Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Public Health Rep. 2023 Nov-Dec;138(6):896-907. doi: 10.1177/00333549221148173. Epub 2023 Jan 26.
Tuberculosis (TB) is a public health problem, especially among people experiencing homelessness (PEH). The Advisory Council for the Elimination of Tuberculosis issued recommendations in 1992 for TB prevention and control among PEH. Our goal was to provide current guidelines and information in one place to inform medical and public health providers and TB programs on TB incidence, diagnosis, and treatment among PEH.
We reviewed and synthesized diagnostic and treatment recommendations for TB disease and latent TB infection (LTBI) as of 2022 and information after 1992 on the magnitude of homelessness in the United States, the incidence of TB among PEH, the role of public health departments in TB case management among PEH, and recently published evidence.
In 2018, there were 1.45 million estimated PEH in the United States. During the past 2 decades, the incidence of TB was >10 times higher and the prevalence of LTBI was 7 to 20 times higher among PEH than among people not experiencing homelessness. TB outbreaks were common in overnight shelters. Permanent housing for PEH and the use of rapid TB diagnostic tests, along with isolation and treatment, reduced TB exposure among PEH. The use of direct observation enhanced treatment adherence among PEH, as did involvement of social workers to help secure shelter, food, safety, and treatment for comorbidities, especially HIV and substance use disorders. Testing and treatment for LTBI prevented progression to TB disease, and shorter LTBI regimens helped improve adherence. Federal agencies and the National Health Care for the Homeless Council have helpful resources.
Improvements in TB diagnosis, treatment, and prevention among PEH are possible by following existing recommendations and using client-centered approaches.
结核病（TB）是一个公共卫生问题，尤其是在无家可归者（PEH）中。1992 年，消除结核病咨询委员会发布了针对 PEH 的结核病预防和控制建议。我们的目标是提供当前的指南和信息，以便向医疗和公共卫生提供者以及结核病项目提供有关 PEH 中结核病发病率、诊断和治疗的信息。
我们回顾并综合了截至 2022 年的结核病疾病和潜伏性结核病感染（LTBI）的诊断和治疗建议，以及 1992 年以来美国无家可归者人数、PEH 中结核病发病率、公共卫生部门在 PEH 中结核病病例管理中的作用以及最近发表的证据等方面的信息。
2018 年，美国估计有 145 万无家可归者。在过去的 20 年中，PEH 中的结核病发病率比非无家可归者高 10 倍以上，LTBI 的患病率高 7 至 20 倍。PEH 中常发生结核病暴发，为其提供永久性住房和使用快速结核病诊断测试，以及进行隔离和治疗，可减少结核病暴露。直接观察有助于提高 PEH 的治疗依从性，社会工作人员参与帮助获得住房、食物、安全和治疗合并症（特别是 HIV 和药物使用障碍）也有助于提高治疗依从性。LTBI 的检测和治疗可预防结核病疾病的进展，缩短 LTBI 疗程有助于提高治疗依从性。联邦机构和国家无家可归者卫生保健委员会有相关的有益资源。
通过遵循现有建议并采用以客户为中心的方法，可改善 PEH 中的结核病诊断、治疗和预防。
