Street talk: knowledge and attitudes about tuberculosis and tuberculosis control among homeless adults.

OBJECTIVES: To measure knowledge and perceived susceptibility to tuberculosis among homeless adults in San Francisco and attitudes toward control measures used to improve adherence to treatment for tuberculosis.

DESIGN: A cross-sectional survey via interview of homeless shelter residents was done at five shelters.

RESULTS: Of 292 persons interviewed, 21.6% reported a positive skin test, and 57.1% of the positives had received preventive therapy. Over 60% had misconceptions about transmission, in particular confusion with transmission of the human immunodeficiency virus (HIV). Knowledge of skin testing procedures and symptoms was generally good, and most reported health care providers as the main source of information. Over half reported concern about catching tuberculosis and over 80% favored controls to ensure adherence, in particular directly observed therapy. Higher TB knowledge score (P = 0.0155) and male sex (P = 0.0357) were associated with a favorable attitude toward directly observed therapy.

CONCLUSIONS: Health care providers should expand educational messages beyond skin testing. Greater knowledge about tuberculosis may increase acceptance of control measures. Targeted education plus social norms favoring completion of therapy may improve screening and treatment outcomes in this population.