TB Challenge: Partnering to Eliminate TB
in African Americans
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A Successful Intervention to Improve TB Treatment
Outcomes in Georgia’s Homeless: An Interview with Pamela Collins,
American Lung Association of Georgia
Michael Fraser, DTBE/ FSEB
Michael Fraser: How and when did the homeless TB patient
program get started?
Pam Collins: It started after the closing of the TB inpatient
unit—a wing at the Northwest Georgia Regional Hospital in
Rome — in June 1996. This wing could house up to 10
in a semi-secured area for TB patients and had done so for some
50 years. With the closing of the unit, the alternative housing
project, which is a collaboration between the American Lung Association
of Georgia (ALA GA) and the Georgia Department of Human Resources
(DHR) Division of Public Health, Prevention Services, Tuberculosis
Program, was begun to provide housing for homeless TB clients in
the state of Georgia. Today, we can provide housing for homeless
or inadequately housed TB clients within their locale; we work closely
with DHR to locate motels, trailers, or apartments that will house
infectious TB patients in the various health districts. Funds allocated
for this project pay for rent, meals, and personal supplies, and
even provide transportation to medical appointments that are unrelated
to TB. We also offer social service referrals and make various accommodations
for patient families; some of these include shared housing for spouses
and children. Project funds are used to ensure that clients with
little or no income, and those who cannot work because of their
infectiousness, maintain their basic necessities. There is
no assistance, however, for such amenities as phone or cable services.
MF: How did you come up with this intervention and get
support for it?
PC: The GA DHR TB control program manager, Beverly
DeVoe-Payton, had been in communication with the ALA of North Carolina
and learned that they had a project that provided housing for TB
clients. However, we decided to take a different approach in the
design and implementation of our project. For example, in
North Carolina, funds were provided directly to the health districts
for overall management of their housing program. Here in Georgia,
we wanted to have staff directly oversee project activities and
funding. We worked closely with the state's TB control program
to remove obstacles that may present barriers to completing treatment;
also, our monitoring/case management efforts have ensured that clients
receiving our services are not lost to medical follow-up in the
process.
MF: What are the criteria for TB clients to enter
into this program and who makes the decision about who is eligible?
PC: First of all, the patient must be infectious, or if
the infectious status is unknown, a determination is made through
medical consultation at the local health department referring the
client for housing. The TB client must also demonstrate that he/she
has an unstable home environment. If they are in the hospital and
they're saying that they can't go back home because they do not
have a home to go to, then an assessment is made by the health department
and hospital social service staff to confirm this. Clients
may have been residing, prior to admission, in a homeless shelter
and quite frankly we would want to pull them out of that setting.
If a client is indicating that he/she does not wish to return to
a housing environment that is with family, but unstable, then we
work with the client to provide housing.
MF: Can you indicate how successful this project has been?
PC: Sure. From July 1, 1996, through June 30, 2004, we
have had 538 clients utilize our services. We have been successful
in that there was a 97% compliance rate with directly observed therapy
and a 91% completion of therapy rate in this cohort of TB clients.
MF: What is the racial and demographic profile of clients
served?
PC: For the cohort mentioned earlier, 77% were reported
as black or African American; 12%, Caucasian; 8% percent,
Hispanic; and 2%, Asian. In addition, 82% were male
and 18% were female.
MF: What is the length of stay for TB clients in alternative
housing?
PC: It just depends. Even if a TB client becomes
sputum-smear negative, the health department may feel strongly that
a TB client may become noncompliant with TB treatment; then all
efforts for that client to remain are made, up to completion of
therapy. Ordinarily, TB clients in the metro Atlanta area
will stay in the program until they have three negative smears and
one negative culture. Usually that takes up to 90 days from the
time residency begins. Ninety days is our target; however,
discharge from alternative housing in the state could occur before
90 days are up. There are other sources in the community that
the ALA works with for continued housing of TB clients, when necessary.
Some of these include the Antioch Urban Ministries, along with many
others. We have 159 counties in Georgia that we provide services
for. If a patient is in Blakely County, we're there, and if
they are in Catoosa County, we're there too.
MF: What are some of the rules that TB clients must adhere
to in order to remain in the program?
PC: TB clients are expected to keep their rooms clean and
undamaged. As a matter of fact, we don't want them to damage any
property. At the end of their stay, we want them to make sure that
their room is left clean. After a new client is placed in
alternative housing, there is follow-up from the ALA and DHR.
Of course, directly observed therapy for the client's TB is a requirement
for housing. There is accountability for TB clients receiving
alternative housing during their treatment for TB; patients who
are recipients of alternative housing are periodically reviewed
by the state TB control program during regularly scheduled case
reviews, although there is co-management with ALA.
MF: Finally, are there any plans to house persons diagnosed
with HIV who are infected with TB? As you know, these are
persons who are at high-risk for developing TB disease.
PC: Yes. We are always looking for new projects and the
opportunities to work collaboratively across disease programs.
Last Reviewed: 05/18/2008 Content Source: Division of Tuberculosis Elimination
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
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