 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
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| The 131st Annual Meeting (November 15-19, 2003) of APHA |
Syed N. Khalil, PhD, MPH1, Larry D. Teeter, PhD2, Tung Bui, MD2, James M. Musser, MD, PhD3, and Edward A. Graviss, PhD, MPH2. (1) Pathology, Houston Tuberculosis Initiative 209E, Baylor College of Medicine, One Baylor Plaza, Texas Medical Center, Houston, TX 77030, 713 798-8809, skhalil@bcm.tmc.edu, (2) Department of Pathology, Baylor College of Medicine, One Baylor Plaza (209E), Texas Medical Center, Houston, TX 77030, (3) Rocky Mountain Laboratories, NIAID, NIH, 903 South 4th Street, Hamilton, MT 59840
Background: Several studies have suggested that HIV seropositive (HIV+) TB cases are less infectious than HIV seronegative (HIV-). We analyzed this relationship in the context of TB patients with a history of homelessness and their contacts.
Methods: Demographic, clinical and laboratory data were collected on TB cases enrolled in an on-going population-based surveillance project in Houston, Texas. Outcomes of contact investigations of TB cases conducted by the City of Houston Department of Health and Human Services were analyzed by HIV serostatus of the index case. Index cases had a history of homelessness and pulmonary TB diagnosed between 10/1/95 and 9/30/99. TB transmission to contacts was assessed by the outcome of tuberculin skin tests (TST), chest roentgenograms and clinical impression.
Results: A total of 350 pulmonary TB cases, 108 HIV+ and 242 HIV-, with a history of homelessness and diagnosed during the study period were enrolled. Contacts were identified for 92 (85.2%) HIV+ and 187 (77.3%) HIV- index cases, totaling 850 and 1659 respectively. Presumed TB transmission occurred from HIV+ index cases to 36 contacts, and from HIV- cases to 81 contacts. Overall, HIV+ cases were less likely to transmit TB to contacts that were friends or household members than HIV- cases (P<0.001). However, HIV+ cases were more likely to infect contacts from a work or school setting than HIV- cases (P<0.001).
Conclusion: Our data provide a more comprehensive picture of TB transmission dynamics among the homeless and their contacts. These results should benefit TB Control program(s) evaluation.
Learning Objectives:
Keywords: Homelessness, TB
Presenting author's disclosure statement:
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.