Homelessness and Tuberculosis: What Can We Do?

written by Lisa Stand
February 24, 2014

With flu season over, or almost over, Americans may be breathing a healthy sigh of relief, even as public health officials turn to preventing next year’s outbreaks. People living and working in homeless shelters still have to contend with an airborne bacterium that never goes out of season – tuberculosis, or TB as it is more frequently known. TB is a curable condition that can be fatal if left untreated, and a controllable disease that can spread widely unless precautions are taken.

People experiencing homeless populations have extraordinarily high rates of TB, as much as 10 times the rate in the general community. Public health experts cite a number of reasons for this disparity, including overall poor health status; poor nutrition; lack of access to health care services; and staying at close quarters in emergency shelters and other congregate settings. Even so, communities concerned about homelessness can take steps to ease TB’s impact on vulnerable people and promote interventions that make the spread of TB less likely.

Housing people and ending their homelessness quickly can play a big role – reducing the risks of transmission overall. Many communities are building their capacities for Housing First and rapid rehousing solutions, while others are working to come together and devise effective strategies. Meanwhile, more direct responses to TB are needed in programs that assist people experiencing homelessness. These responses should include:

  • Regular practices that identify, treat and follow up TB cases, with priority given to people who are suffering from symptoms;
  • Staff education about TB and how to prevent it in themselves and others;
  • In shelters, proper ventilation and bed assignments that reduce transmission risks and facilitate monitoring of cases;
  • Community housing and service options that support TB treatment, risk reduction, and public health monitoring after people exit homelessness.

Shelter managers and crisis response workers cannot be expected to function as experts on their own. They can consult with local public health departments and collaborate with Health Care for the Homeless (HCH) projects and other community health centers.  The HCH Clinicians’ Network, in a recent publication, profiled communities making concerted efforts to reduce TB in their homeless populations. Examples from California, Florida, Illinois, Indiana, and New York show what can be done. Another resource is Shelters and TB: What Staff Need to Know offered by the Curry International TB Center. The video and companion piece include information and tools for shelter managers as well as frontline staff.