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U.S. Department of Health and Human Services


TB Challenge: Partnering to Eliminate TB
in African Americans

A Successful Intervention to Improve TB Treatment Outcomes in Georgia’s Homeless: An Interview with Pamela Collins, American Lung Association of Georgia

Michael Fraser, DTBE/ FSEB

Michael Fraser: How and when did the homeless TB patient program get started?

Pam Collins: It started after the closing of the TB inpatient unit—a wing at the Northwest Georgia Regional Hospital in Rome — in June 1996. This wing could house up to 10 in a semi-secured area for TB patients and had done so for some 50 years. With the closing of the unit, the alternative housing project, which is a collaboration between the American Lung Association of Georgia (ALA GA) and the Georgia Department of Human Resources (DHR) Division of Public Health, Prevention Services, Tuberculosis Program, was begun to provide housing for homeless TB clients in the state of Georgia. Today, we can provide housing for homeless or inadequately housed TB clients within their locale; we work closely with DHR to locate motels, trailers, or apartments that will house infectious TB patients in the various health districts. Funds allocated for this project pay for rent, meals, and personal supplies, and even provide transportation to medical appointments that are unrelated to TB. We also offer social service referrals and make various accommodations for patient families; some of these include shared housing for spouses and children. Project funds are used to ensure that clients with little or no income, and those who cannot work because of their infectiousness, maintain their basic necessities. There is no assistance, however, for such amenities as phone or cable services.

MF: How did you come up with this intervention and get support for it?

PC: The GA DHR TB control program manager, Beverly DeVoe-Payton, had been in communication with the ALA of North Carolina and learned that they had a project that provided housing for TB clients. However, we decided to take a different approach in the design and implementation of our project. For example, in North Carolina, funds were provided directly to the health districts for overall management of their housing program. Here in Georgia, we wanted to have staff directly oversee project activities and funding. We worked closely with the state's TB control program to remove obstacles that may present barriers to completing treatment; also, our monitoring/case management efforts have ensured that clients receiving our services are not lost to medical follow-up in the process.

MF: What are the criteria for TB clients to enter into this program and who makes the decision about who is eligible?

PC: First of all, the patient must be infectious, or if the infectious status is unknown, a determination is made through medical consultation at the local health department referring the client for housing. The TB client must also demonstrate that he/she has an unstable home environment. If they are in the hospital and they're saying that they can't go back home because they do not have a home to go to, then an assessment is made by the health department and hospital social service staff to confirm this. Clients may have been residing, prior to admission, in a homeless shelter and quite frankly we would want to pull them out of that setting. If a client is indicating that he/she does not wish to return to a housing environment that is with family, but unstable, then we work with the client to provide housing.

MF: Can you indicate how successful this project has been?

PC: Sure. From July 1, 1996, through June 30, 2004, we have had 538 clients utilize our services. We have been successful in that there was a 97% compliance rate with directly observed therapy and a 91% completion of therapy rate in this cohort of TB clients.

MF: What is the racial and demographic profile of clients served?

PC: For the cohort mentioned earlier, 77% were reported as black or African American; 12%, Caucasian; 8% percent, Hispanic; and 2%, Asian. In addition, 82% were male and 18% were female.

MF: What is the length of stay for TB clients in alternative housing?

PC: It just depends. Even if a TB client becomes sputum-smear negative, the health department may feel strongly that a TB client may become noncompliant with TB treatment; then all efforts for that client to remain are made, up to completion of therapy. Ordinarily, TB clients in the metro Atlanta area will stay in the program until they have three negative smears and one negative culture. Usually that takes up to 90 days from the time residency begins. Ninety days is our target; however, discharge from alternative housing in the state could occur before 90 days are up. There are other sources in the community that the ALA works with for continued housing of TB clients, when necessary. Some of these include the Antioch Urban Ministries, along with many others. We have 159 counties in Georgia that we provide services for. If a patient is in Blakely County, we're there, and if they are in Catoosa County, we're there too.

MF: What are some of the rules that TB clients must adhere to in order to remain in the program?

PC: TB clients are expected to keep their rooms clean and undamaged. As a matter of fact, we don't want them to damage any property. At the end of their stay, we want them to make sure that their room is left clean. After a new client is placed in alternative housing, there is follow-up from the ALA and DHR. Of course, directly observed therapy for the client's TB is a requirement for housing. There is accountability for TB clients receiving alternative housing during their treatment for TB; patients who are recipients of alternative housing are periodically reviewed by the state TB control program during regularly scheduled case reviews, although there is co-management with ALA.

MF: Finally, are there any plans to house persons diagnosed with HIV who are infected with TB? As you know, these are persons who are at high-risk for developing TB disease.

PC: Yes. We are always looking for new projects and the opportunities to work collaboratively across disease programs.


Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination -

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Communications, Education, and Behavioral Studies Branch
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