Tuberculosis in socially maladapted persons (homeless people): causes, symptoms, diagnosis, treatment

Socially maladapted groups of the population include people without a fixed abode (HOM), migrating both within the country and from countries near and far abroad, refugees from areas of interethnic and local military conflicts, unemployed people, people suffering from chronic alcoholism (and drug addiction), prisoners, and people living in shelters for the disabled and the elderly.

A significant portion of socially maladjusted individuals are not “permanent residents” and are formally outside the responsibility of health care institutions, but it is necessary to implement a range of anti-tuberculosis measures among them (social support for the tuberculosis control program, creation of rehabilitation centers, and health education work).

In most cases, tuberculosis among homeless people and the migrant population is detected "by appeal", therefore, widespread acute forms that are difficult to treat are diagnosed. Such patients are potential sources of the spread of tuberculosis, including multidrug-resistant ones.

The team method and mobile fluorography are used to detect and diagnose tuberculosis among migrants and homeless people. The methods make it possible to detect tuberculosis in most adult migrants in places of their greatest concentration - temporary accommodation points (hotels, sanatoriums, rest homes, schools), their places of work (study), charity society points, labor exchanges, refugee committees. For the treatment of the migrating population and homeless people, specialized hospitals (departments), rehabilitation centers and boarding houses for those who have had tuberculosis or for those with chronic forms are organized.

Refugee services often do not pay due attention to the fight against tuberculosis. Service employees ensure that refugees have food, clothing and housing. Health workers should pay special attention to the fight against tuberculosis, promptly identify and treat patients. Constant monitoring is necessary when treating refugees and homeless people.

The reasons for the increase in the number of patients with untreatable forms of tuberculosis are varied. Increasing the effectiveness of tuberculosis treatment in socially maladjusted individuals depends not so much on the treatment tactics in hospitals or outpatient settings, but on the conditions of the socio-economic situation and on the factors of tuberculosis transmission. An important condition is the patient's desire for recovery. For patients from socially maladjusted groups, individual monitoring of the patient's behavior at different stages of treatment is developed. As a rule, men (90%) under the age of 45, single, with a low level of education, unemployed and without a permanent place of residence, suffering from alcoholism and previously in places of imprisonment refuse treatment.

To reduce the frequency of treatment refusals and cases of regime violations, it is necessary to provide social assistance to patients: distribution of food or hygiene kits, reimbursement of transportation costs, organization of food outlets, rehabilitation of former prisoners.

If tuberculosis is detected in shelters, nursing homes and homes for the elderly, it is necessary to examine all persons who have been in contact with the patient and administer controlled preventive chemotherapy to them.

Pretrial detainees and prisoners are also at risk of contracting tuberculosis. Persons in prisons are poorly educated and have disadvantageous socioeconomic conditions. The spread of HIV infection complicates the control of tuberculosis in penitentiary institutions.

Prisoners are frequently transferred within a prison, between different law enforcement agencies, and between correctional services. Prison staff and visitors come into contact with prisoners , so a TB reservoir in a prison poses a risk to the community. Effective control of TB in prisons is essential to protect the health of prisoners and the community.

To identify patients with tuberculosis, defendants undergo chest fluorography upon admission to a pretrial detention facility. Prisoners undergo X-ray examination once every six months. However, in some regions of Ukraine, most infectious forms of pulmonary tuberculosis are detected 2-3 months after the next examination. Therefore, when a prisoner exhibits symptoms observed with pulmonary tuberculosis (cough with sputum production, chest pain, subfebrile temperature, hemoptysis), sputum is examined for Mycobacterium tuberculosis (at least three samples). This allows for the identification of infectious patients, examination of contact persons and the prevention of group tuberculosis.

The regional program to combat tuberculosis should be uniform for both civil society and penitentiary institutions. It is necessary to provide prisoners with full anti-tuberculosis treatment and observation after release.

However, the form and content of tuberculosis control programs in penitentiary institutions and in municipal institutions differ. It is necessary to monitor not only the treatment process (ensuring strict control over the intake of drugs and preventing their entry into the "black market"), but also strict control over the diagnosis of tuberculosis, especially when obtaining sputum samples from prisoners, since both simulation and concealment of tuberculosis are possible.

Special attention should be given to prisoners who are transferred within or between prisons. If the patient is being treated in one facility, the process is easier to monitor. When transferring a patient to another correctional facility, it is necessary to ensure that the full course of treatment is completed in the facility to which the prisoner is being transferred.

Thanks to increased control over the diagnosis and treatment of tuberculosis and improved drug provision, the proportion of tuberculosis cases identified in penitentiary institutions among all newly registered patients has decreased from 22-25% to 11-13% over the past 4-5 years.

Conducting anti-tuberculosis measures among the entire population of the administrative territory undoubtedly improves control over tuberculosis incidence and can lead to stabilization of tuberculosis incidence and mortality rates and their reduction.