Screening for TB in an urban shelter for homeless in Switzerland: a prospective study
Abstract
Background
Whereas high risk groups
such as asylum seekers are systematically screened for active
tuberculosis (TB) upon entry in Switzerland, this strategy does
not apply to homeless persons despite a reported high risk.
Geneva health and social authorities implemented an
intersectoral project to screen for active TB in homeless
persons. We aimed to assess acceptability of this program and
prevalence of active TB in this group.
Methods
This prospective study
targeted all homeless adults registering for shelter
accommodation in Geneva during winter 2015. Applicants were
proposed a questionnaire-based screening (www.tb-screen.ch)
exploring epidemiological and clinical risk factors for active
TB. Participants with a positive score underwent diagnostic
procedures at Geneva University Hospital. Enhanced TB
surveillance targeting homeless persons in the community was
continued 3 months after the study termination.
Results
Overall, 726/832 (87.3%)
homeless persons accepted the screening procedure. Most were
young male migrants without access to care in Switzerland. Male
gender (adjusted OR: 2.14; 95% confidence interval:
1.27–3.62), age below 25 years (aOR: 4.16; 95% CI:
1.27–13.64) and short duration of homelessness (aOR: 1.75;
95% CI: 1.06–2.87) were predictors of acceptance. Thirty
(4.1%) had positive screening scores but none of the 24 who
underwent further testing had active TB. Post-study surveillance
did not identify any incident case in Geneva.
Conclusions
Active TB screening
targeting highly mobile homeless persons in shelters was well
accepted and feasible. The participants’ sociodemographic
profile highlighted the heterogeneity of homeless groups in
Europe and the null TB prevalence the variability of their
active TB risks. These findings underline the feasibility of
health programs targeting this hard to reach group and the need
for close monitoring of this social group considering the rapid
changes in international mobility patterns to tailor preventive
and screening strategies to the local context.
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Source:
BMC Infectious Diseases
