Introduction: Tuberculosis (TB) outbreaks continue to affect people experiencing homelessness in the US. The homeless also suffer greater consequences of TB disease. A resurgent outbreak of TB occurred among homeless persons in a large US metropolitan city from 2014-2016. In response, active case finding was implemented to find and treat TB cases, and halt disease transmission. A TB testing mandate was enacted that required regular TB testing of persons entering homeless facilities. Educational campaigns were designed to alert the homeless population of the ongoing outbreak and encourage testing. Using novel data, we evaluated the impact of these citywide interventions on TB awareness and compliance with the testing mandate among the homeless.
Methods: Data from a cross-sectional survey of homeless persons in Atlanta, GA in January 2016 were analyzed to determine patient characteristics that could best predict non-compliance with the TB testing mandate and lack of awareness of the current TB outbreak. Bivariate analysis was performed among demographic and medical history variables. Logistic regression was performed to build models to predict a person's odds of non-compliance with the testing mandate and to predict a person's odds of unawareness of the TB outbreak.
Results: Compliance with the testing mandate and awareness of the outbreak rose from 2015 to 2016. Non-compliance with the testing mandate was significantly lower among persons who resided in homeless shelters (aOR: 0.48; 95%CI: 0.32, 0.72) and among persons who were aware of the current TB outbreak (aOR: 0.28; 95%CI: 0.20, 0.40). Lack of awareness of the outbreak was associated with living outside a shelter (aOR: 0.55; 95%CI: 0.40, 0.76), non-compliance with the TB testing mandate (aOR: 0.28; 95%CI: 0.20, 0.41), and being male (aOR: 0.58; 95%CI: 0.39, 0.85).
Conclusions: Active case finding through mandated TB screening and educational outreach efforts were able to target a large portion of the homeless people who reside in homeless facilities in Atlanta. Widespread implementation of administrative controls in other cities could help reduce TB outbreaks in the homeless population. Public health efforts targeting unsheltered homeless persons may improve the reach of future interventions aimed at TB control in these communities.
Table of Contents
CHAPTER I: BACKGROUND/LITERATURE REVIEW-1
Tuberculosis Among the Homeless-3
Tuberculosis Outbreak in Atlanta, 2014-6
Point In Time Dataset-10
Study Purpose/Specific Aims-12
CHAPTER II: MANUSCRIPT-13
CHAPTER III: SUMMARY, PUBLIC HEALTH IMPLICATIONS, AND POSSIBLE FUTURE DIRECTIONS-26
Public Health Implications-26
Possible Future Directions-27
LETTER OF IRB EXEMPTION-36
About this Master's Thesis
|Committee Chair / Thesis Advisor|
|THE IMPACT OF TARGETED INTERVENTIONS ON PREVALENCE AND PREDICTORS OF TB AWARENESS AND LTBI TESTING AMONG THE HOMELESS DURING A LARGE TB OUTBREAK, 2015-2016 ()||2018-08-28||