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

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.