Impact of Targeted Local Interventions on Tuberculosis Awareness and Screening Among Persons Experiencing Homelessness During a Large Tuberculosis Outbreak in Atlanta, Georgia, 2015-2016

Abstract

Objectives Tuberculosis (TB) outbreaks disproportionately affect persons experiencing homelessness (PEH) in the United States. During 2014-2016, a resurgent TB outbreak occurred among PEH in Atlanta, Georgia. To control the outbreak, citywide policies and educational interventions were implemented in January 2015. Policy changes standardized and enforced TB screening requirements for PEH in homeless shelters. Educational campaigns informed PEH of the outbreak and encouraged TB screening. We evaluated factors associated with, and the effect policy changes and educational interventions had on, TB screening and awareness among PEH in Atlanta. Methods Questions related to TB screening and awareness of the outbreak were added to an annual US Department of Housing and Urban Development survey of PEH in Atlanta in 2015 (n = 296 respondents) and 2016 (n = 1325 respondents). We analyzed the 2016 survey data to determine characteristics associated with outcomes. Results From 2015 to 2016, reported TB screening increased from 81% to 86%, and awareness of the TB outbreak increased from 68% to 75%. In 2016, sheltered PEH were significantly more likely than unsheltered PEH to report being evaluated for TB in the previous 6 months (prevalence odds ratio [pOR] = 3.18; 95% confidence interval [CI], 2.28-4.47) and to report being aware of the TB outbreak (pOR = 4.00; 95% CI, 2.89-5.55). Conclusions Implementation of required TB screening and educational interventions may reduce the incidence and severity of TB outbreaks among PEH in other communities. Furthermore, the annual survey of PEH offers an opportunity to collect data to better inform practices and policies.

Assessment of contact tracing for COVID-19 among people experiencing homelessness, Salt Lake County Health Department, March–May 2020

“…Limiting movement may help reduce the large number of PEH who could not be located or contacted. Leveraging partnerships that provide services to shelters, routinely collecting and maintaining records of shelter residents, providing educational interventions, and implementing administrative controls and policy changes are among approaches taken to facilitate contact investigations and reduce the severity of tuberculosis outbreaks [ 10 , 11 , 12 ]. Similar approaches can be adapted for COVID-19.…”

Occupational exposures and mitigation strategies among homeless shelter workers at risk of COVID-19

“…Homeless shelters have previously experienced outbreaks such as tuberculosis, hepatitis A and invasive bacterial disease. [16][17][18][19] Control measures have primarily focused on controlling the outbreak among the client population rather than shelter workers. In a study of occupational exposures to infectious agents, an estimated 32.4% of community and social services sector workers are exposed > 1 time/month to infection or disease; 7.7% are estimated to be exposed > 1 time/week.…”

Tuberculosis in Adolescents and Young Adults: Emerging Data on TB Transmission and Prevention among Vulnerable Young People

“…Limited data show that these vulnerable AYA develop TB infection and disease at higher rates than other AYA. AYA who experience homelessness or incarceration likely have a higher risk for acquiring TB because they live in congregate settings that support TB transmission [55][56][57]. Data on TB incidence in AYA who use tobacco are minimal.…”