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John Concato, MD, MS, MPH; William N. Rom, MD, MPH

Arch Intern Med. 1994;154(18):2069-2073.

Abstract
Objectives
The purpose of the study was to describe demographic and clinical characteristics of patients at the only long-term care facility for homeless men with tuberculosis in New York City, and to evaluate the outcome of a directly observed therapy program for these men.

Methods
The study population included residents at the "tuberculosis unit" for men in the New York City municipal shelter system. A cross-sectional survey described the characteristics of 76 men in the unit during November 1991. A retrospective cohort study evaluated 104 consecutive admissions to the facility from October 1, 1990, through March 30, 1991, and determined the outcome of directly observed therapy.

Results
Cross-sectional survey (n=76). The median age was 43 years (range, 25 to 60 years); 67 patients (88%) had pulmonary tuberculosis. Among 58 isolates of Mycobactarium tuberculosis, eight were resistant to one drug (14%) and an additional nine were resistant to at least two drugs (16%). A history of previous treatment was associated with an odds ratio of 5.1 for having multiple drug-resistant tuberculosis (exact 95% confidence interval, 0.8 to 53.5). Retrospective cohort (n=104). Excluding 21 men whose care was transferred to other agencies or institutions, 39 (47%) of 83 subjects completed or were still receiving treatment after 12 months and 44 (53%) of 83 subjects failed to complete the program.

Conclusions
As expected, previous treatment for tuberculosis among homeless men is associated with an increased risk of having multiple-drug resistance. A directly observed therapy program successfully treated less than half of the enrolled subjects. Increased efforts are needed to control the spread of tuberculosis among homeless individuals.

(Arch Intern Med. 1994;154:2069-2073)

Author Affiliations
From the Department of Medicine, Division of Pulmonary and Critical Care Medicine, New York University School of Medicine, and the Chest Service, Bellevue Hospital Center (Drs Concato and Rom), and the New York City (NY) Department of Health (Dr Concato). Dr Concato is now with the Yale University School of Medicine, New Haven, Conn, and the West Haven (Conn) Veterans Affairs Medical Center.

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