A targeted testing program for tuberculosis control and prevention among Baltimore city's homeless population

To identify cases of latent tuberculosis infection (LTBI) and improve access to TB treatment among the inner-city homeless.

This is an intervention study describing the impact of a public health program on TB prevention and control.

The target population for the project was residents and recent graduates of a residential addictions recovery program in a faith-based, inner-city mission.

Faculty and student nurses administered purified protein derivative (PPD) tuberculin skin tests and TB symptom assessments on site to homeless Mission residents. Residents testing positive for TB infection were referred to the local city health department for follow-up. Residents placed on prophylactic therapy received intensive tracking and coaching interventions to encourage adherence to the 9-month regimen.

Ninety-eight percent of the target population was screened for LTBI. Ninety percent of residents requiring treatment for LTBI successfully accessed treatment services. Thirty-three percent of residents completed at least 6 months of treatment.

The program demonstrated a modest improvement in treatment completion among the inner-city homeless when compared with local City Health Department treatment completion rates. This program demonstrates how a faith-based organization, an academic institution, and local government can successfully partner together to meet community needs.