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Waddell CJ, Saldana CS, Schoonveld MM, Meehan AA, Lin CK, Butler JC, Mosites E. Infectious Diseases Among People Experiencing Homelessness: A Systematic Review of the Literature in the United States and Canada, 2003-2022. Public Health Rep 2024; 139:532-548. [PMID: 38379269 PMCID: PMC11344984 DOI: 10.1177/00333549241228525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024] Open
Abstract
Homelessness increases the risk of acquiring an infectious disease. We conducted a systematic review of the literature to identify quantitative data related to infectious diseases and homelessness. We searched Google Scholar, PubMed, and SCOPUS for quantitative literature published from January 2003 through December 2022 in English from the United States and Canada. We excluded literature on vaccine-preventable diseases and HIV because these diseases were recently reviewed. Of the 250 articles that met inclusion criteria, more than half were on hepatitis C virus or Mycobacterium tuberculosis. Other articles were on COVID-19, respiratory syncytial virus, Staphylococcus aureus, group A Streptococcus, mpox (formerly monkeypox), 5 sexually transmitted infections, and gastrointestinal or vectorborne pathogens. Most studies showed higher prevalence, incidence, or measures of risk for infectious diseases among people experiencing homelessness as compared with people who are housed or the general population. Although having increased published data that quantify the infectious disease risks of homelessness is encouraging, many pathogens that are known to affect people globally who are not housed have not been evaluated in the United States or Canada. Future studies should focus on additional pathogens and factors leading to a disproportionately high incidence and prevalence of infectious diseases among people experiencing homelessness.
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Affiliation(s)
- Caroline J. Waddell
- Office of Readiness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Carlos S. Saldana
- Division of Infectious Disease, School of Medicine, Emory University, Atlanta, GA, USA
| | - Megan M. Schoonveld
- Office of Readiness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Oak Ridge Institute for Science and Education, US Department of Energy, Oak Ridge, TN, USA
| | - Ashley A. Meehan
- Office of Readiness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christina K. Lin
- Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Jay C. Butler
- Office of Readiness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Division of Infectious Disease, School of Medicine, Emory University, Atlanta, GA, USA
| | - Emily Mosites
- Office of Readiness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Greenwald MA, Edwards N, Eastlund DT, Gurevich I, Ho APZ, Khalife G, Lin-Torre J, Thompson HW, Wilkins RM, Alrabaa SF. The American Association of Tissue Banks tissue donor screening for Mycobacterium tuberculosis-Recommended criteria and literature review. Transpl Infect Dis 2024:e14294. [PMID: 38852068 DOI: 10.1111/tid.14294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/12/2024] [Accepted: 04/25/2024] [Indexed: 06/10/2024]
Abstract
After two multistate outbreaks of allograft tissue-transmitted tuberculosis (TB) due to viable bone, evidence-based donor screening criteria were developed to decrease the risk of transmission to recipients. Exclusionary criteria, commentary, and references supporting the criteria are provided, based on literature search and expert opinion. Both exposure and reactivation risk factors were considered, either for absolute exclusion or for exclusion in combination with multiple risk factors. A criteria subset was devised for tissues containing viable cells. Risk factors for consideration included exposure (e.g., geographic birth and residence, travel, homelessness, incarceration, healthcare, and workplace) and reactivation (e.g., kidney disease, liver disease, history of transplantation, immunosuppressive medications, and age). Additional donor considerations include the possibility of sepsis and chronic illness. Donor screening criteria represent minimal criteria for exclusion and do not completely exclude all possible donor TB risks. Additional measures to reduce transmission risk, such as donor and product testing, are discussed but not included in the recommendations. Careful donor evaluation is critical to tissue safety.
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Affiliation(s)
- Melissa A Greenwald
- American Association of Tissue Banks, McLean, Virginia, USA
- Uniformed Services University, Bethesda, Maryland, USA
- Donor Alliance, Denver, Colorado, USA
| | | | | | | | | | - Ghada Khalife
- Solvita, Dayton, Ohio, USA
- Wright State University, Dayton, Ohio, USA
| | - Janet Lin-Torre
- MTF Biologics, Edison, New Jersey, USA
- Department of Medicine, Cooperman Barnabas Medical Center, Livingston, New Jersey, USA
| | | | | | - Sally F Alrabaa
- University of South Florida, Morsani College of Medicine, Tampa, Florida, USA
- LifeLink Tissue Bank, Tampa, Florida, USA
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3
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Besrat BN, Mosites E, Montgomery MP, Garcia-Williams AG, Trautner E, Clarke KEN, Marshall B, Vassell C, Rutt C, Jones SL. A qualitative assessment of cleaning and hand hygiene practices at shelters serving people experiencing homelessness during the COVID-19 pandemic, Atlanta, GA - May-June, 2020. BMC Public Health 2024; 24:247. [PMID: 38254119 PMCID: PMC10801948 DOI: 10.1186/s12889-023-16504-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 08/10/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Cleaning practices and hand hygiene are important behaviors to prevent and control the spread of infectious disease, especially in congregate settings. This project explored hygiene- and cleaning-related experiences in shelters serving people experiencing homelessness (PEH) during May-June 2020 of the COVID-19 pandemic. METHODS We conducted qualitative, in-depth interviews by phone with 22 staff from six shelters in Atlanta, Georgia. The interview guide included questions about cleaning routines, cleaning barriers and facilitators, cleaning promotion, hand hygiene promotion, and hand hygiene barriers and facilitators. We analyzed interview transcripts using thematic analysis. RESULTS Multiple individuals, such as shelter individuals (clients), volunteers, and staff, played a role in shelter cleaning. Staff reported engaging in frequent hand hygiene and cleaning practices. Barriers to cleaning included staffing shortages and access to cleaning supplies. Staff reported barriers (e.g., differing perceptions of cleanliness) for clients who were often involved in cleaning activities. Barriers to hand hygiene included limited time to wash hands, forgetting, and inconvenient handwashing facilities. Specific guidance about when and how to clean, and what supplies to use, were requested. CONCLUSION During the early months of the COVID-19 pandemic, shelters serving PEH in the Atlanta-metro area needed resources and support to ensure sufficient staffing and supplies for cleaning activities. As part of future pandemic planning and outbreak prevention efforts, shelters serving PEH could benefit from specific guidance and training materials on cleaning and hand hygiene practices.
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Grants
- 20-15-1671, 20-15-1682, 20-15-1678 Emergency Resource Request (ERR)
- 20-15-1671, 20-15-1682, 20-15-1678 Emergency Resource Request (ERR)
- 20-15-1671, 20-15-1682, 20-15-1678 Emergency Resource Request (ERR)
- 20-15-1671, 20-15-1682, 20-15-1678 Emergency Resource Request (ERR)
- 20-15-1671, 20-15-1682, 20-15-1678 Emergency Resource Request (ERR)
- 20-15-1671, 20-15-1682, 20-15-1678 Emergency Resource Request (ERR)
- 20-15-1671, 20-15-1682, 20-15-1678 Emergency Resource Request (ERR)
- 20-15-1671, 20-15-1682, 20-15-1678 Emergency Resource Request (ERR)
- 20-15-1671, 20-15-1682, 20-15-1678 Emergency Resource Request (ERR)
- 20-15-1671, 20-15-1682, 20-15-1678 Emergency Resource Request (ERR)
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Affiliation(s)
- Bethlehem N Besrat
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA
| | - Emily Mosites
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA
| | - Martha P Montgomery
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA
| | | | | | - Kristie E N Clarke
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA
| | - Brittany Marshall
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA
| | | | - Candace Rutt
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA.
| | - Shantrice L Jones
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA
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Kaliner E, Bornstein S, Kabha D, Lidji M, Sheffer R, Mor Z. A retrospective cohort analysis of treatment outcomes of patients with tuberculosis who used substances in Tel Aviv, Israel. Alcohol Alcohol 2024; 59:agad073. [PMID: 37961929 DOI: 10.1093/alcalc/agad073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 10/03/2023] [Accepted: 10/16/2023] [Indexed: 11/15/2023] Open
Abstract
AIMS To outline the demographic, clinical, laboratory characteristics, and treatment outcomes of tuberculosis (TB) patients who used substances. METHODS This retrospective cohort study compared 50 TB patients who used substances with a matched random sample of 100 TB patients who did not use substances between 2007 and 2017. Treatment failure was defined as a sputum smear or culture that tested positive after 5 months of treatment, loss to follow-up, unevaluated patients, or death. RESULTS TB patients who used substances were typically younger, experienced homelessness, smokers, and had fewer chronic diseases than those who did not use substances. They also were hospitalized for longer periods, their treatment durations were longer, had higher rates of multidrug resistant strains, increased rates of treatment failure, and higher mortality. Individuals whose treatment failed predominantly originated from the former Soviet Union, experienced homelessness, and had chronic diseases compared with those whose treatment was successful. In the multivariate analysis, homelessness [odds ratios (OR) = 6.7], chronic diseases (OR = 12.4), and substance use (OR = 4.0) were predictors of treatment failures. CONCLUSIONS TB patients who used substances were more likely to have treatment failure. Targeted interventions, including early diagnosis and enhanced support during treatment, are essential to achieve treatment success in this vulnerable population, in addition to TB-alcohol/drug collaborative activities.
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Affiliation(s)
- Ehud Kaliner
- Central District Department of Health, Ministry of Health, Ramla, Israel
| | - Sandy Bornstein
- School of Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Tel Aviv Department of Health, Ministry of Health, Tel Aviv, Israel
| | - Doaa Kabha
- School of Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Lidji
- Tel Aviv Tuberculosis Clinic, Association Against Tuberculosis and Lung Diseases, Tel Aviv, Israel
| | - Rivka Sheffer
- Tel Aviv Department of Health, Ministry of Health, Tel Aviv, Israel
| | - Zohar Mor
- Central District Department of Health, Ministry of Health, Ramla, Israel
- School of Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Public Health, Ashkelon Academic College, Ashkelon, Israel
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Marks SM, Self JL, Venkatappa T, Wolff MB, Hopkins PB, Augustine RJ, Khan A, Schwartz NG, Schmit KM, Morris SB. Diagnosis, Treatment, and Prevention of Tuberculosis Among People Experiencing Homelessness in the United States: Current Recommendations. Public Health Rep 2023; 138:896-907. [PMID: 36703605 PMCID: PMC10576477 DOI: 10.1177/00333549221148173] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE Tuberculosis (TB) is a public health problem, especially among people experiencing homelessness (PEH). The Advisory Council for the Elimination of Tuberculosis issued recommendations in 1992 for TB prevention and control among PEH. Our goal was to provide current guidelines and information in one place to inform medical and public health providers and TB programs on TB incidence, diagnosis, and treatment among PEH. METHODS We reviewed and synthesized diagnostic and treatment recommendations for TB disease and latent TB infection (LTBI) as of 2022 and information after 1992 on the magnitude of homelessness in the United States, the incidence of TB among PEH, the role of public health departments in TB case management among PEH, and recently published evidence. RESULTS In 2018, there were 1.45 million estimated PEH in the United States. During the past 2 decades, the incidence of TB was >10 times higher and the prevalence of LTBI was 7 to 20 times higher among PEH than among people not experiencing homelessness. TB outbreaks were common in overnight shelters. Permanent housing for PEH and the use of rapid TB diagnostic tests, along with isolation and treatment, reduced TB exposure among PEH. The use of direct observation enhanced treatment adherence among PEH, as did involvement of social workers to help secure shelter, food, safety, and treatment for comorbidities, especially HIV and substance use disorders. Testing and treatment for LTBI prevented progression to TB disease, and shorter LTBI regimens helped improve adherence. Federal agencies and the National Health Care for the Homeless Council have helpful resources. CONCLUSION Improvements in TB diagnosis, treatment, and prevention among PEH are possible by following existing recommendations and using client-centered approaches.
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Affiliation(s)
- Suzanne M. Marks
- Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Julie L. Self
- Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Thara Venkatappa
- Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marilyn B. Wolff
- Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Peri B. Hopkins
- Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ryan J. Augustine
- Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Awal Khan
- Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Noah G. Schwartz
- Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kristine M. Schmit
- Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sapna Bamrah Morris
- Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Althomsons SP, Winglee K, Heilig CM, Talarico S, Silk B, Wortham J, Hill AN, Navin TR. Using Machine Learning Techniques and National Tuberculosis Surveillance Data to Predict Excess Growth in Genotyped Tuberculosis Clusters. Am J Epidemiol 2022; 191:1936-1943. [PMID: 35780450 PMCID: PMC10790200 DOI: 10.1093/aje/kwac117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 05/05/2022] [Accepted: 06/28/2022] [Indexed: 02/01/2023] Open
Abstract
The early identification of clusters of persons with tuberculosis (TB) that will grow to become outbreaks creates an opportunity for intervention in preventing future TB cases. We used surveillance data (2009-2018) from the United States, statistically derived definitions of unexpected growth, and machine-learning techniques to predict which clusters of genotype-matched TB cases are most likely to continue accumulating cases above expected growth within a 1-year follow-up period. We developed a model to predict which clusters are likely to grow on a training and testing data set that was generalizable to a validation data set. Our model showed that characteristics of clusters were more important than the social, demographic, and clinical characteristics of the patients in those clusters. For instance, the time between cases before unexpected growth was identified as the most important of our predictors. A faster accumulation of cases increased the probability of excess growth being predicted during the follow-up period. We have demonstrated that combining the characteristics of clusters and cases with machine learning can add to existing tools to help prioritize which clusters may benefit most from public health interventions. For example, consideration of an entire cluster, not only an individual patient, may assist in interrupting ongoing transmission.
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Affiliation(s)
- Sandy P. Althomsons
- Division of TB Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Kathryn Winglee
- Division of TB Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Charles M. Heilig
- Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Sarah Talarico
- Division of TB Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Benjamin Silk
- Division of TB Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Jonathan Wortham
- Division of TB Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Andrew N. Hill
- Division of TB Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Thomas R. Navin
- Division of TB Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
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7
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Onwubiko UN, Yoon JC, Ajoku S, Khan AN, Holland DP. Homeless Shelters: HIV Testing During the Atlanta Tuberculosis Outbreak (2008-2018). Am J Public Health 2022; 112:881-885. [PMID: 35420895 PMCID: PMC9137003 DOI: 10.2105/ajph.2022.306801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2022] [Indexed: 11/04/2022]
Abstract
People experiencing homelessness are at increased risk of tuberculosis (TB) and HIV. We examined the impact of integrating HIV testing and mandatory TB screening on HIV test uptake (HTU) during a multishelter TB outbreak in Atlanta, Georgia (2008-2018). Overall HTU was low; however, the intervention led to a reversal of declining HTU trend (rate ratio = 1.11; 95% confidence interval = 1.04, 1.19). Concerted efforts to increase HIV testing access and uptake alongside robust TB control efforts may increase progress toward the goals of End TB and Ending the HIV Epidemic. (Am J Public Health. 2022;112(6):881-885. https://doi.org/10.2105/AJPH.2022.306801).
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Affiliation(s)
- Udodirim N Onwubiko
- Udodirim N. Onwubiko and Anum N. Khan are with the Rollins School of Public Health, Emory University, Atlanta, GA. Jane C. Yoon and David P. Holland are with the Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA. David P. Holland, Udodirim N. Onwubiko, Sophia Ajoku, and Jane C. Yoon are with the Fulton County Board of Health, Atlanta, GA. Anum N. Khan is with the Windsor-Essex County Health Unit, Windsor, Ontario, Canada
| | - Jane C Yoon
- Udodirim N. Onwubiko and Anum N. Khan are with the Rollins School of Public Health, Emory University, Atlanta, GA. Jane C. Yoon and David P. Holland are with the Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA. David P. Holland, Udodirim N. Onwubiko, Sophia Ajoku, and Jane C. Yoon are with the Fulton County Board of Health, Atlanta, GA. Anum N. Khan is with the Windsor-Essex County Health Unit, Windsor, Ontario, Canada
| | - Sophia Ajoku
- Udodirim N. Onwubiko and Anum N. Khan are with the Rollins School of Public Health, Emory University, Atlanta, GA. Jane C. Yoon and David P. Holland are with the Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA. David P. Holland, Udodirim N. Onwubiko, Sophia Ajoku, and Jane C. Yoon are with the Fulton County Board of Health, Atlanta, GA. Anum N. Khan is with the Windsor-Essex County Health Unit, Windsor, Ontario, Canada
| | - Anum N Khan
- Udodirim N. Onwubiko and Anum N. Khan are with the Rollins School of Public Health, Emory University, Atlanta, GA. Jane C. Yoon and David P. Holland are with the Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA. David P. Holland, Udodirim N. Onwubiko, Sophia Ajoku, and Jane C. Yoon are with the Fulton County Board of Health, Atlanta, GA. Anum N. Khan is with the Windsor-Essex County Health Unit, Windsor, Ontario, Canada
| | - David P Holland
- Udodirim N. Onwubiko and Anum N. Khan are with the Rollins School of Public Health, Emory University, Atlanta, GA. Jane C. Yoon and David P. Holland are with the Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA. David P. Holland, Udodirim N. Onwubiko, Sophia Ajoku, and Jane C. Yoon are with the Fulton County Board of Health, Atlanta, GA. Anum N. Khan is with the Windsor-Essex County Health Unit, Windsor, Ontario, Canada
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8
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Muloma E, Stewart R, Townsend H, Koch S, Burkholder S, Railey S, White K, Redington-Noble R, Caine V. Multipronged Approach to Controlling a Tuberculosis Outbreak Among Persons Experiencing Homelessness. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:199-202. [PMID: 32956287 PMCID: PMC8576823 DOI: 10.1097/phh.0000000000001211] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In May 2009, the Marion County Public Health Department in Indiana declared a tuberculosis (TB) outbreak among persons experiencing homelessness in Marion County, began active case finding to detect additional cases, and formed a TB outbreak response team to plan and coordinate outbreak activities. Outbreak-associated cases had 1 of 2 outbreak genotypes and either reported experiencing homelessness themselves or had an epidemiologic link to a shelter or a person experiencing homelessness. The last of 53 outbreak-associated cases was detected in 2019 after more than 2 years without a case. The Marion County Public Health Department continues to address TB-related issues and implement prevention measures at homeless shelters and among persons experiencing homelessness in 2019. This example, in addition to other published guidance, can be used by jurisdictions to plan and implement their own TB outbreak prevention and response activities among persons experiencing homelessness.
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Affiliation(s)
- Eva Muloma
- Foreign-Born/Refugee Health & TB Control Program, Marion County Public Health Department, Indianapolis, Indiana (Drs Muloma and Caine and Mss Townsend, Koch, Burkholder, and Redington-Noble); Department of Infectious Disease, Eskenazi Health, Indianapolis, Indiana (Drs Muloma and Caine); Indiana University School of Medicine, Indianapolis, Indiana (Drs Muloma and Caine); Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia (Mss Stewart and Railey); and Tuberculosis/Refugee Health Program, Indiana State Department of Health, Indianapolis, Indiana (Ms White)
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9
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Wortham JM, Li R, Althomsons SP, Kammerer S, Haddad MB, Powell KM. Tuberculosis Genotype Clusters and Transmission in the U.S., 2009-2018. Am J Prev Med 2021; 61:201-208. [PMID: 33992497 PMCID: PMC9254502 DOI: 10.1016/j.amepre.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/15/2021] [Accepted: 02/09/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION In the U.S., universal genotyping of culture-confirmed tuberculosis cases facilitates cluster detection. Early recognition of the small clusters more likely to become outbreaks can help prioritize public health resources for immediate interventions. METHODS This study used national surveillance data reported during 2009-2018 to describe incident clusters (≥3 tuberculosis cases with matching genotypes not previously reported in the same county); data were analyzed during 2020. Cox proportional hazards regression models were used to examine the patient characteristics associated with clusters doubling in size to ≥6 cases. RESULTS During 2009-2018, a total of 1,516 incident clusters (comprising 6,577 cases) occurred in 47 U.S. states; 231 clusters had ≥6 cases. Clusters of ≥6 cases disproportionately included patients who used substances, who had recently experienced homelessness, who were incarcerated, who were U.S. born, or who self-identified as being of American Indian or Alaska Native race or of Black race. A median of 54 months elapsed between the first and the third cases in clusters that remained at 3-5 cases compared with a median of 9.5 months in clusters that grew to ≥6 cases. The longer time between the first and third cases and the presence of ≥1 patient aged ≥65 years among the first 3 cases predicted a lower hazard for accumulating ≥6 cases. CONCLUSIONS Clusters accumulating ≥3 cases within a year should be prioritized for intervention. Effective response strategies should include plans for targeted outreach to U.S.-born individuals, incarcerated people, those experiencing homelessness, people using substances, and individuals self-identifying as being of American Indian or Alaska Native race or of Black race.
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Affiliation(s)
- Jonathan M Wortham
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Rongxia Li
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sandy P Althomsons
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Steve Kammerer
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maryam B Haddad
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Krista M Powell
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia
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10
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Chen MP, Miramontes R, Kammerer JS. Multidrug-resistant tuberculosis in the United States, 2011-2016: patient characteristics and risk factors. Int J Tuberc Lung Dis 2021; 24:92-99. [PMID: 32005311 DOI: 10.5588/ijtld.19.0173] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE: To determine risk factors for multidrug-resistant tuberculosis (MDR-TB) and describe MDR-TB according to three characteristics: previous TB disease, recent transmission of MDR-TB, and reactivation of latent MDR-TB infection.SETTING and DESIGN: We used 2011-2016 surveillance data from the US National Tuberculosis Surveillance System and National Tuberculosis Genotyping Service and used logistic regression models to estimate risk factors associated with MDR-TB.RESULTS: A total of 615/45 209 (1.4%) cases were confirmed as MDR-TB; 111/615 (18%) reported previous TB disease; 41/615 (6.7%) were attributed to recent MDR-TB transmission; and 449/615 (73%) to reactivation. Only 12/41 (29%) patients with TB attributed to recent transmission were known to be contacts of someone with MDR-TB. For non-US-born patients, the adjusted odds ratios of having MDR-TB were 32.6 (95%CI 14.6-72.6) among those who were known to be contacts of someone with MDR-TB and 6.5 (95%CI 5.1-8.3) among those who had had previous TB disease.CONCLUSION: The majority of MDR-TB cases in the United States were associated with previous TB disease or reactivation of latent MDR-TB infection; only a small proportion of MDR-TB cases were associated with recent transmission.
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Affiliation(s)
- M P Chen
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - R Miramontes
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - J S Kammerer
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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11
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Self JL, McDaniel CJ, Bamrah Morris S, Silk BJ. Estimating and Evaluating Tuberculosis Incidence Rates Among People Experiencing Homelessness, United States, 2007-2016. Med Care 2021; 59:S175-S181. [PMID: 33710092 PMCID: PMC8324075 DOI: 10.1097/mlr.0000000000001466] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Persons experiencing homelessness (PEH) are disproportionately affected by tuberculosis (TB). We estimate area-specific rates of TB among PEH and characterize the extent to which available data support recent transmission as an explanation of high TB incidence. METHODS We estimated TB incidence among PEH using National Tuberculosis Surveillance System data and population estimates for the US Department of Housing and Urban Development's Continuums of Care areas. For areas with TB incidence higher than the national average among PEH, we estimated recent transmission using genotyping and a plausible source-case method. For cases with ≥1 plausible source case, we assessed with TB program partners whether available whole-genome sequencing and local epidemiologic data were consistent with recent transmission. RESULTS During 2011-2016, 3164 TB patients reported experiencing homelessness. National incidence was 36 cases/100,000 PEH. Incidence estimates varied among 21 areas with ≥10,000 PEH (9-150 cases/100,000 PEH); 9 areas had higher than average incidence. Of the 2349 cases with Mycobacterium tuberculosis genotyping results, 874 (37%) had ≥1 plausible source identified. In the 9 areas, 23%-82% of cases had ≥1 plausible source. Of cases with ≥1 plausible source, 63% were consistent and 7% were inconsistent with recent transmission; 29% were inconclusive. CONCLUSIONS Disparities in TB incidence for PEH persist; estimates of TB incidence and recent transmission vary by area. With a better understanding of the TB risk among PEH in their jurisdictions and the role of recent transmission as a driver, programs can make more informed decisions about prioritizing TB prevention strategies.
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Affiliation(s)
- Julie L Self
- Division of Tuberculosis Elimination, US Centers for Disease Control and Prevention, Atlanta, GA
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12
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Labuda SM, McDaniel CJ, Talwar A, Braumuller A, Parker S, McGaha S, Blissett C, Wortham JM, Mukasa L, Stewart RJ. Tuberculosis Outbreak Associated With Delayed Diagnosis and Long Infectious Periods in Rural Arkansas, 2010-2018. Public Health Rep 2021; 137:94-101. [PMID: 33729050 PMCID: PMC8721759 DOI: 10.1177/0033354921999167] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES During 2010-2018, the Arkansas Department of Health reported 21 genotype-matched cases of tuberculosis (TB) among residents of a rural county in Arkansas with a low incidence of TB and in nearby counties. The Arkansas Department of Health and the Centers for Disease Control and Prevention investigated to determine the extent of TB transmission and provide recommendations for TB control. METHODS We reviewed medical and public health records, interviewed patients, and reviewed patients' social media posts to describe patient characteristics, identify epidemiologic links, and establish likely chains of transmission. RESULTS We identified 21 cases; 11 reported during 2010-2013 and 10 during 2016-2018. All case patients were US-born non-Hispanic Black people. Eighteen case patients had the outbreak genotype, and 3 clinically diagnosed (non-culture-confirmed) case patients had epidemiologic links to patients with the outbreak genotype. Social media reviews revealed epidemiologic links among 10 case patients not previously disclosed during interviews. Eight case patients (38%) had ≥1 health care visit during their infectious period, and 7 patients had estimated infectious periods of >12 months. CONCLUSIONS Delayed diagnoses and prolonged infectiousness led to TB transmission in this rural community. TB education and awareness is critical to reducing transmission, morbidity, and mortality, especially in areas where health care providers have limited TB experience. Use of social media can help elucidate people at risk, especially when traditional TB investigation techniques are insufficient.
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Affiliation(s)
- Sarah M. Labuda
- Arkansas Department of Health, Little Rock, AR, USA,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA,Sarah M. Labuda, MD, MPH, Centers for Disease Control and Prevention, US Embassy, Rua Houari Boumedienne, #32, Miramar, Luanda, Angola.
| | - Clinton J. McDaniel
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Amish Talwar
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA,Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Anthwan Braumuller
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sarah Parker
- Arkansas Department of Health, Little Rock, AR, USA
| | | | | | - Jonathan M. Wortham
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Rebekah J. Stewart
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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13
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Harrist AV, McDaniel CJ, Wortham JM, Althomsons SP. Developing National Genotype-Independent Indicators for Recent Mycobacterium Tuberculosis Transmission Using Pediatric Cases-United States, 2011-2017. Public Health Rep 2021; 137:81-86. [PMID: 33606947 PMCID: PMC8721760 DOI: 10.1177/0033354920985215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Pediatric tuberculosis (TB) cases are sentinel events for Mycobacterium tuberculosis transmission in communities because children, by definition, must have been infected relatively recently. However, these events are not consistently identified by genotype-dependent surveillance alerting methods because many pediatric TB cases are not culture-positive, a prerequisite for genotyping. METHODS We developed 3 potential indicators of ongoing TB transmission based on identifying counties in the United States with relatively high pediatric (aged <15 years) TB incidence: (1) a case proportion indicator: an above-average proportion of pediatric TB cases among all TB cases; (2) a case rate indicator: an above-average pediatric TB case rate; and (3) a statistical model indicator: a statistical model based on a significant increase in pediatric TB cases from the previous 8-quarter moving average. RESULTS Of the 249 US counties reporting ≥2 pediatric TB cases during 2009-2017, 240 and 249 counties were identified by the case proportion and case rate indicators, respectively. The statistical model indicator identified 40 counties with a significant increase in the number of pediatric TB cases. We compared results from the 3 indicators with an independently generated list of 91 likely transmission events involving ≥2 pediatric cases (ie, known TB outbreaks or case clusters with reported epidemiologic links). All counties with likely transmission events involving multiple pediatric cases were identified by ≥1 indicator; 23 were identified by all 3 indicators. PRACTICE IMPLICATIONS This retrospective analysis demonstrates the feasibility of using routine TB surveillance data to identify counties where ongoing TB transmission might be occurring, even in the absence of available genotyping data.
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Affiliation(s)
- Alexia V. Harrist
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Clinton J. McDaniel
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jonathan M. Wortham
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sandy P. Althomsons
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA,Sandy P. Althomsons, MA, MHS, Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, 1600 Clifton Rd NE, US 12-4, Atlanta, GA 30329, USA.
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14
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Washington-Brown L, Cirilo RW. Advancing the health of homeless populations through vaccinations. J Am Assoc Nurse Pract 2020; 33:824-830. [PMID: 33038117 DOI: 10.1097/jxx.0000000000000509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 07/10/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Homeless individuals and families are at an increased risk for contracting and transmitting communicable infections and diseases. Due to poor living conditions and limited access to health care resources, homeless people of all ages are vulnerable to acquiring communicable infections, such as pneumococcal pneumonia. LOCAL PROBLEM Less than 40% of sheltered and unsheltered homeless people in South Florida, who were interviewed for this project, knew their immunization status and/or were up-to-date with their recommended vaccine histories. METHODS The immunization project implemented a five-step process to provide pneumococcus (pneumococcal polysaccharide vaccine 23) and Prevnar 13 vaccinations to a convenience sample of adult homeless men and women (N = 209) participants, who completed the financial eligibility form (J11) during their intake process to admission, for sheltered services from two local clinics. INTERVENTIONS To promote herd immunity, the five-step process was followed. As per the Centers for Disease Control and Prevention guidelines, initial training was provided to homeless shelter health care providers on vaccine storage, handling, and vaccination. A subsequent 1-week follow-up was completed with participants to determine if any delayed vaccination adverse reactions occurred. RESULTS Descriptive statistics was used to examine data from the initial project implementation. Findings indicated that more African Americans (n = 117) participated in the project than Whites (n = 50), Hispanics (n = 35), or Haitians (n = 7). CONCLUSIONS Homeless individuals experience illnesses that are preventable through involvement with a structured immunization program. Collectively, nurse practitioners can reduce barriers to immunization by increasing vaccine coverage and introducing incremental policy changes that enhance the health status among homeless populations.
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Affiliation(s)
| | - Rose Wimbish Cirilo
- Miami Rescue Mission Clinic, Broward College, Broward County, Florida
- Broward College, Fort Lauderdale, Florida
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15
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Kerr EM, Vonnahme LA, Goswami ND. Impact of Targeted Local Interventions on Tuberculosis Awareness and Screening Among Persons Experiencing Homelessness During a Large Tuberculosis Outbreak in Atlanta, Georgia, 2015-2016. Public Health Rep 2020; 135:90S-99S. [PMID: 32735200 PMCID: PMC7407052 DOI: 10.1177/0033354920932644] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Tuberculosis (TB) outbreaks disproportionately affect persons experiencing homelessness (PEH) in the United States. During 2014-2016, a resurgent TB outbreak occurred among PEH in Atlanta, Georgia. To control the outbreak, citywide policies and educational interventions were implemented in January 2015. Policy changes standardized and enforced TB screening requirements for PEH in homeless shelters. Educational campaigns informed PEH of the outbreak and encouraged TB screening. We evaluated factors associated with, and the effect policy changes and educational interventions had on, TB screening and awareness among PEH in Atlanta. METHODS Questions related to TB screening and awareness of the outbreak were added to an annual US Department of Housing and Urban Development survey of PEH in Atlanta in 2015 (n = 296 respondents) and 2016 (n = 1325 respondents). We analyzed the 2016 survey data to determine characteristics associated with outcomes. RESULTS From 2015 to 2016, reported TB screening increased from 81% to 86%, and awareness of the TB outbreak increased from 68% to 75%. In 2016, sheltered PEH were significantly more likely than unsheltered PEH to report being evaluated for TB in the previous 6 months (prevalence odds ratio [pOR] = 3.18; 95% confidence interval [CI], 2.28-4.47) and to report being aware of the TB outbreak (pOR = 4.00; 95% CI, 2.89-5.55). CONCLUSIONS Implementation of required TB screening and educational interventions may reduce the incidence and severity of TB outbreaks among PEH in other communities. Furthermore, the annual survey of PEH offers an opportunity to collect data to better inform practices and policies.
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Affiliation(s)
- Eleanor M Kerr
- 25798 Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Laura A Vonnahme
- 1242 Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Neela D Goswami
- 25798 Emory University Rollins School of Public Health, Atlanta, GA, USA
- 1242 Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA, USA
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16
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Yoon JC, Montgomery MP, Buff AM, Boyd AT, Jamison C, Hernandez A, Schmit K, Shah S, Ajoku S, Holland DP, Prieto J, Smith S, Swancutt MA, Turner K, Andrews T, Flowers K, Wells A, Marchman C, Laney E, Bixler D, Cavanaugh S, Flowers N, Gaffga N, Ko JY, Paulin HN, Weng MK, Mosites E, Morris SB. COVID-19 Prevalence among People Experiencing Homelessness and Homelessness Service Staff during Early Community Transmission in Atlanta, Georgia, April-May 2020. Clin Infect Dis 2020; 73:e2978-e2984. [PMID: 32898272 PMCID: PMC7499502 DOI: 10.1093/cid/ciaa1340] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 09/02/2020] [Indexed: 11/28/2022] Open
Abstract
Background In response to reported COVID-19 outbreaks among people experiencing homelessness (PEH) in other U.S. cities, we conducted multiple, proactive, facility-wide testing events for PEH living sheltered and unsheltered and homelessness service staff in Atlanta, Georgia. We describe SARS-CoV-2 prevalence and associated symptoms and review shelter infection prevention and control (IPC) policies Methods PEH and staff were tested for SARS-CoV-2 by reverse transcription polymerase chain reaction (RT-PCR) during April 7–May 6, 2020. A subset of PEH and staff was screened for symptoms. Shelter assessments were conducted concurrently at a convenience sample of shelters using a standardized questionnaire Results Overall, 2,875 individuals at 24 shelters and nine unsheltered outreach events underwent SARS-CoV-2 testing and 2,860 (99.5%) had conclusive test results. SARS-CoV-2 prevalence was 2.1% (36/1,684) among PEH living sheltered, 0.5% (3/628) among PEH living unsheltered, and 1.3% (7/548) among staff. Reporting fever, cough, or shortness of breath in the last week during symptom screening was 14% sensitive and 89% specific for identifying COVID-19 cases compared with RT-PCR. Prevalence by shelter ranged 0%–27.6%. Repeat testing 3–4 weeks later at four shelters documented decreased SARS-CoV-2 prevalence (0%–3.9%). Nine of 24 shelters completed shelter assessments and implemented IPC measures as part of the COVID-19 response Conclusions PEH living in shelters experienced higher SARS-CoV-2 prevalence compared with PEH living unsheltered. Facility-wide testing in congregate settings allowed for identification and isolation of COVID-19 cases and is an important strategy to interrupt SARS-CoV-2 transmission
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Affiliation(s)
- Jane C Yoon
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Martha P Montgomery
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ann M Buff
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Andrew T Boyd
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Calla Jamison
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alfonso Hernandez
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Kristine Schmit
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sarita Shah
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - David P Holland
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA.,Fulton County Board of Health, Atlanta, GA, USA
| | | | - Sasha Smith
- Fulton County Board of Health, Atlanta, GA, USA
| | | | - Kim Turner
- Fulton County Board of Health, Atlanta, GA, USA
| | | | | | | | | | - Emaline Laney
- Emory University School of Medicine, Atlanta, GA, USA
| | - Danae Bixler
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sean Cavanaugh
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nicole Flowers
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nicholas Gaffga
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jean Y Ko
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Heather N Paulin
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mark K Weng
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Emily Mosites
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sapna Bamrah Morris
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
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17
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Tobolowsky FA, Gonzales E, Self JL, Rao CY, Keating R, Marx GE, McMichael TM, Lukoff MD, Duchin JS, Huster K, Rauch J, McLendon H, Hanson M, Nichols D, Pogosjans S, Fagalde M, Lenahan J, Maier E, Whitney H, Sugg N, Chu H, Rogers J, Mosites E, Kay M. COVID-19 Outbreak Among Three Affiliated Homeless Service Sites - King County, Washington, 2020. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2020; 69:523-526. [PMID: 32352954 PMCID: PMC7206987 DOI: 10.15585/mmwr.mm6917e2] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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18
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Jiang T, Chen XS. Outcome Impacts Due to Pathogen-Specific Antimicrobial Resistance: A Narrative Review of Published Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17041395. [PMID: 32098182 PMCID: PMC7068360 DOI: 10.3390/ijerph17041395] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 01/31/2020] [Accepted: 02/19/2020] [Indexed: 12/19/2022]
Abstract
Antimicrobial resistance (AMR) has become a global threat to not only public health impacts but also clinical and economic outcomes. During the past decades, there have been many studies focusing on surveillance, mechanisms, and diagnostics of AMR in infectious diseases but the impacts on public health, clinical and economic outcomes due to emergence of these AMRs are rarely studied and reported. This review was aimed to summarize the findings from published studies to report the outcome impacts due to AMR of malaria, tuberculosis and HIV and briefly discuss the implications for application to other infectious diseases. PubMed/Medline and Google Scholar databases were used for search of empirical and peer-reviewed papers reporting public health, clinical and economic outcomes due to AMR of malaria, tuberculosis and HIV. Papers published through 1 December 2019 were included in this review. A total of 76 studies were included for this review, including 16, 49 and 11 on public health, clinical and economic outcomes, respectively. The synthesized data indicated that the emergence and spread of AMR of malaria, tuberculosis and HIV have resulted in adverse public health, clinical and economic outcomes. AMR of malaria, tuberculosis and HIV results in significant adverse impacts on public health, clinical and economic outcomes. Evidence from this review suggests the needs to consider the similar studies for other infectious diseases.
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Affiliation(s)
- Tingting Jiang
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing 210042, China;
- National Center for STD Control, Chinese Center for Disease Control and Prevention, Nanjing 210042, China
| | - Xiang-Sheng Chen
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing 210042, China;
- National Center for STD Control, Chinese Center for Disease Control and Prevention, Nanjing 210042, China
- Correspondence: ; Tel.: +86-25-8547-8901
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19
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Holland DP, Alexander S, Onwubiko U, Goswami ND, Yamin A, Mohamed O, Sales RM, Grant G, Talboy P, Ray S, Toomey KE. Response to Isoniazid-Resistant Tuberculosis in Homeless Shelters, Georgia, USA, 2015-2017. Emerg Infect Dis 2019; 25:593-595. [PMID: 30789335 PMCID: PMC6390744 DOI: 10.3201/eid2503.181678] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In 2008, an outbreak of isoniazid-resistant tuberculosis was identified among residents of homeless shelters in Atlanta, Georgia, USA. When initial control efforts involving standard targeted testing failed, a comprehensive approach that involved all providers of services for the homeless successfully interrupted the outbreak.
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20
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Lee WG, Wong LL, Olivas R, Apana A, Kickertz K, Ogihara M. Should a homeless person become a deceased organ donor? Clin Transplant 2019; 33:e13685. [PMID: 31381199 DOI: 10.1111/ctr.13685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/29/2019] [Accepted: 07/31/2019] [Indexed: 11/29/2022]
Abstract
Efforts to increase deceased donation have included the use of US Public Health Service (PHS) high-risk donors. The homeless have high rates of medical and substance abuse issues that are often unrecognized. This study investigates whether the homeless should become suitable organ donors. We retrospectively reviewed 193 brain-dead prospective donors from Hawaii's organ procurement organization (OPO; 2013-2018) and compared two groups: homeless (n = 13) and non-homeless (n = 180) prospective donors. The homeless prospective donors were older (48.0 vs 40.7 years, P = .009) and had more substance abuse (30.8% vs 10%, P = .046), methamphetamine use (53.8% vs 12.2%, P = .001), cocaine use (23.1% vs 3.9%, P = .022), and urine with amphetamines (54.5% vs 17.9%, P = .049). The homeless prospective donors trended toward more PHS high-risk designation (50% vs 19%, P = .062). There was no difference in medical history, gender/race, hepatitis serologies, authorization for donation, and organs procured/transplanted between prospective donors. We have provided evidence that the homeless should become prospective organ donors; however, they have more high-risk behaviors and often have limited information. Larger studies from OPOs are needed to better characterize organ donation and track disease transmission in this population.
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Affiliation(s)
- William G Lee
- Department of Surgery, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii
| | - Linda L Wong
- Department of Surgery, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii
| | - Roderick Olivas
- Department of Surgery, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii
| | - Ailea Apana
- Department of Surgery, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii
| | | | - Makoto Ogihara
- Department of Surgery, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii
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21
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Haas MK, Reves R. Strong Community–Public Health Partnerships May Help Us Move Closer to Tuberculosis Elimination. Am J Public Health 2019; 109:958-959. [DOI: 10.2105/ajph.2019.305133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Michelle K. Haas
- The authors are with the Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, and the Denver Metro Tuberculosis Program, Denver, CO
| | - Randall Reves
- The authors are with the Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, and the Denver Metro Tuberculosis Program, Denver, CO
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22
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Onwubiko U, Wall K, Sales RM, Holland DP. Using Directly Observed Therapy (DOT) for latent tuberculosis treatment - A hit or a miss? A propensity score analysis of treatment completion among 274 homeless adults in Fulton County, GA. PLoS One 2019; 14:e0218373. [PMID: 31226132 PMCID: PMC6588273 DOI: 10.1371/journal.pone.0218373] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 06/02/2019] [Indexed: 01/06/2023] Open
Abstract
Latent tuberculosis infection (LTBI) treatment in persons at increased risk of disease progression is a key strategy with the strong potential to increase rate of tuberculosis (TB) decline in the United States. However, LTBI treatment in homeless persons, a population at high-risk of active TB disease, is usually associated with poor adherence. We describe the impact of using directly observed treatment (DOT) versus self-administered treatments (SAT) as an adherence-improving intervention to administer four months of daily rifampin regimen for LTBI treatment among homeless adults in Atlanta. Retrospective analysis of clinical care data on 274 homeless persons who initiated daily rifampin treatment for LTBI treatment at a county health department between January 2014 and December 2016 was performed. To reduce bias from non-random assignment of treatment, an inverse probability of treatment weighted (IPTW) logistic regression model was used to assess the effect of treatment type on treatment completion. Subgroup analyses were performed to assess heterogeneity of treatment effect on LTBI completion. Of 274 LTBI treatment initiators, 177 (65%) completed treatment [DOT 118/181 (65%), SAT 59/93 (63%)]. In the fully adjusted and weighted analysis, the odds of completing LTBI treatment on DOT was 40% higher than the odds of completing treatment by SAT [adjusted odds ratio (95% CI), aOR: 1.40 (1.07, 1.82), p = 0.014]. The unstable nature of homeless persons' lifestyle makes LTBI treatment difficult for many reasons. Our study lends support to the use of DOT to improve LTBI treatment completion among subgroups of homeless persons on treatment with daily rifampin.
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Affiliation(s)
- Udodirim Onwubiko
- Medical and Preventive Services, Fulton County Board of Health, Atlanta, Georgia, United States of America
| | - Kristin Wall
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Rose-Marie Sales
- Tuberculosis Program, Georgia Department of Public Health, Atlanta, Georgia, United States of America
| | - David P. Holland
- Medical and Preventive Services, Fulton County Board of Health, Atlanta, Georgia, United States of America
- Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, Georgia, United States of America
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23
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Collins JM, Onwubiko U, Holland DP. QuantiFERON-TB Gold Versus Tuberculin Screening and Care Retention Among Persons Experiencing Homelessness: Georgia, 2015-2017. Am J Public Health 2019; 109:1028-1033. [PMID: 31095412 DOI: 10.2105/ajph.2019.305069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To characterize the cascade of care for latent tuberculosis infection (LTBI) in persons experiencing homelessness (PEH) and evaluate the effect of screening by QuantiFERON-TB Gold (QFT) versus tuberculin skin test (TST). Methods. We performed a retrospective cohort study of all PEH screened for LTBI by QFT and TST from May 2015 to April 2017 in Fulton County, Georgia. Results. There were 3504 PEH screened by QFT and 5509 by TST, with 2925 TSTs administered on site at community shelters and 2584 at the health department. More valid test results were obtained in those screened by QFT (99.0% vs 69.0%; P < .001) because of low return rates for reading in both TST arms. For tests administered on site, testing by QFT versus TST improved retention in care with significantly more estimated LTBI cases following up for a medical examination (67.8% vs 51.0%; P < .001) and starting LTBI treatment (58.4% vs 39.8%; P < .001). Conclusions. A QFT-based screening strategy in PEH improved diagnosis and retention in care for new LTBI cases compared with TST and may be an effective strategy to limit progression to active tuberculosis.
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Affiliation(s)
- Jeffrey M Collins
- Jeffrey M. Collins and David P. Holland are with the School of Medicine, Emory University, Atlanta, GA. Udodirim Onwubiko and David P. Holland are with the Fulton County Board of Health, Atlanta
| | - Udodirim Onwubiko
- Jeffrey M. Collins and David P. Holland are with the School of Medicine, Emory University, Atlanta, GA. Udodirim Onwubiko and David P. Holland are with the Fulton County Board of Health, Atlanta
| | - David P Holland
- Jeffrey M. Collins and David P. Holland are with the School of Medicine, Emory University, Atlanta, GA. Udodirim Onwubiko and David P. Holland are with the Fulton County Board of Health, Atlanta
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Bizune DJ, Kempker RR, Kagei M, Yamin A, Mohamed O, Holland DP, Oladele A, Wang YF, Rebolledo PA, Blumberg HM, Ray SM, Schechter MC. Treatment Complexities Among Patients with Tuberculosis in a High HIV Prevalence Cohort in the United States. AIDS Res Hum Retroviruses 2018; 34:1050-1057. [PMID: 30105915 DOI: 10.1089/aid.2018.0126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The association between human immunodeficiency virus (HIV) infection and tuberculosis (TB) mortality has been studied extensively, but the impact of HIV on other clinically relevant aspects of TB care such as TB drug-related adverse events (AEs), hospital readmissions, and TB treatment duration is less well characterized. We describe the association of HIV infection with TB clinical complexities and outcomes in a high HIV prevalence cohort in the United States. This is a retrospective cohort study among patients treated for culture-confirmed TB between 2008 and 2015 at an inner-city hospital in Atlanta, GA. Univariate analysis was used to estimate association of HIV with TB treatment interruption due to AEs, hospital readmissions, and treatment duration. Final unfavorable TB treatment outcome was defined as death, loss to follow-up, or recurrent TB. Logistic regression modeling was used to estimate association of HIV with final unfavorable outcomes. Among 274 patients with TB, 96 (35%) had HIV coinfection. HIV-positive patients had more TB treatment interruptions due to AE (34% vs. 15%), were more likely to have a hospital readmission (50% vs. 21%), and received longer TB treatment (9.9 months vs. 8.8 months) compared to HIV-negative patients (p < .01 for all). HIV infection was not associated with final unfavorable outcomes in univariate [odds ratio (OR) = 1.86; confidence interval (95% CI) 0.99-3.49] or multivariate analysis (aOR = 1.13; 95% CI 0.52-2.39) (p ≥ .05 for both). While HIV infection was not associated with final unfavorable TB outcomes, TB/HIV coinfected patients had more complex treatment course underscoring the importance of maintaining resources and expertise to treat coinfected patients in our and similar settings.
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Affiliation(s)
| | - Russell R. Kempker
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | | | - Aliya Yamin
- Communicable Disease Prevention Branch, Fulton County Board of Health, Atlanta, Georgia
| | - Omar Mohamed
- Communicable Disease Prevention Branch, Fulton County Board of Health, Atlanta, Georgia
| | - David P. Holland
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Communicable Disease Prevention Branch, Fulton County Board of Health, Atlanta, Georgia
| | | | - Yun F. Wang
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
- Department of Pathology, Grady Memorial Hospital, Atlanta, Georgia
| | - Paulina A. Rebolledo
- Rollins School of Public Health, Emory University, Atlanta, Georgia
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Henry M. Blumberg
- Rollins School of Public Health, Emory University, Atlanta, Georgia
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Susan M. Ray
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Marcos C. Schechter
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
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Hino P, Monroe AA, Takahashi RF, Souza KMJD, Figueiredo TMRMD, Bertolozzi MR. Tuberculosis control from the perspective of health professionals working in street clinics. Rev Lat Am Enfermagem 2018; 26:e3095. [PMID: 30517582 PMCID: PMC6280170 DOI: 10.1590/1518-8345.2691.3095] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 09/17/2018] [Indexed: 08/10/2023] Open
Abstract
PURPOSE to present the opinion of professionals about street dwellers undergoing treatment of tuberculosis and identify strategies of control of tuberculosis in this population. METHOD an exploratory and descriptive study involving 17 health professionals working in street clinics. A semi-structured study composed of closed questions and a guiding question. The statements were analyzed using the discourse analysis technique, resulting in the identification of two analytical categories: 1. Meanings attributed to street dwellers with tuberculosis, and 2. Control of tuberculosis in homeless people. RESULTS the analysis identified situations that limited adherence to tuberculosis treatment, including the reasons for staying in the streets, living conditions, and risk factors (dependence on alcohol and other drugs, short-sightedness, constant relocations, and lack of perspectives). Street dwellers were knowledgeable about the disease. Furthermore, there were difficulties in solving several problems of people living in the streets, including living conditions and lifestyle, social stigma, relocations, drug abuse, and lack of life project. CONCLUSION coping with the complexity of situations related to living in the streets limits to the work of health professionals because these situations go beyond health care and require intersectoral actions.
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Affiliation(s)
- Paula Hino
- Universidade Federal de São Paulo, Escola Paulista de Enfermagem, São Paulo, SP, Brazil
| | - Aline Aparecida Monroe
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
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Schechter MC, Bizune D, Kagei M, Holland DP, Del Rio C, Yamin A, Mohamed O, Oladele A, Wang YF, Rebolledo PA, Ray SM, Kempker RR. Challenges Across the HIV Care Continuum for Patients With HIV/TB Co-infection in Atlanta, GA [corrected]. Open Forum Infect Dis 2018; 5:ofy063. [PMID: 29657955 PMCID: PMC5890473 DOI: 10.1093/ofid/ofy063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 03/17/2018] [Indexed: 11/13/2022] Open
Abstract
Background Antiretroviral therapy (ART) for persons with HIV infection prevents tuberculosis (TB) disease. Additionally, sequential ART after initiation of TB treatment improves outcomes. We examined ART use, retention in care, and viral suppression (VS) before, during, and 3 years following TB treatment for an inner-city cohort in the United States. Methods Retrospective cohort study among persons treated for culture-confirmed TB between 2008 and 2015 at an inner-city hospital. Results Among 274 persons with culture-confirmed TB, 96 (35%) had HIV co-infection, including 23 (24%) new HIV diagnoses and 73 (76%) previous diagnoses. Among those with known HIV prior to TB, the median time of known HIV was 6 years, and only 10 (14%) were on ART at the time of TB diagnosis. The median CD4 at TB diagnosis was 87 cells/uL. Seventy-four (81%) patients received ART during treatment for TB, and 47 (52%) has VS at the end of TB treatment. Only 32% of patients had continuous VS 3 years after completing TB treatment. There were 3 TB recurrences and 3 deaths post–TB treatment; none of these patients had retention or VS after TB treatment. Conclusions Among persons with active TB co-infected with HIV, we found that the majority had known HIV and were not on ART prior to TB diagnosis, and retention in care and VS post–TB treatment were very low. Strengthening the HIV care continuum is needed to improve HIV outcomes and further reduce rates of active TB/HIV co-infection in our and similar settings.
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Affiliation(s)
- Marcos C Schechter
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
| | - Destani Bizune
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | - David P Holland
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia.,Communicable Disease Prevention Branch, Fulton County Health Board of Health, Atlanta, Georgia
| | - Carlos Del Rio
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia.,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Aliya Yamin
- Communicable Disease Prevention Branch, Fulton County Health Board of Health, Atlanta, Georgia
| | - Omar Mohamed
- Communicable Disease Prevention Branch, Fulton County Health Board of Health, Atlanta, Georgia
| | | | - Yun F Wang
- Department of Pathology and Laboratory Medicine, School of Medicine, Emory University School of Medicine, Atlanta, Georgia.,Department of Pathology, Grady Memorial Hospital, Atlanta, Georgia
| | - Paulina A Rebolledo
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia.,Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Susan M Ray
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
| | - Russell R Kempker
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
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Schechter MC, Bizune D, Kagei M, Machaidze M, Holland DP, Oladele A, Wang YF, Rebolledo PA, Ray SM, Kempker RR. Time to Sputum Culture Conversion and Treatment Outcomes Among Patients with Isoniazid-Resistant Tuberculosis in Atlanta, Georgia. Clin Infect Dis 2017; 65:1862-1871. [PMID: 29020173 PMCID: PMC5850645 DOI: 10.1093/cid/cix686] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 07/28/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Although isoniazid-resistant tuberculosis is more common than multidrug-resistant tuberculosis, it has been much less studied. We examined the impact of isoniazid resistance and treatment regimen, including use of a fluoroquinolone, on clinical outcomes. METHODS A retrospective cohort study among patients with sputum culture-positive tuberculosis was performed. Early fluoroquinolone (FQ) use was defined as receiving ≥5 doses during the first month of treatment. The primary outcome was time to sputum culture conversion (tSCC). A multivariate proportional hazards model was used to determine the association of isoniazid resistance with tSCC. RESULTS Among 236 patients with pulmonary tuberculosis, 59 (25%) had isoniazid resistance. The median tSCC was similar for isoniazid-resistant and -susceptible cases (35 vs 29 days; P = .39), and isoniazid resistance was not associated with tSCC in multivariate analysis (adjusted hazard ratio = 0.83; 95% confidence interval [CI], .59-1.17). Early FQ use was higher in isoniazid-resistant than -susceptible cases (20% vs 10%; P = .05); however, it was not significantly associated with tSCC in univariate analysis (hazard ratio = 1.48; 95% CI, .95-2.28). Patients with isoniazid-resistant tuberculosis were treated with regimens containing rifampin, pyrazinamide, and ethambutol +/- a FQ for a median of 9.7 months. Overall, 191 (83%) patients were cured. There was no difference in initial treatment outcomes; however, all cases of acquired-drug resistance (n = 1) and recurrence (n = 3) occurred among patients with isoniazid-resistant tuberculosis. CONCLUSIONS There was no significant association with isoniazid resistance and tSCC or initial treatment outcomes. Although patients with isoniazid-resistant tuberculosis had a high cure rate, the cases of recurrence and acquired drug resistance are concerning and highlight the need for longer-term follow-up studies.
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Affiliation(s)
- Marcos C Schechter
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine
| | | | | | | | - David P Holland
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine
- Communicable Disease Prevention Branch, Fulton County Health Department of Health and Wellness, Atlanta
| | | | - Yun F Wang
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine
- Department of Pathology, Grady Memorial Hospital, Atlanta, Georgia
| | - Paulina A Rebolledo
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine
- Rollins School of Public Health
| | - Susan M Ray
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine
| | - Russell R Kempker
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine
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Connors WJ, Hussen SA, Holland DP, Mohamed O, Andes KL, Goswami ND. Homeless shelter context and tuberculosis illness experiences during a large outbreak in Atlanta, Georgia. Public Health Action 2017; 7:224-230. [PMID: 29018769 DOI: 10.5588/pha.17.0040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 07/10/2017] [Indexed: 11/10/2022] Open
Abstract
Setting: Persons experiencing homelessness (PEH) represent a population at high risk for tuberculosis (TB). While quantitative studies have characterized some important features of this key group, less has been captured directly from PEH about how they experience TB illness itself and the prevention and control measures implemented in response to an outbreak. This qualitative study aimed to explore PEH's TB disease experiences in the context of a large TB outbreak involving homeless shelters in Atlanta, Georgia, USA. Design: This was a qualitative cross-sectional study involving in-depth interviews with 10 PEH with active TB disease. Key themes were identified through coded data analysis. Results: The central theme to emerge was that stressful social environments of homeless shelters shape illness experiences and health care seeking behaviors, and limit the influence of shelter-based prevention and control measures implemented in response to a TB outbreak. Despite availability, shelter-based latent tuberculous infection (LTBI) testing and education services were minimally engaged. Furthermore, hardships inherent to homelessness were interrelated with disease normalization and symptom minimization. Conclusions: Homeless shelter-related stress may have important implications for the prevention and control of TB outbreaks in this setting. This stress may hinder case finding; a model of supplemental TB education and testing for LTBI at proximal community venues is necessary.
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Affiliation(s)
- W J Connors
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - S A Hussen
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA.,Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - D P Holland
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Communicable Disease Prevention Branch, Fulton County Department of Health and Wellness, Atlanta, Georgia, USA
| | - O Mohamed
- Communicable Disease Prevention Branch, Fulton County Department of Health and Wellness, Atlanta, Georgia, USA
| | - K L Andes
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - N D Goswami
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA.,Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
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