Relation of Tuberculosis with Homeless Population in Nashville, TN

BACKGROUND: Although, Nashville's Tuberculosis (TB) case rate has decreased 20% over 1 year (2008-2009), Nashville still contributes the highest TB cases in the state of Tennessee, increasing from 19% (2004) to 31% (2009). METHODOLGY: The Metropolitan Public Health Department (manages all TB cases in Nashville) conducted a five year (2004-2008) retrospective analysis of patient data via chart review. It was found that a significant percent of the homeless smoked. This study led to a comparative study of demographic characteristics and risk factors between homeless and nonhomeless persons. RESULTS: The annual proportion of homeless TB cases reported in Nashville are between 10-22%. Preliminary results based on chi-square tests show a significant association between substance abuse, country of origin and homelessness (p< .01). Blacks, males aged 30 to 59 years represented the highest proportion of TB cases among the homeless and nonhomeless. TB cases in foreign born homeless persons (17%) were less than nonhomeless persons (48%). Also, homeless persons had a higher prevalence of substance use (80% smokers, 65% alcohol abuse and 29.5% inhalant use), and 28.5% had co-infection with human immunodeficiency virus. 89 % of the TB cases among the homeless completed treatment. DISCUSSION: TB risk factors overlaps with risk factors for homelessness. This complex social relationship is important to consider in planning and implementing TB treatment. Recommendations for practice may include offering non-traditional methods of services, incentives and enablers. For example, providing a cell phone through Assurance Safe Link or leasing a room at a boarding house with meals included.