Impact of Active Case-Finding on Tuberculosis Transmission Among the Homeless in Fulton County, Georgia, 2010-2015: Secondary Data Analysis Open Access

Abstract

Despite the efforts of the active-case finding program to detect and prevent tuberculosis (TB) transmission among the homeless shelters in Fulton County, there was an increase in the number of isoniazid-resistant TB among homeless persons in the county in 2014-2015.

To assess the impact of active-case finding on the transmission of TB among the homeless population in Fulton County.

A secondary de-identified data analysis was conducted using the Fulton County Department of Health and Wellness TB database on 344 cases with their cohort of 4472 contacts identified from January 01, 2010- December 31, 2015.

Of 344 cases of TB reported from 2010-2015, 110 (32%) occurred among the homeless. The mean age for the homeless cases was 50 years, with a median of 51 years (range 3-75 years), with the 45-64-year group comprising 75% of the homeless cases. The homeless cases were 88% male, 86% black, 91% US-born and 37% HIV positive. Treatment completion rate was 89% among both homeless and non-homeless cases. Directly observed therapy was used in 100% of the homeless cases compared to 94% among the non-homeless cases (p<0.0016). A mean of 7 high-risk contacts were elicited per case with a mean of 12 (median 13) days between case identification and interview of contacts. Evaluation was completed among 86% of homeless contacts. However, treatment completion rate for contacts to homeless cases was 8% lower than the state target for 2015 (67% vs. 75%) and 12% lower than the national target (67% vs.79%). Five TB cases (0.3%) and 102 (5.2%) cases of Latent Tuberculosis Infection were identified among 1948 contacts who completed evaluation.

The active-case finding program identified 0.3% additional TB cases and appeared to be effective in preventing TB transmission among the homeless population in Fulton County from 2010-2015. However, the study found lower treatment completion rate among contacts to homeless TB cases. Further studies need to be conducted to assess the factors associated with lower treatment completion rate among contacts to homeless TB cases in Fulton County.

Table of Contents

List of Figures....................................................................................................................................................................viii . viii

Background and Aims.....................................................................................................................................................1 . 1

Methods.............................................................................................................................................................................3 . 3

Data Analysis and IRB "Non-research" Determination...........................................................................................5 . 5

Results.................................................................................................................................................................................5 . 5

Reported TB Cases............................................................................................................................................................6 . 6

Demographic Characteristics...........................................................................................................................................6 . 6

Risk Factors for TB Transmission....................................................................................................................................7 . 7

Disease Characteristics......................................................................................................................................................7 . 7

TB Treatment and Outcomes............................................................................................................................................8

Outcomes of Contact Investigation................................................................................................................................11 . 11

Time to contact interview.................................................................................................................................................11 .. 11

Characteristics of Contacts................................................................................................................................................11 . 11

TST Placement and Positivity..........................................................................................................................................12 . 12

Chest Radiograph...............................................................................................................................................................12 . 12

Evaluation Completion......................................................................................................................................................12 . 12

Diagnosis of TB....................................................................................................................................................................12 .. 12

Therapy Recommendation.................................................................................................................................................13 . 13

Type of treatment Regimen................................................................................................................................................13 . 13

Completion of Therapy......................................................................................................................................................13

Discussion...............................................................................................................................................................................15 . 15

Conclusions...........................................................................................................................................................................18 . 18

References...............................................................................................................................................................................18 . 18

List of Figures

Figure 1.................................................................................................................................................................................2

Figure 2..................................................................................................................................................................................6

Figure 3............................................................................................................................................................................. ..11

List of Tables

Table 1.....................................................................................................................................................................................9

Table 2......................................................................................................................................................................................14

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	HIV Tuberculosis Isoniazid-resistant Secondary Data Analysis Fulton County, Atlanta, Georgia Homeless population Treatment completion Directly Observed Therapy Active case-finding
Committee Chair / Thesis Advisor	Castro, Kenneth G, Emory University
Committee Members	Holland, David P, Emory University
Partnering Agencies	Does not apply (no collaborating organization)

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