Background: To examine the effects of a community program on tuberculosis incidence, prevalence,
and transmission requiring users of public facilities to carry cards certifying their
compliance with a tuberculosis screening, prophylaxis, and treatment program. Community
knowledge of tuberculosis and costs and benefits of the program are described.
Setting: A West Coast “skid row” community with historically high rates of tuberculosis, homelessness,
poverty, and use of drugs and alcohol.
Design: Analysis of tuberculosis activity in communities in Oregon using Oregon Health Division
Tuberculosis Data Bank data. Description of community response and cost considerations.
Main
Outcome
Measures:
Rates of active disease, mortality, and skin-test response. Compliance with card use and
understanding of tuberculosis control measures. Program expenditures.
Results: An 89% drop in active disease in the highest-risk community in Oregon occurred over the
first 10 years of the program. Compliance with the program permitting the use of public
facilities, based on cooperation with skin testing, radiology, sputum collection, and therapy
has been between 33% of converters completing prophylaxis in the worst year to 100% of
active cases completing 4-drug therapy in the best. Facilities that provide services have been
almost universal in requiring cooperation for participants. Costs have been reduced.
Conclusion: A program of mandated compliance with tuberculosis skin testing, radiologic and sputum
examination and treatment, coupled with education and outreach, succeeded in drastically
reducing active tuberculosis, transmission, deaths, and cost in a homeless community.
Mandated Tuberculosis Screening in a Community of Homeless People