Chapter 15

Responses to TB-associated social risk factors should be addressed by a dedicated TB-program social worker; the ability of programs to do this should be monitored. Among communicable infectious diseases, TB in particular illustrates how structural barriers imposed by racism, classism and colonialism in Canada require political commitment to make health systems available and accessible to all (see Chapter 12: An Introductory Guide to Tuberculosis Care Serving Indigenous Peoples and Chapter 13: Tuberculosis Surveillance and Tuberculosis Testing and Treatment in Migrants).^42,43 At the same time, psycho-social, behavioral and biological considerations complicate TB disease and its management (eg, substance use disorders, contact network structures, HIV/AIDS (acquired immunodeficiency syndrome), diabetes, undernutrition).^44–55 Because the specific tasks of the dedicated TB-program social worker may vary, programs can assess the impact of this support in various ways, including: 1) reporting the proportion of patients connected to a primary care provider by the end of TB care; 2) reporting the proportion of patients experiencing homelessness who are adequately housed by the end of TB care; and 3) assessing housing conditions among patients with infectious TB.