142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

304896
A SPA 4 Collaborative Response to a Tuberculosis Outbreak Affecting the Homeless in Skid Row

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Monday, November 17, 2014 : 12:30 PM - 12:45 PM

Paula Marin, PHN , Nursing-SPA 4, LA County Department of Public Health, Los Angeles, CA
Eileen Alagot, RN, MSN , Nursing-SPA 4, LA County Department of Public Health, Los Angeles, CA
Rosaisela Bernal-Murillo, PHN, MPA , Nursing-SPA 4, LA County Department of Public Health, Los Angeles, CA
Background/Issue: Homeless individuals have risk factors that increase their susceptibility to Tuberculosis (TB) infection and disease.  Prompt identification of individuals with active TB disease and those exposed is vital for preventing the spread of TB.  The challenges enmeshed in managing TB in the homeless community and their poor adherence, as indicated by the 0% completion rate of latent TB infection (LTBI) prophylaxis in Skid Row within the past decade, necessitated efficiency in the response to this outbreak.

Description: In June of 2013, SPA 4 initiated a TB Contact Investigation for approximately 800 TB contacts in Skid Row.  Public Health Nurses strategically developed an operational kit, received trainings on the 12-dose regimen for LTBI, QuantiFERON/T-Spot field collection/process, and conducted TB screening outreaches.  The strategies applied have contributed to the TB evaluation of 435 contacts, treatment for active TB cases identified, completion of 22 LTBI contacts on the12-dose regimen, and evaluation of 570 clients at outreache sites as of December 2013.    

Lessons Learned: A strong collaboration from all disciplines including, clinic/ancillary staff, Los Angeles County TB Control Program, Public Health Investigators, shelter providers, and the guidance of SPA 4 management team, were deemed essential in the efficient management of this ongoing outbreak.     

Implications/Recommendations: The importance of having an open communication and collaborative approach by the multidisciplinary team, trainings, and the utilization of the TB homeless tool were found to be fundamental in the effective management at all levels of prevention of the TB homeless outbreak affecting the Skid Row community.

Learning Areas:

Diversity and culture
Other professions or practice related to public health
Protection of the public in relation to communicable diseases including prevention or control
Public health or related education
Public health or related nursing
Public health or related public policy

Learning Objectives:
List three risk factors of the homeless population that increase their susceptibility to TB infection and disease. Identify at least two challenges involved in conducting Tuberculosis Contact Investigation (TBCI) in the homeless community in Skid Row.

Keyword(s): Tuberculosis, Homelessness

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None

Qualified on the content I am responsible for because: I have been a Public Health Nurse working in Los Angeles County for the Department of Public Health for 10 years. As a Public Health Nurse I work with the diverse communities of Downtown LA with a primary focus that include disease investigation,case management and education.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.