title: Housing insecurity and lack of public assistance are risk factors for tuberculin skin test conversion among persons who use illicit drugs in New York City.
abstract: BACKGROUND
  Persons who use illicit drugs are at increased risk of new tuberculosis (TB) infection. We conducted a prospective cohort study to assess rates and risk factors for tuberculin skin test (TST) conversion among persons with a history of illicit drug use, who were enrolled in a methadone program and had a negative baseline 2-step TST (eligible participants).
  
  
  METHODS
  TST and standardized interviews were administered to 401 eligible participants from 1995 through 1999, every 6 months for a 2-year follow-up time. Analyses were conducted in 2006.
  
  
  RESULTS
  A total of 1,447 repeat TSTs were performed during 843 person-years of follow-up (median: 2.0 years). The TST conversion rate was 3.7 per 100 person-years. In multivariate analysis, participants who converted were more likely to report ever having been homeless (HR, 2.4; 95% CI, 1.2-5.0) or ever having lived in a homeless shelter (HR, 2.4; 95% CI, 1.2-4.9) at the baseline interview, and less likely to have reported receiving public assistance since the last study visit (RR, 0.15; 95% CI, 0.07-0.32).
  
  
  CONCLUSIONS
  This is the first study utilizing 2-step TST at baseline to measure the incidence of TST conversion among persons who use illicit drugs. Controlling for homelessness, persons with a lack of current public assistance was identified as a risk factor for TST conversion. These individuals may most benefit from annual tuberculin skin testing.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, New York University School of Medicine, New York, NY, 10016.
authors.forename: Sumathi
authors.initials: S
authors.lastname: Sivapalasingam
authors.forename: Robert S
authors.initials: RS
authors.lastname: Klein
authors.forename: Andrea
authors.initials: A
authors.lastname: Howard
authors.forename: Angie
authors.initials: A
authors.lastname: Qin
authors.forename: Chi-Hong
authors.initials: CH
authors.lastname: Tseng
authors.forename: Marc N
authors.initials: MN
authors.lastname: Gourevitch