Development of housing programs to aid in the treatment of tuberculosis inhomeless individuals: A pilot study

Study objectives: To describe our experience with novel supervised housing programs developed to aid in the treatment of tuberculosis (TB) in homeless individuals, including a preliminary analysis of their effectiveness and e stimate of potential cost savings. Design: Retrospective chart review. Setting: A county TB control program. Methods: The San Diego Count? TB Control Program's computer database was us ed to identify homeless individuals placed in one of two supervised housing programs for treatment of TB [Young Men's Christian Association (YMCA), fo r noninfectious patients, or Bissell House, for infectious patients]. Chart s for all these patients were reviewed and information regarding their demo graphics, underlying medical conditions, therapy, microbiologic markers of response to therapy, hospitalizations, and participation in supervised hous ing programs was recorded. Measurements and results: The sputum culture conversion and treatment compl etion rates for those housed in the YMCA were 100 and 84.6%, respectively. Of the patients in the Bissell House program, 100% had converted their smea r and culture. In addition, all patients in this program completed an adequ ate course of supervised therapy. These rates of microbiologic conversion a nd treatment completion compare favorably with historical data from San Die go County and other locations, Estimated cost savings for placing medically stable infectious patients in the Bissell House for respiratory isolation and supervised treatment were estimated to be $27,034 per patient, Conclusions: Use of supervised housing to aid in treatment of TB in the hom eless appears to be effective and results in substantial cost savings. A la rger multicenter study should be considered to confirm these findings and b etter quantify the cost-effectiveness of such programs.