Originally posted in Feb 2011
Tuberculosis should be extinct, but it’s not.
An editorial in the most recent Lancet notes that in 1911, the journal’s editor wrote that he was looking forward to the day when “the demon of tuberculosis” would finally be eradicated. Though society and medicine have, of course, made great strides in the last 100 years, the “demon” still exists, especially among homeless populations in large cities.
The writer of this year’s Lancet editorial notes that in Toronto, the percentage of homeless people who die within after diagnosis has remained unchanged over the last ten years. Getting people diagnosed, and after diagnosis, getting them to follow medication dosing instructions are complicated tasks when patients are homeless. New York City’s approach is called “active case finding” and it involves going out into the streets and finding people who need treatment. Patients are admitted to an intermediate care facility, where their treatment is monitored.
Tuberculosis rates are declining in New York City, as reported in this New York Times blog, such that the vast majority of cases in the City now are immigrants from other countries. While such a decline could be due to a number of factors, it’s quite possible that this case finding program is responsible for the drop. What appears to be true in either case is that, as far as TB risk goes, you’re better off as a homeless New Yorker than an immigrant. What’s more, multi-drug resistant TB in New York is nearly gone, with only eight cases reported in 2009.
The Lancet editor notes that London uses a similar program that is in jeopardy. Find and Treat is the name of the organization that does case finding for London, and the British National Health Service is about to put the responsibility for “commissioning”, running the day-to-day treatment operations of NHS within communities, into the hands of general practitioners, who may choose to end the relationship between NHS and Find and Treat.
The editor’s fear may turn out to be unfounded. Let’s all hope this is the case.
Tuberculosis should be extinct, but it’s not.
An editorial in the most recent Lancet notes that in 1911, the journal’s editor wrote that he was looking forward to the day when “the demon of tuberculosis” would finally be eradicated. Though society and medicine have, of course, made great strides in the last 100 years, the “demon” still exists, especially among homeless populations in large cities.
The writer of this year’s Lancet editorial notes that in Toronto, the percentage of homeless people who die within after diagnosis has remained unchanged over the last ten years. Getting people diagnosed, and after diagnosis, getting them to follow medication dosing instructions are complicated tasks when patients are homeless. New York City’s approach is called “active case finding” and it involves going out into the streets and finding people who need treatment. Patients are admitted to an intermediate care facility, where their treatment is monitored.
Tuberculosis rates are declining in New York City, as reported in this New York Times blog, such that the vast majority of cases in the City now are immigrants from other countries. While such a decline could be due to a number of factors, it’s quite possible that this case finding program is responsible for the drop. What appears to be true in either case is that, as far as TB risk goes, you’re better off as a homeless New Yorker than an immigrant. What’s more, multi-drug resistant TB in New York is nearly gone, with only eight cases reported in 2009.
The Lancet editor notes that London uses a similar program that is in jeopardy. Find and Treat is the name of the organization that does case finding for London, and the British National Health Service is about to put the responsibility for “commissioning”, running the day-to-day treatment operations of NHS within communities, into the hands of general practitioners, who may choose to end the relationship between NHS and Find and Treat.
The editor’s fear may turn out to be unfounded. Let’s all hope this is the case.
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