Background: A collaborative public health effort, in response to an outbreak of tuberculosis (TB) at a men's homeless shelter, was studied.
Methods: In 1999, a coalition of health care providers, shelter administration, shelter staff and the health department implemented a TB Control Plan. A two-month course of pyrazinamide (PZA) and rifampin was used for latent tuberculosis infection (LTBI) treatment, unless contraindicated. Engineering and administrative controls were implemented.
Results: During 30 months, there were 21 cases of active TB. In 20 of the cases, two genotypes were identified ascertaining that the incidence of primary (recently acquired) TB was 85.7%. HIV co-infection occurred in 38% of the patients. Thirty-five residents were identified as having been inadequately or never treated for LTBI. Twenty-five clients started treatment (with PZA and Rifampin) and 15 (43%) remained in care. From the 35 needing therapy, 11 (31%) completed therapy. Fourteen were lost to follow-up. All patients tolerated the treatment regimen well except for one. Five (14%) were unable to take the dual-drug regimen due to potential drug interactions or elevated liver enzymes. There have been no additional active TB cases during six months of follow-up.
Conclusion: Two months of pyrazinamide and rifampin showed to be a viable option for treatment of LTBI in homeless shelters. This strategy appears efficacious.
Learning Objectives: N/A
Keywords: Treatment Adherence, Tuberculosis
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.