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Related Experiment Videos

Tuberculosis in the homeless. A prospective study.

A R Moss1, J A Hahn, J P Tulsky

  • 1Department of Epidemiology, Biostatistics, and Medicine, University of California San Francisco, San Francisco, USA.

American Journal of Respiratory and Critical Care Medicine
|August 10, 2000
PubMed
Summary

Tuberculosis is highly prevalent in San Francisco

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Area of Science:

  • Epidemiology
  • Infectious Diseases
  • Public Health

Background:

  • Tuberculosis (TB) remains a significant public health concern, particularly within vulnerable populations.
  • The homeless population faces unique challenges that can increase TB risk and transmission.
  • Understanding TB incidence and transmission dynamics in this group is crucial for effective control.

Purpose of the Study:

  • To determine the incidence of tuberculosis among the homeless in San Francisco.
  • To identify independent risk factors associated with tuberculosis development in this population.
  • To investigate the molecular transmission patterns of tuberculosis within the homeless cohort.

Main Methods:

  • A cohort study of 2,774 homeless individuals in San Francisco, followed from 1990-1994.

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  • Incident TB cases were identified and analyzed for demographic and clinical risk factors.
  • Molecular methods, including restriction fragment length polymorphism (RFLP), were used to assess TB transmission patterns.

    • Main Results:

    • An overall TB incidence of 270 per 100,000 per year was observed.
    • Significantly higher incidence rates were noted in African Americans (350/100,000) and other nonwhites (450/100,000).
    • Independent risk factors included HIV infection, nonwhite ethnicity, positive tuberculin skin test (TST), age, and lower education.
    • Sixty percent of TB cases showed clustered RFLP patterns, indicating recent transmission.
    • Clustering was particularly high among African Americans (77%) and HIV-seropositive individuals (88%).

    Conclusions:

    • The high TB rate in the homeless is driven by recent transmission, especially in HIV-positive and nonwhite individuals.
    • African Americans and other nonwhites may be at increased risk for TB infection or rapid disease progression.
    • Recommended control measures include directly observed therapy, incentives, treatment of latent TB infection in HIV-positive individuals, and targeted screening.