Tuberculosis Among Homeless Population from Medellín, Colombia: Associated Mental Disorders and Socio-Demographic Characteristics

Abstract

Homeless people are highly susceptible to tuberculosis. It has been suggested that this population have high rates of mental disorders associated with tuberculosis. We assessed tuberculosis incidence, its transmission patterns and association with socio-demographic factors and mental disorders in Colombian homeless people. Prospective study which socio-demographic characteristics and mental disorders were assessed through interviews. Sputa from patients with respiratory symptoms were processed and clinical isolates analyzed by IS6110-RFLP. Multivariate analysis performed by logistic regression model. From 426 homeless studied, tuberculosis incidence found was 7.9 %. 44 % of isolates were clustering. It was found high risk of having tuberculosis associated with income from drugs trade (OR: 3.40 [95 % CI: 1.28-9.05]), dysthymia (OR: 2.54 [95 % CI: 1.10-5.86]) and receiving food from other homeless (OR: 2.47 [95 % CI: 1.16-5.25]). Tuberculosis incidence and degree of transmission are high in homeless studied. Implementing programs to better control tuberculosis among homeless population must consider socio-demographic factors and mental disorders associated with the disease.

Smear positive pulmonary tuberculosis and associated factors among homeless individuals in Dessie and Debre Birhan towns, Northeast Ethiopia

“…In addition, relatively lower prevalence of TB in Iran might be due to lower prevalence of HIV infection (3.4 %) [15]. However, TB prevalence in this study is lower than studies conducted among homeless individuals in USA (6.1 %) [28], Seoul, South Korea (24.86 %) [13], North-eastern Poland (4.13 %) [29] and Colombia (7.9 %) [30], the difference might be due to difference in study design and setting, sample size and laboratory diagnosis method used. Particularly a study in USA, the analysis covered a wide geographic area with large sample size and the cases were either smear positive PTB or culture confirmed other form of TB [28].…”

“…In North-eastern Poland, the participants were first screened by chest radiography, then molecular testing and culture were performed [29], the use of an advanced diagnostic technique might be not underestimated the actual prevalence. In Colombia all reported cases were culture positive for MTB [30], could be revealed all types of TB in addition to smear positive PTB.…”

The relationship between mental health and risk of active tuberculosis: a systematic review

“…Reasons for exclusion are presented in figure 1, with the most common being that mental health is not a primary outcome or that the study design does not meet the inclusion criteria outlined above. Included studies span multiple locations, including five in Asia, [36][37][38][39][40] three in South America, [41][42][43] one in Africa 44 and one across low-income and middle-income countries (LMICs). 45 Two studies were published in the 1980s 38 40 and the remainder within the last 10 years.…”

Differential determinants of virulence in twoMycobacterium tuberculosisColombian clinical isolates of the LAM09 family

“…The county of Antioquia has one of the highest number of incident cases and its capital city Medellin showed an increase from 50 cases to 70 cases per 100,000 individuals in 2016, but in some vulnerable populations such as homeless people, the incidence reaches 7.9% [3]. What is worrisome is that the incidence of TB in prisons and some native Indian communities in Colombia are in the order of 500-600 cases per 100,000 inhabitants, which is comparable to some of the major TB incident countries mentioned above [4].…”