Street talk: knowledge and attitudes about tuberculosis and tuberculosis control among homeless adults

OBJECTIVES: To measure knowledge and perceived susceptibility to tuberculos is among homeless adults in San Francisco and attitudes toward control meas ures used to improve adherence to treatment for tuberculosis. DESIGN: A cross-sectional survey via interview of homeless shelter resident s was done at five shelters. RESULTS: Of 292 persons interviewed, 21.6% reported a positive skin test, a nd 57.1% of the positives had received preventive therapy. Over 60% had mis conceptions about transmission, in particular confusion with transmission o f the human immunodeficiency virus (HIV). Knowledge of skin testing procedu res and symptoms was generally good, and most reported health care provider s as the main source of information. Over half reported concern about catch ing tuberculosis and over 80% favored controls to ensure adherence, in part icular directly observed therapy. Higher TB knowledge score (P = 0.0155) an d male sex (P = 0.0357) were associated with a favorable attitude toward di rectly observed therapy. CONCLUSIONS: Health care providers should expand educational messages beyon d skin testing. Greater knowledge about tuberculosis may increase acceptanc e of control measures. Targeted education plus social norms favoring comple tion of therapy may improve screening and treatment outcomes in this popula tion.