific characteristics, may contribute to TB elimination in Portugal.