In the United States, homeless populations have more than 10 times the risk of tuberculosis as that of the general population. One reason is that many people experiencing homelessness are already infected with tuberculosis, having been exposed during past stays in shelters. While treatment can clear the infection and prevent development of disease, people experiencing homelessness have had trouble completing the three- to six-month-long treatment.
The project will develop a partnership involving Boston Health Care for the Homeless, Mercy Care (Atlanta), Healthcare for the Homeless – Houston, public tuberculosis programs in the three cities, and the applicant (a researcher). The three community-based organizations provide healthcare services to persons experiencing homelessness, and these organizations have Community Advisory Boards composed of persons affected by homelessness. Tuberculosis programs provide free treatment for tuberculosis infection but lack resources to work in communities. The applicant contributes experience in implementing tuberculosis infection treatment studies.
The project objectives are to (1) engage providers and homeless community members to discuss strategies for delivering tuberculosis infection treatment and propose patient-centered measures of treatment quality, and (2) develop a comparative effectiveness research proposal evaluating different models to deliver this treatment in homeless communities. The applicant will engage Community Advisory Board members, healthcare providers, and tuberculosis program staff members in each city. Community-based organizations will convene focus groups of persons experiencing homelessness. A cross-site working group will be formed. A conference will be held to discuss ideas for treatment delivery and patient-centered outcome measures. The applicant and community-based co-leads will prepare a multisite patient-centered outcomes research funding application focused on treating tuberculosis infection.
*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.