Original Article

Journal of General Internal Medicine

, Volume 12, Issue 1, pp 25-33

First online:

Tuberculosis Skin Testing Among Homeless Adults

  • Lillian GelbergAffiliated withDivision of Family Medicine, UCLA School of Medicine
  • , Christopher J. PanaritesAffiliated withDepartment of Health Services, UCLA School of Public Health
  • , Hal MorgensternAffiliated withDepartment of Epidemiology, UCLA School of Public Health
  • , Barbara LeakeAffiliated withUCLA School of Nursing and Division of Family Medicine
  • , Ronald M. AndersenAffiliated withDepartment of Health Services, UCLA School of Public Health
  • , Paul KoegelAffiliated withRAND Corp.

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OBJECTIVE:

To document the prevalence of tuberculosis (TB) skin test positivity among homeless adults in Los Angeles and determine whether certain characteristics of homelessness were risk factors for TB.

DESIGN:

Cross-sectional study.

SETTING:

Shelters, soup lines, and outdoor locations in the Skid Row and Westside areas of Los Angeles.

MEASUREMENTS AND MAIN RESULTS:

Tuberculosis tine test reactivity was measured. The overall prevalence of TB skin test positivity was 32%: 40% in the inner-city Skid Row area and 14% in the suburban Westside area. Using multiple logistic regression, TB skin test positivity was found to be associated with living in crowded or potentially crowded shelter conditions, long-term homelessness, geographic area, history of a psychiatric hospitalization, and age.

CONCLUSIONS:

Homeless adults living in congested inner-city areas are at high risk of both latent and active TB. Endemic risk factors and limited access to medical care support the need for aggressive treatment of active TB cases and innovative programs to ensure completion of prophylactic regimens by homeless individuals with latent infection.

tuberculosis homeless persons screening