TUBERCULOSIS SKIN TESTING AMONG HOMELESS ADULTS

OBJECTIVE: To document the prevalence of tuberculosis (TB) skin test p ositivity among homeless adults in Los Angeles and determine whether c ertain characteristics of homelessness were risk factors for TB. DESIG N: Cross-sectional study. SETTING: Shelters, soup lines, and outdoor l ocations in the Skid Row and Westside areas of Los Angeles. PARTICIPAN TS: A representative sample of 260 homeless adults. MEASUREMENTS AND M AIN RESULTS: Tuberculosis tine test reactivity was measured. The overa ll prevalence of TB skin test positivity was 32%: 40% in the inner-cit y Skid Row area and 14% In the suburban Westside area. Using multiple logistic regression, TB skin test positivity was found to be associate d with living in crowded or potentially crowded shelter conditions, lo ng-term homelessness, geographic area, history of a psychiatric hospit alization, and age. CONCLUSIONS: Homeless adults living in congested i nner-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 ens ure completion of prophylactic regimens by homeless individuals with l atent infection.