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
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.
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.
AFB = acid-fast bacillus; ALASDIC = American Lung Association of
San Diego and Imperial Counties; CDC = Centers for Disease Control
and Prevention; DOT = directly observed therapy;
MDR = multiple-drug resistant; SDDHS = San Diego Department of
Health Services; UCSD = University of California, San Diego;
YMCA = Young Men’s Christian Association