AEGiS-15IAC: Assessment of TB screening inclusion in time-limited case management for homeless with mental illness at risk for HIV in New York City: TB screening and Critical Time Intervention (CTI) services.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

Assessment of TB screening inclusion in time-limited case management for homeless with mental illness at risk for HIV in New York City: TB screening and Critical Time Intervention (CTI) services.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. TuOrD1206)

Valencia ES, Saez HV
Parnassia Psychiatric Research Center, The Hague, Netherlands

BACKGROUND: Homeless mentally ill persons at risk for HIV are also at risk for TB. There is a need to include TB screening in their specialized services. We report on the inclusion of TB screening as part of Critical Time Intervention services to homeless mentally ill in a large NYC shelter during a five-year period. CTI is an effective short-term case management approach to stabilize mentally ill persons in community living (Susser, Valencia et al, AJPH 1997). Previously, we reported a 19% HIV prevalence and risky sexual behaviors (Susser et al, AJPH 1993; 1994, AJP), and high concurrent TB and HIV prevalence - during the latest TB epidemic in NYC- in this population (Saez et al, AJPH 1996).

METHODS: All 200 men placed in community living during this period were offered tuberculin skin testing and a chest radiograph follow-up as part of their CTI services. CTI workers accompanied them to their appointments. We also collected information on the demographic characteristics and psychiatric diagnoses of these men. Research raters were blind to the study aims.

RESULTS: Most men were African-American and Latinos, 69% and 25% respectively, and were under forty years (77%). The predominant diagnosis was schizophrenia.(61%). The majority had a comorbid diagnosis of drug (66.%) or alcohol (59%) abuse. PPD testing was completed by 184 (92%) men: 67 positive (33.5%),11 inconclusive (5.5), 106 (53%) negative. Chest X-ray follow-up was completed by 157 (78.5%) men -including all PPD positive and inconclusive results. Six active TB cases (3%) were identified in HIV positive men, they were referred for treatment.

CONCLUSION: This study suggests that TB screening can also be successfully implemented in time limited case management services, such as CTI. Although TB has declined in NYC, effective TB control requires targeting cases in hard-to-reach groups at risk for HIV, such as homeless, which otherwise may remain a focus for its spread.

Keywords: AEGIS, Acquired Immunodeficiency Syndrome, New York City, HIV Seropositivity, Mental Disorders, Prevalence, Case Management, Sexual Behavior, Tuberculosis, Time Management, Mass Screening, Substance-Related Disorders, Tuberculin Test, Diagnosis, Dual (Psychiatry), Humans, Male, diagnosis, methods

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TuOrD1206