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Tuberculosis


             Investigations into the policies of three major U.S. cities (New York, San Francisco, Chicago ) have presented the current state of tuberculosis treatment amongst the homeless. Information about the disease and its epidemiology was first obtained through articles found in the library. The general history of public health policy against the disease was then also researched in published articles found in the library and on the internet. The current programs in each respective city were then researched by accessing the city's department of public health homepages on the internet and by calling faculty in the departments for specific information. .
             The results of the research into the policies of the cities is as follows. New York is hardest hit by the reemergence of the disease, and suffers four times as many cases as other major cities. Due to the sheer size of the homeless population, the New York City Department of Health has issued a "Comissioner's Order for Directly Observed Therapy" (CODOT) to ensure the expansion of the treatment in highly infectious areas such as homeless shelters. As a last resort, patients may even be detained until an adequate course of treatment is completed. An additional organization has been created: The Education and Training Unit. Conceived by the Bureau of tuberculosis control, health care providers perform "grand rounds", visiting the many shelters throughout the city to diagnose potential cases and educate the homeless and shelter staff members. The city's health department may also be noted for its extensive use of formerly homeless volunteers to execute policies. .
             Although San Francisco's population is much smaller than other major cities, it has the fifth highest tuberculosis rate in the country. The city's Health Care for the Homeless program has extended PPD skin testing in homeless shelters and food lines. In addition, to increase patient compliance, patients under the DOT program receive transportation vouchers and food which act as incentives to complete the therapy.


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2. Tuberculosis-Mycobacterium

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