The Spectrum of Tuberculosis in a New York City Men's Shelter Clinic (1982-1988)

McAdam, John M.; Brickner, Philip W.; Scharer, Lawrence; Crocco, John A.; Duff, Amy

doi:10.1378/chest.97.4.798

Cited by 68 publications

(24 citation statements)

References 19 publications

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“…[80][81][82] Not surprisingly, previous studies with homeless populations have obtained compliance rates under 50% with TB evaluation and treatment for both active and inactive disease even when directly observed therapy was used. 56,[83][84][85] Suggestions to improve compliance include shorter courses of treatment, 86 as well as directly observed isoniazid therapy administered twice a week. 87,88 Almost 80% of our subjects with a positive skin test reported seeking medical attention after being informed of their condition.…”

Section: Discussionmentioning

confidence: 99%

“…Prevalences varied from 32%, 57 to 44%, 56 , to 79%. 54 Factors associated with TB skin test positivity in these studies included age, 56,57 African-American ethnicity, 56 injection drug use, 56,57 duration of homelessness, 57 and length of stay in shelters 54,56,57 or in single-room-occupancy hotels. 57 Previous incarceration, psychiatric hospitalization, and medical hospitalization were not associated with TB infection.…”

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confidence: 99%

See 1 more Smart Citation

Tuberculosis Skin Testing Among Homeless Adults

Gelberg

Panarites²,

Morgenstern

et al. 1997

J Gen Intern Med

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OBJECTIVE:To document the prevalence of tuberculosis (TB) skin test positivity among homeless adults in Los Angeles and determine whether certain characteristics of homelessness were risk factors for TB. DESIGN:Cross-sectional study. SETTING: Shelters, soup lines, and outdoor locations in the Skid Row and Westside areas of Los Angeles.PARTICIPANTS: A representative sample of 260 homeless adults. MEASUREMENTS AND MAIN RESULTS:Tuberculosis tine test reactivity was measured. The overall prevalence of TB skin test positivity was 32%: 40% in the inner-city Skid Row area and 14% in the suburban Westside area. Using multiple logistic regression, TB skin test positivity was found to be associated with living in crowded or potentially crowded shelter conditions, long-term homelessness, geographic area, history of a psychiatric hospitalization, and age. nderstanding the epidemiology of tuberculosis (TB) among the homeless, as well as other high-risk populations, is critical. Despite relatively recent predictions that TB could be eradicated in the United States by the year 2010, 1-3 we have been confronted by a sharp rise in active TB (10% increase between 1985 and 1994) 4 and an increase in multidrug-resistant TB since 1985 when reported cases of TB reached their lowest levels since national reporting began in 1953. [4][5][6][7] This increase in active TB has also led to increased numbers of individuals with newly acquired asymptomatic TB infection resulting from contact with persons with active contagious disease. Such individuals are at increased risk of developing active disease: the 1-year risk of becoming an active case is 3% within 1 year of infection and 0.5% in each subsequent year after 2 years of infection. 8 A multiplicity of factors, including the HIV/AIDS epidemic, increasing poverty and homelessness in America's cities, illicit drug use, budgetary constraints on local health departments, immigration from high-prevalence nations, and high rates of noncompliance among TB patients, have contributed to the resurgence of TB. [9][10][11][12][13][14][15][16][17][18][19][20][21][22] Previous research on homeless adults demonstrated their elevated risk of asymptomatic TB infection, active disease, and multidrug-resistant TB. [23][24][25][26][27][28] Further, reports have cited outbreaks of TB in emergency shelters for the homeless in Boston and Ohio,29,30 as well as in a neighborhood bar frequented by a homeless person with active disease. 31 Why is the risk of TB increased among homeless persons? Among the homeless, men outnumber women approximately four to one and ethnic and racial minority groups, especially African Americans, are overrepresented. [32][33][34] A disproportionate number of individuals with serious mental health problems (including previous psychiatric hospitalization), or a history of substance dependence, have been found among the homeless, and a significant number of homeless persons have dual diagnoses of mental illness and substance dependence. [35][36][37][38] Further, homeless persons have gr...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Tuberculosis Skin Testing Among Homeless Adults

Gelberg

Panarites²,

Morgenstern

et al. 1997

J Gen Intern Med

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“…But the most important means of ensuring compliance is, in fact, the implementation of directly observed therapy (DOT), which can be achieved with daily, twice weekly or thrice weekly administration of medication with presently available regimens [57,58,90,91]. Even high-risk groups for noncompliance, such as homeless individuals and patients with drug-resistant disease, have responded to such therapy [92,93]. Organization of DOT and comprehensive services certainly have significant financial implications, but the cost of treating patients with MDR-TB even in small numbers is enormously larger [3,91].…”

Section: Patient Compliance and Drug-resistant Tuberculosismentioning

confidence: 99%

Drug-resistant tuberculosis in the 1990s

Ch²

1995

Eur Respir J

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D Dr ru ug g--r re es si is st ta an nt t t tu ub be er rc cu ul lo os si is s i in n tABSTRACT: There has been an upsurge of tuberculosis in many parts of the world in the past decade. The high rates of drug-resistant tuberculosis currently reported in many countries are alarming. The most catastrophic phenomenon is the emergence of multidrug-resistant strains of Mycobacterium tuberculosis. These organisms have caused epidemic outbreaks in nosocomial and health-care settings in the USA and some European countries. In addition to immigration, poverty, alcoholism and intravenous substance abuse, human immunodeficiency virus (HIV) infection has also had a significant impact on the prevalence of drug resistance, since amongst these patient groups a common factor giving rise to drug resistance is noncompliance.Rapid drug susceptibility tests are needed, and effective chemotherapy regimens with newly developed drugs in combination with traditional second-line antituberculosis agents for established multidrug-resistant tuberculosis are urgently being sought. There is also a quest for other novel modalities of therapy. Measures should be actively adopted to prevent the development of drug resistance. Well formulated short-course chemotherapy as initial treatment and ensurance of compliance are the most important components. The organization of a national tuberculosis control programme with a sound and adequately functioning infrastructure remains the most effective strategy to combat the resurgence of tuberculosis and to curtail drug resistance.

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“…Homeless people have been identified as a high-risk population for TB infection and disease since the early 1900s [Knopf 1914]. With the increase in homelessness in the United States since the 1980s, TB among homeless persons has become a subject of heightened interest and concern [CDC 1985;1992;2003a,b;2005a;Barry et al 1986;Slutkin 1986;McAdam et al 1990;Nolan 1991].…”

Section: Introductionmentioning

confidence: 99%

Health hazard evaluation report: evaluation of environmental controls at a homeless shelter associated with a tuberculosis outbreak - Texas.

2014

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The Spectrum of Tuberculosis in a New York City Men's Shelter Clinic (1982-1988)

Cited by 68 publications

References 19 publications

Tuberculosis Skin Testing Among Homeless Adults

Tuberculosis Skin Testing Among Homeless Adults

Drug-resistant tuberculosis in the 1990s

Health hazard evaluation report: evaluation of environmental controls at a homeless shelter associated with a tuberculosis outbreak - Texas.

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