The impact of social factors on tuberculosis management

Aim. This paper is a report of a study to examine the impact of social factors on the management of tuberculosis including engagement with services, hospitalization and extended treatment. Background. Rates of tuberculosis in major European cities have increased greatly in the last 10 years. The changing epidemiology of the disease, concentrated in marginalized groups, presents new challenges to the control of tuberculosis. Methods. A prospective cohort study of 250 newly diagnosed tuberculosis patients was conducted in London between January 2003 and January 2005. Data were collected by means of a risk assessment tool and from medical records. Outcome measures included missed appointments, frequency and duration of hospitalization and length of treatment. Results. The median age of the study sample was 33·82 (range 16·4-92·5) and 56·8% were male. Thirty-two per cent were hostel/street homeless or temporarily sharing accommodation with friends or relatives. Thirty-nine per cent were in receipt of welfare benefits and 13·2% had no income. Over a third anticipated difficulties taking their medicines and 30·3% had noone to remind them of this. Increased hospitalization was associated with hostel/street homelessness, drug or alcohol use and having noone to remind them to take their medicines (all P ≤ 0·01). Missed appointments were associated with drug/alcohol use and previous tuberculosis treatment. Extended treatment was also associated with drug/alcohol use; previous tuberculosis treatment, drug resistance and those anticipating difficulties taking medication (all P ≤ 0·001). Conclusions. The development of a social outreach model of care with an emphasis on prevention and support is an essential aspect of modern, international tuberculosis care.