High prevalence of latent tuberculosis and bloodborne virus infection in a homeless population

Aldridge, Robert W; Hayward, Andrew; Hemming, S; Yates, S; Ferenando, Gloria; Possas, Lucia; Garber, Elizabeth; Watson, John M.; Geretti, Anna María; McHugh, Timothy D.; Lipman, Marc; Story, Alistair

doi:10.1136/thoraxjnl-2016-209579

Cited by 30 publications

(35 citation statements)

References 24 publications

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“…UK prisons have reported varying levels of HBV vaccine uptake (22–70.2%), depending on the type and location [28–31]. There is a lack of evidence of HBV vaccine uptake in the homeless, although a recent cross-sectional survey of a London homeless population has estimated the prevalence of past HBV infection as 10.4% and identified the importance of maximising vaccination uptake in this group [9]. Similarly, our study included a number of homeless people without the presence of other risk factors, who are not targets for the pre-exposure HBV immunisation programme per se.…”

Section: Discussionmentioning

confidence: 99%

“…Although homelessness is not a specific indicator for HBV vaccination in the UK, this population group overlaps with the target groups of the Green Book. Previous research has highlighted the association between homelessness and tri-morbidity (the combination of physical and mental ill-health and substance abuse), unprotected sex, exposure to blood-borne viruses and IDU [9–14]. The cycle of homelessness and imprisonment is also well documented [15–17].…”

Section: Introductionmentioning

confidence: 99%

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Hepatitis B vaccination uptake in hard-to-reach populations in London: a cross-sectional study

et al. 2019

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Background In the UK, hepatitis B virus (HBV) incidence is associated with migrants from particular high-burden countries and population groups deemed ‘hard-to-reach’ by standard healthcare services: the homeless, people who inject drugs and ex-prisoners. Currently, there is a national targeted HBV vaccine policy for such at-risk groups, but there is limited recent evidence about 1) the levels of vaccine uptake, 2) the factors associated with incomplete vaccination, and 3) reasons for incomplete vaccination. Methods A questionnaire capturing social and medical history, demographic factors and information about HBV vaccination status was completed by individuals deemed hard-to-reach due to socio-structural factors that criminalise, isolate and stigmatise who consented to participate in a randomised controlled trial of a peer intervention to promote engagement with hepatitis C services. The questionnaire also captured the reasons for incomplete vaccination. Descriptive, univariable and multivariable regression analyses were undertaken. Results Three hundred fourty six participants completed the questionnaire. 1) 52.3% ( n = 181) reported full HBV vaccination. 2) Within a multivariable model adjusting for sociodemographic variables, the presence of one or two or more socio-structural factors that are included in the national targeted vaccination policy was associated with protection against incomplete HBV vaccination (51.7% vaccine coverage in those with one factor, odds ratio 0.43 [95% confidence interval 0.20–0.92]); 70.1% coverage with two or more factors, 0.19 [0.09–0.39]; overall p -value < 0.001). Being female was also associated with lower vaccine uptake (2.37 [1.24–4.57], 0.01). Examining the socio-structural factors individually, intravenous drug use was associated with protection against incomplete HBV vaccination. 3) The most common reasons declared for incomplete vaccination were never being offered the vaccine or not returning for further doses. Conclusion Within this study of HBV vaccination uptake among hard-to-reach population groups in London, UK, we document 52.3% coverage of the full vaccine course. Critically, although participants recommended for immunisation within national guidelines had an increased likelihood of receiving a complete vaccine course, we note surprisingly low coverage in the presence of the risk factors that are national indicators for vaccination. Public health bodies should make additional efforts to improve coverage in the hard-to-reach through improved vaccine delivery systems. Trial registration ISRCTN24707359 , Registered 19th October 2012. Electronic supplementary material The online version of this article (10.1186/s12879-019-3926-2) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hepatitis B vaccination uptake in hard-to-reach populations in London: a cross-sectional study

et al. 2019

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“…This may be a result of difficulties attending follow-up after a positive HCV diagnosis, or because the diagnosis has not yet been made. Patient groups who may have difficulty accessing HCV services include PWID, people with mental health problems and people who are homeless (38). For example, only around half of PWID sampled in the UK's PHE Unlinked Anonymous Survey in 2016 were aware of their positive HCV antibody status (39).…”

Section: Difficult-to-engage Patient Groupsmentioning

confidence: 99%

Consensus recommendations for resistance testing in the management of chronic hepatitis C virus infection: Public Health England HCV Resistance Group

Bradshaw

Mbisa

Geretti

et al. 2019

Journal of Infection

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“…This was part of a previously published study where the primary aim was to determine the prevalence of latent tuberculosis infection, though participants were also tested for blood borne viruses. 24 Subjects were recruited from 39 homeless hostels and 20 drug treatment services through the National Health Services Find and Treat (F&T) Service 25 -a specialist outreach team with the main aim of tackling TB in people who are homeless, vulnerable migrants and drug or alcohol users. The service screens almost 10 000 high-risk people every year, covering every London borough.…”

Section: Study Populationmentioning

confidence: 99%

Hepatitis C among vulnerable populations: A seroprevalence study of homeless, people who inject drugs and prisoners in London

Aisyah

Shallcross

Hayward

et al. 2018

Journal of Viral Hepatitis

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Injecting drugs substantially increases the risk of hepatitis C virus (HCV) infection and is common in the homeless and prisoners. Capturing accurate data on disease prevalence within these groups is challenging but is essential to inform strategies to reduce HCV transmission. The aim of this study was to estimate the prevalence of HCV in these populations. We conducted a cross-sectional study between May 2011 and June 2013 in London and, using convenience sampling, recruited participants from hostels for the homeless, drug treatment services and a prison. A questionnaire was administered and blood samples were tested for hepatitis C. We recruited 491 individuals who were homeless (40.7%), 205 drug users (17%) and 511 prisoners (42.3%). Eight per cent of patients (98/1207, 95% CI: 6.7%-9.8%) had active HCV infection and 3% (38/1207, 95% CI: 2.3%-4.3%) past HCV infection. Overall, one quarter (51/205) of people recruited in drug treatment services, 13% (65/491) of people from homeless residential sites and 4% (20/511) prisoners in this study were anti-HCV positive. Seventy-seven of the 136 (56.6%, 95% CI: 47.9%-65%) of HCV infected participants identified had a history of all three risk factors (homelessness, imprisonment and drug use), 27.3% (95% CI: 20.1%-35.6%) had 2 overlapping risk factors, and 15.4% (95% CI: 10.6%-23.7%) one risk factor. Drug treatment services, prisons and homelessness services provide good opportunities for identifying hepatitis C-infected individuals. Effective models need to be developed to ensure case identification in these settings that can lead to an effective treatment and an efficient HCV prevention.

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High prevalence of latent tuberculosis and bloodborne virus infection in a homeless population

Cited by 30 publications

References 24 publications

Hepatitis B vaccination uptake in hard-to-reach populations in London: a cross-sectional study

Hepatitis B vaccination uptake in hard-to-reach populations in London: a cross-sectional study

Consensus recommendations for resistance testing in the management of chronic hepatitis C virus infection: Public Health England HCV Resistance Group

Hepatitis C among vulnerable populations: A seroprevalence study of homeless, people who inject drugs and prisoners in London

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