THE EFFECT OF ALTERNATIVE HOUSING SUPPORT FOR HOMELESS PERSONS WITH TUBERCULOSIS IN FULTON AND DEKALB COUNTIES IN GEORGIA 2009- 2016 Public
Anyalechi, Ndubuisi Kingsley (Spring 2020)
Published
Abstract
Introduction. Tuberculosis (TB) is a contagious infectious disease that has been a permanent challenge throughout human history. Mycobacterium TB (M. TB), the bacteria that causes TB has been present for over 70,000 years, and it currently infects nearly 2 billion people worldwide, with around 10.4 million new cases of TB each year. In 2017, 10 million people fell ill with TB, and 1.6 million died from the disease (including 300,000 people infected with the human immunodeficiency syndrome). While the rate of TB among the United States (US) homeless persons may be 20 times that of the general adult population, studies suggest that most urban homeless TB cases are attributable to ongoing transmission of TB within the homeless group. Since 1996, the State of Georgia TB Program has been housing homeless TB patients through the Alternative Housing Project (AHP) in partnership with the American Lung Association (ALA) to facilitate Directly Observed Therapy (DOT), ensure TB treatment completion, and prevent TB transmission in this population and the community.
Methods. The study is a quantitative retrospective study on homeless TB patients in the US between January 2009 and December 2016. The study aims: to analyze the effect of the AHP on TB treatment completion rates amongst homeless TB patients in Fulton and Dekalb Counties Georgia (FAD); to compare the FAD TB treatment completion rates amongst homeless TB patients with national rates; and to determine the relationship of substance abuse to completion rates. Data for the 175 FAD TB patients participating in the AHP were obtained from the ALA and verified with the State Electronic Notification Disease Surveillance System (SENDSS). The data for the 2,549 homeless TB patients in the national group was obtained from the Centers for Disease Control and Prevention’s National TB Surveillance System through the Wide-ranging On-Line data for Epidemiologic Research. Descriptive statistics were conducted on the patients in both groups, and Pearson’s Chi-square was conducted to determine the relationship between AHP and completion rates; while the odds ratios and 95% Confidence Intervals were used to determine the relationship of substance use with completion rates and alternative housing and completion rates.
Results. Overall TB completion rates were higher in FAD (93%) when compared to national (85%). There was no significant relationship between substance use and TB completion for the FAD (0R 0.350 95% CI (0.121, 1.007)) and National (OR 1.103 95%CI (0.887,1.372) populations. There was a significant relationship AHP and TB completion (OR 2.278 95%CI [1.282, 4.049]).
Discussion. The available evidence of the effect of a structured intervention on treatment initiation, adherence and completion presented in this study suggests that AHP is an effective program in FAD and Georgia and can be replicated in other parts of the U.S. to improve the treatment outcome of homeless TB patients.
Table of Contents
Chapter One: Introduction.....................1
Chapter Two: Literature review……………6
Chapter Three: Methodology………………18
Ethical review……………………………..18
Study Aim………………………………….18
Study population………………………...18
TB Treatment completion data……….20
Data Analysis…………………………….20
Results…………………………………….22
Chapter Four: Discussion…………………..24
References……………………………………..28
Table 1………………………………………….32
Table 2………………………………………….32
Figure 1…………………………………………33
Appendices ……………………………………34
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