Portable X-ray machine to help state fight TB

Wil Humble, the state's assistant director of public health, said Arizona's homeless are most at risk for catching TB because they don't have regular access to health care. And he said the close living situation in many shelters makes it much easier to spread.

The new machine will be sent to shelters around the state, primarily those in Tucson and Phoenix.

Many shelters in Tucson already require homeless people to be tested for TB before they can stay, or before they can stay a certain number of nights, said Deb Harvey, Information and Referral Services call supervisor.

But getting the county Health Department's TB test takes time and expense, and transportation is an issue, she said.

"Having it at the site would be fantastic," she said.

Because of the community setting of most shelters and easy transmission, TB is rampant among the homeless, Harvey said.

But Humble said it would be wrong to see this strictly as a problem for the homeless.

He pointed to the new strains of the disease that are resistant to traditional treatments. And Humble said what could start with one infected person spreads not only to others who are homeless but also to everyone they encounter, potentially causing a public-health crisis.

Right now the most common method of checking for TB is a skin test.

"It's not all that reliable," said Humble. And it requires the person to come back in three days to read the test, something that may prove difficult with a mobile population like the homeless.

"But if you've got a patient in a shelter that you can identify quickly, run a chest X-ray, look at it, and say this looks high risk for active TB, then we can get that person into the treatment system," he said.

"It would be great that they have this because any extra screening is wonderful," said Deborah Dale, chief development officer at the Primavera Foundation, which runs an emergency men's shelter.

"At Primavera we've had one documented active case in 10 years," she said.

Reducing the three-day waiting period for the skin test would be helpful, Dale said.

Primavera requires TB tests for anyone staying longer than five nights, or anyone returning for a second stay regardless of the length of the stay, Dale said.

Humble said the plan is to use the nearly $300,000 his agency got from the state's Health Crisis Fund to get a machine that provides a digital image rather than using film. That not only avoids the time delay in processing the film but the images can be e-mailed to a central location to be read.

"That doesn't mean we're eliminating the risk of TB in shelters," Humble said. "But we're going to be able to do much more in terms of public health to make sure that those folks who do have active TB don't end up in the shelter and affect everyone else."

The homeless don't seem to transmit more airborne diseases than the rest of the population, Dale said, but they have a harder time recovering when sick.

"The problem is, when homeless people get sick they do get sicker because they've got nowhere to recover and they're not eating well," she said.

Arizona has 300 to 320 cases of "active" TB each year, Humble said, with a high proportion of those among the homeless.

"It's especially important now as we're seeing more and more cases of drug-resistant TB," he continued, citing recent news reports. That includes not only the man who traveled back to the United States with TB — which may or may not be a particularly virulent strain — but also a man being held in a jail ward at Maricopa Medical Center with an extremely drug-resistant form of the disease.

"The whole key is finding people early and getting them into treatment," said Humble. It's also essential to have them complete that treatment, which can take between six months and a year.

That is why state law gives his agency the power to quarantine people.

The Salvation Army in Tucson sees so many homeless people in and out of its shelter each day that a more permanent system might be a better approach, said Tamara McElwee, organization spokeswoman.

Access to the mobile X-ray machine once a month, or even once a week, isn't dealing with a large portion of the homeless population, she said.

"It would be something that you'd want to have in-house to make radical differences in serving the population," she said.

The Salvation Army, like Primavera, requires TB screening for long-term stays, McElwee said.

"It could be a wonderful tool if we could depend on having it available," she said.