Tuberculosis among drug users and homeless persons: impact of voluntary X-ray investigation on active case finding

Goetsch, Udo; Bellinger, Oswald; Buettel, K.-L.; Gottschalk, René

doi:10.1007/s15010-011-0238-x

Cited by 22 publications

(49 citation statements)

References 28 publications

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“…In the 1999–2002 period, vulnerable groups of population such as asylum seekers, refugees, undocumented immigrants and homeless persons accounted for 39% of cases in Geneva [17]. In recent years, we observed a change in populations accommodated in shelters with a growing proportion of vulnerable migrants from medium - to high TB prevalence countries, which correlates with findings in other European cities [5]. Unlike Germany where screening for active TB is mandatory for homeless persons living in shelters, Swiss policies restrict systematic screening to asylum seekers.…”

Section: Introductionsupporting

confidence: 80%

“…Incentives may provide a motivational effect and several authors described how appropriate use of incentives enhanced participation to TB screening or treatment programs [22–24]. In Frankfurt, implementing a voluntary X-ray screening program with the help of local social services had a positive impact on participation and coverage [5]. Other studies showed how cooperation between health and social sectors helps to promote health opportunities for underserved groups of population [8, 25].…”

Section: Discussionmentioning

confidence: 99%

“…In Europe, mortality in homeless persons is seven times higher than in the general population and morbidity, both somatic and psychiatric, is also significantly increased [3, 4]. It is associated with a substantial risk of communicable diseases, notably tuberculosis (TB) [5, 6]. In Western Europe, TB prevalence in homeless persons is between 1 and 2% for active and up to 45% for latent infection [5, 7–9].…”

Section: Introductionmentioning

confidence: 99%

“…It is associated with a substantial risk of communicable diseases, notably tuberculosis (TB) [5, 6]. In Western Europe, TB prevalence in homeless persons is between 1 and 2% for active and up to 45% for latent infection [5, 7–9]. This prevalence, considerably higher than in the general population, underlines the public health importance of developing control programs targeting this group.…”

Section: Introductionmentioning

confidence: 99%

“…outside healthcare settings) case-finding strategies in cooperation with community stakeholders and local social services [10, 11]. While screening and treatment is cost effective (US$ 32′000 per QALY) compared to passive strategies among groups with a TB prevalence of 250/100′000 or higher in Europe, low awareness of TB, limited participation in programs, and frequent drop out along diagnostic and therapeutic procedures frequently limit effectiveness of control programs [5, 12, 13]. Various screening modalities have been tested and there is still debate over the optimal strategy [14].…”

Section: Introductionmentioning

confidence: 99%

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Screening for tuberculosis in an urban shelter for homeless in Switzerland: a prospective study

et al. 2017

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BackgroundWhereas 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.MethodsThis 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.ResultsOverall, 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.ConclusionsActive 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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Section: Introductionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Screening for tuberculosis in an urban shelter for homeless in Switzerland: a prospective study

et al. 2017

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Somatische Erkrankungen Wohnungsloser in Deutschland. Ein narratives Literaturreview der Jahre 2009–2019

Schindel

Kleyer

Schenk

2020

Bundesgesundheitsbl

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Zusammenfassung Hintergrund In Deutschland leben Schätzungen zufolge zwischen 337.000 und 650.000 wohnungslose Menschen in gesundheitlich zumeist prekärer Lage. Studien zu ihrer Gesundheit sind selten und methodisch heterogen. Bisherige Übersichtsarbeiten fokussierten auf psychische Erkrankungen. Fragestellung Ziel der Arbeit ist es, einen Überblick über die aktuelle Forschung zu somatischen Erkrankungen von Wohnungslosen in Deutschland zu geben. Methoden Auf Grundlage einer systematischen Literaturrecherche für die Jahre 2009–2019 werden methodisches Vorgehen, Stichprobenzugang und Rekrutierung sowie die berichteten Gesundheitsaspekte betrachtet. Ergebnisse Es wurden 8 Journalbeiträge mit Peer-Review identifiziert. Häufig wurde der Begriff „Wohnungslosigkeit“ nicht operationalisiert. Im Durchschnitt waren die Wohnungslosen 40,9–67 Jahre alt, der Frauenanteil lag bei 0–35,3 %. Der Stichprobenzugang erfolgte in Unterkünften und im Rahmen medizinischer Angebote. Eine Rekrutierungsstrategie war ein modifiziertes Schneeballsystem („respondent driven sampling“) in Verbindung mit Anreizen (Incentives). Häufig wurden Herz-Kreislauf-Erkrankungen (17–37,2 %), Erkrankungen des Muskel-Skelett-Systems (≥20 %) sowie der Atemwege (7–24 %) berichtet. Abhängig vom Ort der Rekrutierung traten vermehrt Infektionskrankheiten auf (Tuberkulose, Hepatitis B und C). Diskussion Studien zur somatischen Gesundheit Wohnungsloser sind häufig selektiv. Überrepräsentiert erscheinen Personen, die älter sind, unteren Bildungsgruppen angehören oder in deutschen Großstädten lebende Männer. Der Begriff „Wohnungslosigkeit“ wird nicht einheitlich verwendet. Im Vergleich mit repräsentativen Bevölkerungsdaten für Deutschland werden erhöhte Erkrankungsrisiken beobachtet. Kohortencharakteristika können diese nur bedingt erklären. Biografische und intersektionale Ansätze werden benötigt, um die multiplen und kumulativen Belastungslagen zu erfassen.

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Mass invading the trachea: a rare presentation of tuberculosis simulating lung cancer

2013

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Tuberculosis among drug users and homeless persons: impact of voluntary X-ray investigation on active case finding

Abstract: A novel targeted TB screening approach with voluntary radiographic examination of illicit drug users and homeless persons can be integrated into the existing public TB prevention programme and provides a high case-finding rate.

Cited by 22 publications

References 28 publications

Screening for tuberculosis in an urban shelter for homeless in Switzerland: a prospective study

Screening for tuberculosis in an urban shelter for homeless in Switzerland: a prospective study

Somatische Erkrankungen Wohnungsloser in Deutschland. Ein narratives Literaturreview der Jahre 2009–2019

Mass invading the trachea: a rare presentation of tuberculosis simulating lung cancer

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