Tuberculosis is among the infectious diseases that the Healthy People 2020 aims to combat and reduce the infection rate. Tuberculosis outbreak is a common occurrence among the homeless individuals in the United States of America. Several states have often recorded outbreaks of tuberculosis but Los Angeles has the highest prevalence among the homeless. The federal government has been dedicated to treating such cases but the lack of perfect policies in intervention is an unfortunate factor that obstructs this quest. Public health nurses have a mandate to attend to the cases of tuberculosis occurrence through the help of the health departments and social welfares. Tuberculosis cases among the Homeless people in Los Angles require proper approaches for the prevention of the disease especially by looking at the social and environmental factors favoring the disease spread.
The Issue and the Population it Affects
The prevalence of homelessness in the United States of America is a social concern that everybody more so the federal government and the local health department should address. Los Angles has about fifty-eight thousand homeless people who are at risk of tuberculosis due to the varied social-economic factors. Most immigrants who make over 3.5 million in Los Angeles are prone to tuberculosis since most of them are homeless and therefore live in overcrowded informal shelters. Overcrowded shelters, increased cases of substance and drug abuse and the high prevalence of HIV infection contribute to the rise in cases of tuberculosis among the homeless in Los Angles (Gupta, Sugg, Butners, Allen-White, & Molnar, 2015). The most vulnerable population affected by Tuberculosis among the homeless are people of all ages, immigrants and people of low economic status. The homeless cannot afford proper homes, meals and proper medical care putting them at increased risk of getting infected. The rate of tuberculosis infection is increasing every year in Los Angeles County. In 2016, over 500 homeless people had tuberculosis infections (Readhead, et al., 2018). The data is an indication of the high prevalence of this disease and urgent attention is needed to curb this deadly ailment.
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Social Determinants
Poverty is a critical determinant of high cases of tuberculosis among the homeless in Los Angles. Lack of enough finance and economic prosperity contributes to a lack of proper housing and homes mainly to the immigrants and other minority groups living in Los Angles such as Hispanics. Financially unfortunate people cannot afford health insurance contributing to their being prone to tuberculosis infection in their camps and other places where they spend their nights (Parrott, et al., 2018). Individuals who lack health insurance have no access to quality and affordable health care. Such people will undergo intense pressures due to the tuberculosis infection. Since the homeless people in Los Angeles have no proper access to healthcare insurance, they are prone to tuberculosis infection.
Lack of proper surveillance on the cases of T.B among the homeless also contributes to high cases of infection in Los Angles among the homeless. Homeless people go untreated in case of an increase in latent infection involving tuberculosis (Gupta, Sugg, Butners, Allen-White, & Molnar, 2015). Although, there are cases of health surveillance by public health departments and bodies such as CDC, lack of funds and other social barriers such as increased numbers of immigrants that have contact with tuberculosis ailment. The government further fails to consider proper surveillance and ideal control among the homeless in Los Angeles since most of them are immigrants. With the rising number of immigrants who arrive with strains of tuberculosis from their mother countries, the public health officials find it difficult to cover all these people in the process of treatment. Lack of ideal surveillance, therefore, contributes to the lack of enough information about the homeless living with tuberculosis since they lack accurate data.
Substance Abuse and poor education also contributes to increased cases of tuberculosis among the homeless in Los Angeles. Many homeless people are prone to abusing drugs and other substances due to increased access to such substances in the streets. Homeless people who inject illicit drugs apply the same syringes thus increasing their risk of contracting HIV. An individual who is HIV/ AIDS positive is at a great risk of contracting TB due to their reduced immunity (Figueroa-Munoz, 2008). People using drugs are prone to cough and transmission occurs very quickly in over-crowded areas because the causative agent is air-borne. Poor education is another issue that is prevalent among the homeless in Los Angeles since most of them are immigrants. Ignorance among this group of people contributes to a lack of proper knowledge on the prevention of tuberculosis infection and its spread. Since the county government is also reluctant in creating awareness of the disease among the homeless, the local people remain ignorant leading to increased cases of TB transmission.
Intervention to the prevention of Tuberculosis among the homeless in Los Angeles
Teaching the Homeless Signs and Symptoms Tuberculosis
Early detection of symptoms and signs of tuberculosis among the homeless might lead to the prevention of the spread of this disease to the entire population in the homeless shelters and the entire United States of American society. An as an aspiring public health officer who mainly deals in cases of social amenities, I will provide technology in the homeless shelters and provide access to information to the homeless in Los Angles concerning the signs and symptoms of tuberculosis. A bad cough, pain in the chest, fever, lack of appetite, weight loss and chills are some of the signs and symptoms of tuberculosis I would clarify to the homeless people in Los Angles. Since accessing such a population might be challenging due to rejection and security risks more so in the streets, I would create an awareness in the homeless shelters and highlight these symptoms through technological means such as projectors. I would also accompany myself with public health personnel to help in determining the best method of intervention.
Facilitation of transportation and locating hospitals
Securing access to hospitals to the homeless suffering from Tuberculosis is vital. Homeless individuals who are prone to drug and substance abuse fail to adhere to T.B treatment and follow up due to lack of means of transportation to healthcare facilities (Nyamathi, 2008). Helping these people to reach the hospital and seek medical attention will reduce the rate of Tuberculosis infection among the homeless in Los Angeles. Educating the homeless on the needs to attend to take their medication and convincing them to attend hospitals is an ideal approach that I will take as a public health practitioner. I will visit the homeless shelters and talk to other homeless people in the streets of Los Angeles aiming to facilitate their transportation to the hospital. The county health department and the institution can assist me in this quest.
Tuberculosis is, therefore, a prevalent disease among homeless people in Los Angeles and needs attention in order to realize the Healthy People 2020 objective of reduced rate of infection of infectious diseases such as TB. The issue arises due to poverty, lack of access to medication, poor living conditions, overcrowding and reluctance by the government to attend to homeless people. Since there are over 55,000 home homeless people in Los Angles, taking care of them to prevent the spread of diseases such Tuberculosis should be the priority of the government. As health personnel, I would facilitate the transportation and location of the hospital to the homeless suffering from tuberculosis and teach them the signs and symptoms of this disease. Undertaking the signs and symptoms will contribute to earlier intervention through medication. Every government should emphasize on measurers that reduce the number of homelessness to prevent the spread of tuberculosis in the country.
References
Figueroa-Munoz, J. (2008). Tuberculosis control in vulnerable groups. Bulletin of the World Health Organization , 86 (9), 733-735. doi:10.2471/blt.06.038737
Gupta, V., Sugg, N., Butners, M., Allen-White, G., & Molnar, A. (2015). Tuberculosis among the Homeless — Preventing Another Outbreak through Community Action. New England Journal of Medicine , 372 (16), 1483-1485. doi:10.1056/nejmp1501316
Greenwood, M. J., & Warriner, W. R. (2011). Immigrants and the spread of tuberculosis in the united states: A hidden cost of immigration. Population Research and Policy Review, 30 (6), 839-859. doi:http://dx.doi.org/10.1007/s11113-011-9213-6
Nyamathi, A., Nahid, P., Berg, J., Burrage, J., Christiani, A., Aqtash, S., Leake, B. (2008). Efficacy of Nurse Case-Managed Intervention for Latent Tuberculosis Among Homeless Subsamples. Nursing Research , 57 (1), 33-39. doi:10.1097/01.nnr.0000280660.26879.38
Readhead A, Chang AH, Ghosh JK, Sorvillo F, Detels R, Higashi J (2018) Challenges and solutions to estimating tuberculosis disease incidence by country of birth in Los Angeles County. PLoS ONE 13(12): e0209051. https://doi.org/10.1371/journal.pone.0209051
Parriott, A., Malekinejad, M., Miller, A. P., Marks, S. M., Horvath, H., & Kahn, J. G. (2018). Care Cascade for targeted tuberculosis testing and linkage to Care in Homeless Populations in the United States: a meta-analysis. BMC Public Health , 18 (1). doi:10.1186/s12889-018-5393-x
