Tuberculosis and Homelessness

INTRODUCTION

Tuberculosis (TB) rates have doubled in the UK in the last ten years and the homeless population is particularly vulnerable to the disease. TB is curable, however without treatment it can kill. Homeless patients are likely to experience considerable delays in reaching TB services and are more likely to present with advanced and infectious forms of TB. They are also more likely to discontinue treatment.

On this page you can find out more about TB, download training and information materials, get information about your local TB services and find links to useful services.

ISSUES

What is TB?

TB is an infection caused by a germ called mycobacterium tuberculosis. Most commonly it affects the lungs but can affect other parts of the body such as the lymph glands, bones or the brain.

TB usually begins as a small inflamed area in one lung. This inflamed area then becomes a hole. If it is not stopped in time the bacteria then spreads to the other lung and the holes become bigger.

If left untreated TB can sometimes be fatal. However, TB treatment is very effective and few now die of the disease.

Improper medication regimes or failing to complete a full course of treatment can lead to drug resistant TB. Multi-Drug Resistant TB (MDR-TB) is a form of the disease that is especially hard to treat. The germ has in this case become resistant to at least two of the most powerful TB drugs. People with MDR-TB are more likely to be infectious for long periods and more likely to die from TB.

TB sometimes causes no immediate problem but remains dormant in the body. Illness may then develop years after the original infection with the germ, particularly if the body's immune system is weakened by other factors.

Why are homeless people more vulnerable?

Research suggests that 10 per cent of TB patients had a history of homelessness and 4 per cent were currently sleeping rough. It also shows that street and hostel homeless were more likely to be diagnosed late, take treatment intermittently and be lost to treatment follow up. These factors increase the risk of TB outbreaks and the emergence of drug resistant TB.

A number of factors increase the risk of TB among homeless people. These are:

  • the increased number of undetected cases among homeless people
  • delayed diagnosis caused by problems accessing health care and the reluctance of some homeless people to consult health services
  • generally poor nutrition and weakened immunity which increases the risk of initial infection and progression to active disease
  • high alcohol intake has a direct effect on immunity and can be linked with poor nutrition
  • hard drug use, especially smoking crack cocaine, can mask TB as it produces similar symptoms
  • overcrowding - crowded or poorly ventilated accommodation with little natural light makes the spread infection more likely
  • taking TB treatment for a minimum of six months is often very difficult for homeless people due to other priorities, low self-esteem, lack of knowledge about TB, alcohol misuse, mental illness or living on the streets or in unsuitable accommodation
  • the prevalence of drug resistant TB among homeless people. This form of the disease is much harder to treat and is likely to be infectious for longer periods of time.

SOLUTIONS

It is vital that there are adequate opportunities for screening of people at risk of TB. Peer to Peer approaches have proved a successful way to encourage take-up of screening. As access to testing can be difficult, services like mobile x-ray units have also proven effective ways to reach rough sleepers and other homeless people at risk of TB.

The government recently launched a new Public Health strategy. As a major public health concern, it is vital to protect funding for screening services and ensure they are effectively targetted to at-risk populations like homeless people.

The following resources were developed as part of a project Homeless Link and the Health Protection Agency. Groundswell have now taken over the long term management of this project – visit their website for more information and contact information.Existing resources are also available:

Tackling Tuberculosis in the homeless population, an article published in the Lancet in December 2010 provides some perspectives from across the sector about what can help address potential rises to TB rates among homeless people in the changing health landscape.