title: Tuberculosis among the homeless: should we change the strategy?
abstract: Tuberculosis (TB) is a major concern among high-risk populations such as the homeless.
  
  
  
  To evaluate TB incidence and treatment outcomes among homeless patients in Portugal and to identify predictors of unsuccessful TB treatment outcomes among the homeless.
  
  
  
  This was a retrospective cohort study of all TB patients notified in Portugal from 2008 to 2014. Characteristics of homeless TB patients were assessed and predictors of unsuccessful TB treatment were determined using logistic regression.
  
  
  
  TB incidence among the homeless was 122/100,000 homeless persons and was positively correlated with TB incidence among non-homeless persons. Homeless TB patients had a higher prevalence of alcohol and/or drug use, human immunodeficiency virus (HIV) co-infection, cavitary TB and smear positivity. The rate of unsuccessful treatment outcomes among the homeless was 28.6%, and was significantly associated with increased age, injection drug use (IDU) and HIV co-infection.
  
  
  
  TB incidence among homeless persons was five times that among the non-homeless, and higher in regions with greater TB incidence among non-homeless persons. The successful treatment outcome rate was lower. Predictors of unsuccessful treatment were age, IDU and HIV co-infection. Integrated TB programmes targeting homeless and non-homeless patients, with measures targeting specific characteristics, may contribute to TB elimination in Portugal.
authors.affiliation: Pulmonology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia.
authors.forename: M
authors.initials: M
authors.lastname: Dias
authors.affiliation: Department of Mathematics, Faculty of Sciences, Centre of Mathematics, University of Porto, Porto.
authors.forename: R
authors.initials: R
authors.lastname: Gaio
authors.affiliation: Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto.
authors.forename: P
authors.initials: P
authors.lastname: Sousa
authors.affiliation: Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto.
authors.forename: M
authors.initials: M
authors.lastname: Abranches
authors.affiliation: EPIUnit, Institute of Public Health, University of Porto, Porto, Occupational Health, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia.
authors.forename: M
authors.initials: M
authors.lastname: Gomes
authors.affiliation: EPIUnit, Institute of Public Health, University of Porto, Porto.
authors.forename: O
authors.initials: O
authors.lastname: Oliveira
authors.affiliation: Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, ICVS/3B's, Portugal Government Associate Laboratory, Braga/Guimarães.
authors.forename: M
authors.initials: M
authors.lastname: Correia-Neves
authors.affiliation: Public Health Department, Agrupamento de Centros de Saúde do Porto Oriental, Porto, Portugal.
authors.forename: E
authors.initials: E
authors.lastname: Ferreira
authors.affiliation: Pulmonology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, EPIUnit, Institute of Public Health, University of Porto, Porto.
authors.forename: R
authors.initials: R
authors.lastname: Duarte
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology; D000995:Antitubercular Agents / Q000008:administration & dosage*; D015331:Cohort Studies; D060085:Coinfection; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011174:Portugal / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000453:epidemiology; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy / Q000453:epidemiology*
chemical_list: D000995:Antitubercular Agents