Role of a housing intervention in the management of a tuberculosis outbreak in a homeless shelter − Illinois, 2010

Background: Stable housing increases medication compliance and improves health outcomes among homeless populations. During a tuberculosis (TB) outbreak in a homeless shelter in Illinois, state and local health department (LHD) staff provided housing to patients to reduce access to illicit drugs, improve treatment adherence, and reduce opportunities for TB transmission. Methods: Cases were defined as shelter staff, residents or contacts diagnosed with TB based on CDC criteria from November 2009 – May 2010. A coalition of state and LHD staff and a shelter representative surveyed 18 motels, identified a facility with suitable ventilation and obtained $90,000 to pay for housing and support services. Patients with smear-positive TB and no suitable housing arrangement were offered a hotel room and services. Treatment adherence and demographic and clinical characteristics were assessed through medical record review. Results: From March 2010 – present, 1124 days of housing were provided to 10 outbreak-associated patients. Six individuals had a substance use disorder. Three had psychiatric illness. Seven patients completed treatment, two patients are currently completing treatment at the hotel, and one patient left the state prior to completion of therapy. By nurse report, substance use was substantially decreased while patients were housed in the motel. Conclusions: A transient population with substantial co-morbidities achieved high rates of treatment completion and adherence. Housing smear-positive patients in a motel reduced transmission risk to uninfected clients and the community. A successful partnership between state, local and shelter staff secured resources for housing and services.