Management of tuberculosis in urban homeless indigents

Tuberculosis patients who are homeless, indigent, and alcoholic infrequently complete a course of chemotherapy, risking treatment failure, recurrence, and continued spread of infection in the community. Obstacles to successful treatment include an erratic schedule, mistrust of authority, and uncooperative or aggressive behavior. Successful management of this problem requires the use of proven case holding techniques, a correct choice of drug regimen, and a prompt and appropriate response to the patient who is lost or refuses treatment. Nine- and six-month drug regimens with proven success are now available; however, the direct observation of medication-taking should be maximized. Patient default may be further minimized by encouraging prompt notification of the health department. Occasionally, the threat or use of existing public health laws on confinement for purposes of treatment are required for noncompliant patients.