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Home / Public Health Action, Volume 7, Number 3

Open Access Homeless shelter context and tuberculosis illness experiences during a large outbreak in Atlanta, Georgia

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Setting: Persons experiencing homelessness (PEH) represent a population at high risk for tuberculosis (TB). While quantitative studies have characterized some important features of this key group, less has been captured directly from PEH about how they experience TB illness itself and the prevention and control measures implemented in response to an outbreak. This qualitative study aimed to explore PEH's TB disease experiences in the context of a large TB outbreak involving homeless shelters in Atlanta, Georgia, USA.

Design: This was a qualitative cross-sectional study involving in-depth interviews with 10 PEH with active TB disease. Key themes were identified through coded data analysis.

Results: The central theme to emerge was that stressful social environments of homeless shelters shape illness experiences and health care seeking behaviors, and limit the influence of shelter-based prevention and control measures implemented in response to a TB outbreak. Despite availability, shelter-based latent tuberculous infection (LTBI) testing and education services were minimally engaged. Furthermore, hardships inherent to homelessness were interrelated with disease normalization and symptom minimization.

Conclusions: Homeless shelter-related stress may have important implications for the prevention and control of TB outbreaks in this setting. This stress may hinder case finding; a model of supplemental TB education and testing for LTBI at proximal community venues is necessary.

Keywords: United States; homelessness; persons experiencing homelessness; qualitative research

Document Type: Research Article

Affiliations: 1: Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA 2: Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA 3: Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA, Communicable Disease Prevention Branch, Fulton County Department of Health and Wellness, Atlanta, Georgia, USA 4: Communicable Disease Prevention Branch, Fulton County Department of Health and Wellness, Atlanta, Georgia, USA 5: Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA, Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA

Publication date: 21 September 2017

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  • Public Health Action (PHA), The Union's quarterly Open Access journal, welcomes the submission of articles on operational research. It publishes high-quality scientific research on health services, providing new knowledge on how to improve access, equity, quality and efficiency of health systems and services.

    The Editors will consider any manuscript reporting original research on quality improvements, cost-benefit analysis, legislation, training and capacity building, with a focus on all relevant areas of public health (e.g. infection control, nutrition, TB, HIV, vaccines, smoking, COVID-19, microbial resistance, outbreaks etc).

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