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TB and Housing

Story, A; Gorton, S; Glyn-Jones, J; Hayward, A; (2004) TB and Housing. London Regional Public Health Group

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Abstract

Executive summary ‘The tuberculous person who is without a normal home may suffer serious handicap by lack of adequate rest and food.’ Hartston, Macgregor (London). Tuberculosis Hostels – a Contribution to the Welfare of the Homeless Phthisic.19531 Fifty years on, the impact of poor housing on TB continues to extend beyond increasing risk of transmission and susceptibility to complicate treatment and care. A safe and supportive environment is essential to recovery and prerequisite to TB treatment. This report highlights the impact of housing on TB treatment in London and calls for options for supported housing and intermediate care to again be made available for homeless and hard to treat TB patients. TB rates in London have doubled in the last decade. Those worst affected are marginalised and have multiple needs including poverty, homelessness, addiction and mental illness. Their environment and lifestyle is often at odds with the routine of TB treatment leading to greatly increased risk of acquired drug resistance, loss to follow up and onward transmission. 1919841198111199612200201020304050829868990992994998000Rates of TBTB rates in LondonTB rates in England & Wales(minus london) Data from a recent survey of over 2000 TB patients in London2 confirm that patients without a place to live in which they could be reasonably expected to take medication and recover from TB are extremely vulnerable and suggest that TB services have not kept pace with the changing profile of patient needs. • 10% of patients had ever been homeless and 4% were currently living on the streets or in hostels where over half took TB treatment intermittently. • Only 2.5% of street and hostel homeless TB patients were started on Directly Observed Treatment (DOT – is recommended for patients who are at risk of not taking medication). • Street and hostel homeless TB patients are five times more likely to be lost to follow up care. • Street and hostel homeless TB patients are three times more likely to be admitted to hospital for more than one week for clinical reasons and eight times more likely to admitted to hospital for more than one week for treatment compliance reasons. • 10.9% of confirmed TB cases among homeless people (now or ever) were multi drug resistant (MDR) of which one third had acquired resistance this treatment episode. • Seven out of nine patients who were detained under Section 38 of the Public Health Act 1984 had previously been street or hostel homeless and three had acquired MDR TB following prolonged intermittent treatment. Improving TB control among homeless and hard-to-treat patients in London is an urgent public health challenge that must be met. Supported housing and intermediate care is considered an essential component of service in many metropolitan centres in the USA and Europe and has an important role to play in tackling TB in London

Type: Report
Title: TB and Housing
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Epidemiology and Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Epidemiology and Health > Epidemiology and Public Health
URI: http://discovery.ucl.ac.uk/id/eprint/56588
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