Shelter Client Tuberculosis Screening Guidelines

City Policy

All clients receiving San Francisco shelter services for more than 3 days (cumulative within a 30-day period) are required to complete tuberculosis screening and evaluation within 10 working days of entering the shelter system.

Screening includes a tuberculin skin test (TST) or QuantiFERON-TB blood test (QFT), symptom review and a history of TB treatment and diagnosis. Documentation of prior TST results should be obtained whenever possible.

A baseline chest x-ray (within one month prior to enrollment) is required for all newly enrolled HIV+ clients regardless of prior or current TST results.

Initial Screening for Newly Enrolled Clients

Test: TST or QFT unless documentation of a prior positive result can be provided

Symptom review: chronic cough (>3 weeks), weight loss, night sweats, fever, hemopytsis (coughing up blood)

History: asess prior TB disease and treatment for active or latent TB infection

If the client is TST or QFT positive and asymptomatic, the following are required (may refer to TB Clinic for the following):

• CXR (within 6 months if HIV-, or within 30 days if HIV+)
• Medical evaluation and risk factor assessment (diabetes, end stage renal disease, cancer, chemotherapy or immune
  modulating drug intake, HIV, etc.)

See the San Francisco Tuberculosis Screening Procedures for Homeless Shelter Clients (below) for more information.

If the client is symptomatic, with a chronic cough (>3 weeks) or has two or more TB-like symptoms, an urgent medical evaluation and CXR should be obtained.

• Referral to TB Clinic is appropriate, and if necessary, call (628) 206-8524 for assistance.
• All clients should be referred to the TB Clinic with documentation of the most recent TST or QFT result and a detailed symptom
  review.

Follow-up Screening

All clients with an initial negative TST or QFT will require a repeat TST or QFT and TB symptom review annually. Certain types of patients will require specific evaluations. See the San Francisco Tuberculosis Screening Procedures for Homeless Shelter Clients (below) for more information.

If the client is symptomatic, with a chronic cough (>3 weeks) or has two or more TB-like symptoms, an urgent medical evaluation and CXR should be obtained.

• Referral to TB Clinic is appropriate, and if necessary, call (628) 206-8524 for assistance.
• All clients should be referred to the TB Clinic with documentation of the most recent TST or QFT result and a detailed symptom
  review.

Initial and Follow-up Screening Documentation

All clients cleared for active TB should have shelter clearance entered into the LCR. If a symptomatic client or TB suspect is lost, enter a clinical alert and contact the TOPS Program Manager at (628) 206-8524 for assistance.

Additional Resources

San Francisco Tuberculosis Screening Procedures for Homeless Shelter Clients