Keywords
Abstract
Tuberculosis (TB) screening remains a substantial public health challenge in correctional facilities and the homeless population. In this prospective cohort study we evaluated TB screening of HIV-infected prisoners, released prisoners and homeless persons compared to the general population. Methods: Prospective data collection of newly registered HIV and TB co-infected cases was conducted in St. Petersburg, Vologda and Leningrad regions between 2008 and 2011. Social and demographic, clinical and epidemiological characteristics of patients were identified and predictors of TB-attributable mortality were assessed. Results: A total of 2888 patients were included in the analysis: 1570 local residents,777 released prisoners, 404 prisoners and 137 homeless persons. There was no significant difference in age but prisoners, released prisoners and homeless persons were more likely to be male, reside in urban areas, lack fulltime employment and report injection drug use, less likely to have microbiological confirmation, presented with a greater incidence of disseminated TB, lower CD4 cell count. Significant predictors of TB-attributable morality were current or prior incarceration, urban residence, unemployment, symptoms lasting over 1 year, extra-pulmonary TB at presentation and CD4 cell count less than 200. Conclusions: HIV-infected prisoners, released prisoners and homeless persons were diagnosed with TB at a significantly more advanced disease stage and presented with greater morbidity and mortality to compare to a general population. Targeted early screening and on time started treatment interventions could improve TB outcomes in these social groups.