Homeless with TB?: Housing Should be Part of the Treatment, not Part of the Problem

Abstract

Chronic homelessness is a red flag symptom, marking a significantly increased risk of ill-health and premature death in homeless people. By definition homeless people tend to have chaotic and transient lives, as their priorities are very different from housed people. When a homeless person has tuberculosis (TB), and must complete a minimum of six months treatment in order to be cured, adherence to the full course can be an insurmountable problem. For people who are in the United Kingdom (UK) illegally, or with no recourse to public services, the situation is even bleaker. A fear of authority can deter them from seeking health care until the disease is extremely advanced. However, once stabilised on medication and medically fit for discharge from hospital, there is a real danger that they will be lost to follow-up because of their homelessness, thus putting themselves and others at risk. A model for housing homeless TB patients has been developed in Hackney, east London. Those housed have predominantly been in the UK illegally. Having the capacity to house them has made a significant difference to the health of the patient, the work of the TB team, and the cost to local health services. What is known about this topic? The problem of non-adherence to medical treatment remains a challenge for health professionals. • Adherence to tuberculosis treatment is poor in high risk groups such as the homeless • Incentives have been used to help patients remain on long term treatment (Giuffrida & Torgerson, 1997; Priebe et al, 2013) What this paper adds: • A ‘social’ problem such as homelessness should be considered as a co-morbidity and addressed at the same time as health problems • Incentives can create conditions for the patient to make other changes to improve overall quality of life Keywords: Tuberculosis, homelessness, accommodation, health care, service level agreement