RESUMEN
A limited number of studies have been published that examine treatment completion rates and interventions used to increase treatment completion within an inner-city population. The purpose of the present study was to determine the rate of latent tuberculosis infection (LTBI) treatment completion in an inner-city population in Edmonton, Alberta, and to identify factors that correlated with treatment completion. A retrospective chart review was conducted involving patients who started LTBI treatment between January 1, 2005 and December 31, 2010 in Edmonton's inner city. A total of 77 patients started treatment and 57 (74%) patients completed LTBI treatment. Homelessness was the only variable that was significantly associated with incomplete treatment (OR 8.0 [95% CI 1.4 to 45.6]) and it remained significant when controlling for drug use (adjusted OR 6.5 [95% CI 1.1 to 38.8]). While the present study demonstrated treatment completion rates comparable with or better than those described in the general population, it highlighted the need for continued emphasis on interventions aimed at improving outcomes within homeless populations.
Quelques études publiées ont porté sur le taux d'achèvement des traitements et les interventions utilisées pour accroître cet achèvement dans la population d'un quartier pauvre. La présente étude visait à déterminer le taux d'achèvement du traitement contre l'infection tuberculeuse latente (ITL) dans la population d'un quartier pauvre d'Edmonton, en Alberta, et déterminer les facteurs qui corrélaient cet achèvement. Les chercheurs ont effectué une recherche rétrospective dans les dossiers des patients qui avaient un amorcé un traitement contre l'ITL entre le 1er janvier 2005 et le 31 décembre 2010 dans un quartier pauvre d'Edmonton. Au total, 77 patients ont amorcé le traitement contre l'ITL et 57 patients (74 %) l'ont terminé. L'itinérance était la seule variable qui s'associait de manière significative à un traitement incomplet (RR 8,0 [95 % IC 1,4 à 45,6]), et elle demeurait significative lorsqu'on tenait compte de la consommation de drogue (RR rajusté 6,5 [95 % IC 1,1 à 38,8]). La présente étude faisait état d'un taux d'achèvement comparable ou meilleur à celui décrit dans la population générale, mais faisait ressortir la nécessité d'insister constamment sur des interventions visant à améliorer les résultats cliniques dans les populations d'itinérants.
RESUMEN
OBJECTIVE: An outbreak of tuberculosis (TB) in a large urban apartment building and three homeless shelters within a one-block radius in Edmonton, Alberta occurred between 2008 and 2009. The purpose of this report is to describe the transmission dynamics of this multiethnic, multicentre inner-city TB outbreak. METHODS: A retrospective chart review was conducted through the Integrated Public Health Information Systems (iPHIS) to extract demographic, clinical and treatment data as well as data for contacts for all 19 cases involved in the outbreak. TB isolates were genotyped using molecular IS6110 restriction fragment-length polymorphism (RFLP). Categorical variables were compared using Fisher's exact test and continuous variables were analyzed using the Kruskal Wallis test. RESULTS: Two groups were identified through genotyping. One group consisted of 9 cases with a newly identified TB genotype circulating in Alberta. All of the cases in this group were among males and two thirds were among individuals from northeast Africa, with subsequent transmission into Canadian-born populations through exposure during shelter stays. The second group (n=3) identified were infected by a previously circulating strain of TB in Alberta and consisted of Canadian-born Aboriginal people. CONCLUSION: This study demonstrates the transmission of a novel TB strain from foreign-born populations to Canadian-born populations through location-based settings serving vulnerable populations. This study highlights the changing demographic and emerging health concerns for under-housed populations in Canada.