Adults experiencing homelessness are more likely to contract and spread tuberculosis than the general population. Among the significant barriers to effectively lowering tuberculosis rates in this population is low treatment adherence. A single-arm pilot study was designed to evaluate the effect of a community-based, nurse-led community health worker intervention on the completion of 3HP treatment (isoniazid-rifapentine once a week for three months) among adults who were homeless and had latent tuberculosis infection, compared with a clinic-based control group.

The study sample included 50 adults who self-reported as experiencing homelessness and were 18 to 60 years old, had been diagnosed with latent tuberculosis infection and cleared for active tuberculosis, and reported current or recent (within the last 12 months) substance use. A multicomponent 3HP latent tuberculosis infection intervention was developed based on community feedback, and a team composed of a research RN and four community health workers was trained to deliver the intervention. For 12 weeks, the team met weekly with the participants and delivered directly observed 3HP treatment and provided health and social service referrals.

The treatment completion rate (based on completion of 11 of 12 doses in the intervention group) was 91.8%, compared with 66% in the control group. The completion rate was lower in participants younger than age 50 and in men. Neither substance use, depression, nor anxiety was associated with treatment completion.

The authors note that a sizable number of potential participants who were screened didn't return for test results-a potentially critical biasing factor in interpreting the results of this study. Also, the sample was small, and the study was underpowered, so the researchers couldn't detect improvements in mental health or drug use that might have been associated with treatment completion. The study was conducted in a small, urban area, so the results can't be generalized to rural homeless or other populations. Nonetheless, the authors conclude that a nurse-led community health worker program may be an effective intervention delivery model that addresses the health and social service needs of adults experiencing homelessness.