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Tuberculosis in Homeless Population
on Skid Row, California
Alegra d’Alessandro WCSN, Kasey Dorney WCSN, & Margaret Gregory WCSN
Evelyn L. Spiro School of Nursing Wagner College
Introduction
● Skid Row is home to one of the largest concentrations
of homeless people in the country. (1)
● There is little access to shelter, food, and healthcare
for these residents. (1)
● California has the largest number of cases of
tuberculosis in the Nation.(1)
● The nature of homelessness allows for communicable
diseases such as tuberculosis to spread more quickly.
● The Program TB on Wheels can reduce the rapid rate
of the disease by providing free education classes
regarding the signs and symptoms, advocating to The
Tuberculosis Control Branch to implement rapid
testing, and referring individuals who test positive to
centers that can treat TB (8).
Problem
Community Assessment & Analysis
(1)
Race
Resources Currently Available:
● There are 6 TB testing centers in the Los Angeles
area: AltaMed Health Services, Arroyo Vista Family
Health Center, Asian Pacific Health Care Venture,
East Valley Community Health Center, JWCH Health
Institute, and Martin Luther King Center for Public
Health. (3)
● Of the 6 available testing centers only one specifically
caters towards the Skid Row population, JWCH
Health Institute. (3)
(1)
One of the major health problems in Skid Row, California is Tuberculosis
which is plaguing the community.
● Due to the large number of homeless in this area, and it being “the
epicenter of LA’s addiction crisis” (5), there has been an increase in the
number of cases of TB.
○ There is a large homeless shelter located in the community that
accounts for over 12,000 people.
■ A large number of people in this community are retired veterans
or drug abusers. They account for a large percentage of the
tuberculosis cases.
○ Due to the living conditions, lack of support, and the nature of the
health problems in this population - TB becomes a widespread
concern.
● Illnesses such as TB, are typically uncontrolled and whenever this
happens, it can be dangerous due to the ability for it to transmit easily
and spread so rapidly.
Populations at risk:
● Migrants
● Children less than 5 years of age
● Groups with high rates of TB transmission
○ Homeless persons
○ Injection drug users
○ People with HIV
Other populations in the world that are experiencing outbreaks/high cases of
TB also consist of a community similar to Skid Row.
Factors contributing to the spread of TB are:
○
○
○
○
Crowding
Poor hygiene
Lack of shelter
Poor nutrition
National and Global Health Data:
● Since 2007, the ‘Skid Row Strain’ has been in the community. Within a 6
year span, 78 people have been diagnosed with the strain, 11 of whom
have died. 60 of the diagnosed cases were from the Skid Row area (6).
● TB in the United States: over 8,000 reported cases in 2019. These were
reported to the CDC from 60 different states, cities, and US territories.
There is an estimated 13 million people living with latent TB infection (2).
● According to the WHO, “TB is the 13th leading cause of death and the
second leading infectious killer after COVID-19. In 2020, an estimated 10
million people fell ill with TB worldwide” (7).
● The health district of Skid Row has a tuberculosis rate
of about 9 per every 100,000, which is above the
countywide rate of tuberculosis (2)
● There are 7,000 males and over 3,000 females that
live in Skid Row (1)
● The average household size for Skid Row is about 10
people versus Los Angeles which is 3 people. (1)
● The population density of people who live in Skid Row
is 3 times greater than of Los Angeles confirming that
those in this community live in close proximity to each
other. (1)
(4)
References
● (1)City-Data. Skid row (Central City East) neighborhood in Los Angeles, California (CA), 90013,
90014, 90021 detailed profile [Internet]. Skid Row (Central City East) neighborhood in Los Angeles,
California (CA), 90013, 90014, 90021 subdivision profile - real estate, apartments, condos, homes,
community, population, jobs, income, streets. 2019 [cited 2022Mar21]. Level VII. Available from:
https://www.city-data.com/neighborhood/Skid-Row-Los-Angeles-CA.html
● (2)Data & Statistics [Internet]. Centers for Disease Control and Prevention. Centers for Disease
Control and Prevention; 2022 [cited 2022Apr8]. Level VII Available from:
https://www.cdc.gov/tb/statistics/default.htm
● (3)Versalles L. TB test centers in Los Angeles: Top 6 [Internet]. Accesa Labs Blog. 2020 [cited
2022Apr19]. Level VII Available from: https://www.accesalabs.com/blog/top-6-los-angeles-tb-testcenters/
● (4)Public Health. In Los Angeles County 2020 - publichealth.lacounty.gov [Internet]. Tuberculosis in
Los Angeles County 2020. 2020 [cited 2022Mar21]. Level VII Available from:
http://publichealth.lacounty.gov/tb/docs/TB2020FactSheet.pdf
● (5)L.A.'s skid row battles tuberculosis outbreak - healthmap [Internet]. [cited 2022Apr8]. Available
from: https://www.diseasedaily.org/diseasedaily/article/las-skid-row-battles-tuberculosis-outbreak351
● (6)Rufo CF. The moral crisis of skid row, LA's most notorious neighborhood [Internet]. New York
Post. New York Post; 2020 [cited 2022Apr8]. Available from: https://nypost.com/2020/02/18/themoral-crisis-of-skid-row-las-most-notorious-neighborhood/
● (7)Tuberculosis (TB) [Internet]. World Health Organization. World Health Organization; [cited
2022Apr8]. Available from: https://www.who.int/news-room/fact-sheets/detail/tuberculosis
● (8)Tuberculosis Control Branch [Internet]. About Us. 2020 [cited 2022Mar21]. Available from:
https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/About-Us.aspx
● (9)Evrevin M, Hermet L, Guillet-Caruba C, Nivose P-L, Sordoillet V, Mellon G, et al. Improving
tuberculosis management in prisons: Impact of a rapid molecular point-of-care test. Journal of
Infection. 2021;82(2):235–9. Level VI.
Proposed Solution
● Program named TB on Wheels, that focuses on
three major activities
■ First activity is free educational classes at
homeless shelters that are taught by
volunteer health care workers regarding
proper hygiene, signs and symptoms of
TB, medication regimen, etc.
● Health care workers will be collecting
donations from their own community to
hand out free hand sanitizers, masks,
food and water.
● They will also be creating their own
flyers to hand out regarding TB
information.
■ Next activity is advocating to healthcare
organizations such as The Tuberculosis
Control Branch in California and applying
for grants to try and implement rapid TB
testing (9).
● The Xpert MTB/RIF Ultra assay (rapid
TB test) was first done in a French
prison hospital, and had a “sensitivity,
specificity, positive and negative
predictive values of around 99% on raw
sputum” (9). The testing is FDA
approved, and can significantly reduce
the rapid spread of TB by 18 days (9).
■ Last program activity is referring individuals
who test positive to centers that can help
treat and manage TB. The Tuberculosis
Control Branch offers various resources
such as testing, treatment and community
resources (8).
● Overall, we want anyone from the homeless
population that is attending TB on Wheels to be
able to identify three early signs and symptoms
of TB after completion of the program, list two
ways of taking proper precaution when
exposed, and be able to verbalize where to
receive treatment.
● In conclusion, TB on Wheels was designed to
stop the spread as efficiently as possible, and
allow the homeless population to seek the
treatment they deserve.
�
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Kasey Dorney
Alegra D'Alessandro
Margaret Gregory
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Tuberculosis in Homeless Population on Skid Row, California
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