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(Chest. 1999;115:218-223.)
© 1999 American College of Chest Physicians

Development of Housing Programs to Aid in the Treatment of Tuberculosis in Homeless Individuals: A Pilot Study*

Philip A. LoBue, MD; Robert Cass; Diana Lobo; Kathleen Moser, MD and Antonino Catanzaro, MD, FCCP

* From the Division of Pulmonary and Critical Care Medicine (Drs. LoBue and Catanzaro), University of California, San Diego Medical Center, and the Tuberculosis Control Program (Mr. Cass, Ms. Lobo, and Ms. Moser), San Diego County Department of Health Services.

Study objectives: To describe our experience with novel supervised housing programs developed to aid in the treatment of tuberculosis (TB) in homeless individuals, including a preliminary analysis of their effectiveness and estimate of potential cost savings.

Design: Retrospective chart review.

Setting: A county TB control program.

Methods: The San Diego County TB Control Program's computer database was used to identify homeless individuals placed in one of two supervised housing programs for treatment of TB [Young Men's Christian Association (YMCA), for noninfectious patients, or Bissell House, for infectious patients]. Charts for all these patients were reviewed and information regarding their demographics, underlying medical conditions, therapy, microbiologic markers of response to therapy, hospitalizations, and participation in supervised housing programs was recorded.

Measurements and results: The sputum culture conversion and treatment completion rates for those housed in the YMCA were 100 and 84.6%, respectively. Of the patients in the Bissell House program, 100% had converted their smear and culture. In addition, all patients in this program completed an adequate course of supervised therapy. These rates of microbiologic conversion and treatment completion compare favorably with historical data from San Diego County and other locations. Estimated cost savings for placing medically stable infectious patients in the Bissell House for respiratory isolation and supervised treatment were estimated to be $27,034 per patient.

Conclusions: Use of supervised housing to aid in treatment of TB in the homeless appears to be effective and results in substantial cost savings. A larger multicenter study should be considered to confirm these findings and better quantify the cost-effectiveness of such programs.

Key Words: directly observed therapy • homelessness • supervised housing • tuberculosis




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