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TB Notes Newsletter

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No. 1, 2014


Report on the DTBE Homeless Work Group

As TB incidence decreases in the United States, focus has turned toward populations at high risk for exposure to M. tuberculosis and for progression to TB disease. One important group includes persons experiencing homelessness. In the United States, the condition of being homeless within 12 months of TB diagnosis is reported in about 6% of TB cases. The common use of congregate settings such as shelters increases the possibility of exposure to TB. This population has high TB case rates relative to the general population—homeless people have a 10-fold higher risk of TB than the general population. In addition, homeless persons have higher rates of HIV infection, substance use, and mental illness than the general population, thereby increasing their likelihood of progressing to TB disease.

Over the last decade, CDC has been involved in helping to investigate and control numerous TB outbreaks involving homeless persons. These recent investigations have demonstrated that outbreaks including TB patients who are homeless involve large numbers of persons (both secondary cases and contacts), relative to those outbreaks not including homeless patients. Despite the recognized risk of TB among persons experiencing homelessness, few evidence-based TB control practices are directed toward interruption of M. tuberculosis transmission in this population.

To help address these issues, DTBE has convened a work group to address TB among persons experiencing homelessness. The mission of the DTBE Homeless Work Group (HWG) is to facilitate the prevention, control, and elimination of TB among persons experiencing homelessness.

One of the first activities of the HWG was to assist in coordination of a meeting regarding TB control with other federal and non-profit agencies that work addressing housing and healthcare in persons experiencing homelessness. The U.S. Interagency Council on Homelessness hosted the meeting. In attendance were representatives of the departments of Housing and Urban Development, Health and Human Services, and Veterans Affairs, the Substance Abuse and Mental Health Services Agency, the National Health Care for the Homeless Council, the National TB Controllers Association, Stop TB, the National Alliance to End Homelessness, and the National HIV/AIDS Housing Coalition, among others. Drs. John Bernardo and Sapna Morris presented information regarding TB infection and disease, and how TB affects persons experiencing homelessness. The information was well received, and many of the attendees acknowledged that their grantees may not be aware of the potential problems that TB disease or infection could present for their agencies or the risk of transmission that could occur if a patient were to go undiagnosed.

Plans have been made for DTBE and local TB programs to provide educational messages to these federal and non-profit partner agencies on TB infection, TB disease, and infection control measures (or measures to reduce transmission). In addition, these partner agencies are enthusiastic about sharing educational messages on housing, substance use treatment, and advocacy for persons experiencing homelessness with TB control programs.

Reported by Sapna Bamrah Morris, MD
Div of TB Elimination

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