Homeless People: A Real Challenge in TB Management in Romania

SESSION TITLE: Chest Infections SESSION TYPE: Original Investigation Poster PRESENTED ON: Saturday, April 16, 2016 at 11:45 AM - 12:45 PM PURPOSE: The incidence of TB in Romania is continuously decreasing: 142.2% 000-2002, 105.5% 000-2008, 72.9% 000-2013. The aim of our study was to establish the impact of homeless population between TB cases in Romania among 2010-2013 and also to follow the evolution of these cases compared by the TB cases in general population. METHODS: Using data from the National TB Control Program, we analyzed the evolution of the proportion of tuberculosis cases occurred among the unemployed and homeless between 2010-2013. The indicators used to reflect the evolution of TB in these groups were: the rate of TB at homeless people among all TB cases; bacteriological confirmation rate calculated as the rate of bacteriologically confirmed cases of all the studied cases; therapy success rate, calculated as the ratio of the number of patients with cured pulmonary TB or with completed treatment to the number of patients declared with pulmonary TB; mortality rate among TB cases at homeless people. RESULTS: Between 2010 and 2013, the number of TB cases at homeless and their percent among all TB patients increased (92=0,43% in 2010, 121=0,63%, 135=0,80% in 2013). The percent of new cases also increased (51% in 2010 and 2011, 56% in 2012, 62,2% in 2013); relapses and abandons are very frequent. Mean age of these patients decreased from 47.00±10.67, in 2010 to 44±11,69 in 2012; 87,78% of patients were men, 81% living in urban areas. Pulmonary localisation is predominent (96-97% of cases each year). Microscopic examination of sputum revealed acid-fast bacillus in 71% of TB cases each year; bacteriological confirmation in culture was 80%. Only 39,66% in 2011 and 45,56% in 2013 of unemployed TB patient were successfully treated. Defaulters represented 32% of cases in 2010 - 2011 and 30% in 2012-2013. CONCLUSIONS: The number and rate of TB cases among homeless population is increasing. Microscopic examination of sputum revealed acid-fast bacillus in 71% of TB cases each year, rising again the epidemiological impact of these cases. Concerning the results of treatment at that social category, we have to underline the high percent of abandoned treatment (∼30%) and deaths (more than 15%). CLINICAL IMPLICATIONS: Given the upward trend of the number of cases among the homeless tuberculosis, we consider the necesity of intensifying active screening campaigns for TB, but also performing DOT in medical institutions for homeless population. DISCLOSURE: The following authors have nothing to disclose: Mara Popescu-Hagen, Mihaela Tanasescu, Rodica Traistaru, Paraschiva Postolache No Product/Research Disclosure Information