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Article |

Endemic Tuberculosis Among Homeless Men in New York City

John Concato, MD, MS, MPH; William N. Rom, MD, MPH
Arch Intern Med. 1994;154(18):2069-2073. doi:10.1001/archinte.1994.00420180077009.
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Objectives:  The purpose of the study was to describe demographic and clinical characteristics of patients at the only long-term care facility for homeless men with tuberculosis in New York City, and to evaluate the outcome of a directly observed therapy program for these men.

Methods:  The study population included residents at the "tuberculosis unit" for men in the New York City municipal shelter system. A cross-sectional survey described the characteristics of 76 men in the unit during November 1991. A retrospective cohort study evaluated 104 consecutive admissions to the facility from October 1, 1990, through March 30, 1991, and determined the outcome of directly observed therapy.

Results:  Cross-sectional survey (n=76). The median age was 43 years (range, 25 to 60 years); 67 patients (88%) had pulmonary tuberculosis. Among 58 isolates of Mycobactarium tuberculosis, eight were resistant to one drug (14%) and an additional nine were resistant to at least two drugs (16%). A history of previous treatment was associated with an odds ratio of 5.1 for having multiple drug-resistant tuberculosis (exact 95% confidence interval, 0.8 to 53.5). Retrospective cohort (n=104). Excluding 21 men whose care was transferred to other agencies or institutions, 39 (47%) of 83 subjects completed or were still receiving treatment after 12 months and 44 (53%) of 83 subjects failed to complete the program.

Conclusions:  As expected, previous treatment for tuberculosis among homeless men is associated with an increased risk of having multiple-drug resistance. A directly observed therapy program successfully treated less than half of the enrolled subjects. Increased efforts are needed to control the spread of tuberculosis among homeless individuals.(Arch Intern Med. 1994;154:2069-2073)


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