Active pulmonary tuberculosis and latent tuberculosis infection among homeless people in Seoul, South Korea: a cross-sectional study

Lee, Chang‐Hoon; Jeong, Yun-Jeong; Heo, Eun Young; Park, Jong Sun; Lee, Ji Sun; Lee, Byoung Jun; Park, Young Sik; Song, Eun Ju; Yang, Yun; Cho, Young Soo; Cho, Enhi; Na, Kyoungin; Oh, Eun Jung; Lee, Jin-Beom; Oh, S. B.; Kim, Hee Jin; Park, Chang Min; Yim, Jae Joon

doi:10.1186/1471-2458-13-720

Cited by 25 publications

(29 citation statements)

References 20 publications

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“…Poverty has been suggested to be related to underweight status and malnutrition, which are known to be closely associated with the TB risk . Similarly, homeless people tend to have LTBI and active TB more frequently than their non‐homeless counterparts . However, adding the socioeconomic status to the model had no impact on the result in our study.…”

Section: Discussioncontrasting

confidence: 61%

Regional differences in the incidence of tuberculosis among patients with newly diagnosed diabetes mellitus

Yang

Kang

Heo

et al. 2017

Clinical Respiratory J

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Section: Discussioncontrasting

confidence: 61%

Regional differences in the incidence of tuberculosis among patients with newly diagnosed diabetes mellitus

Yang

Kang

Heo

et al. 2017

Clinical Respiratory J

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“…Consequently, the risk of hospitalization due to infections (including TB) is higher in homeless persons than in the general population [11]. This is in line with a high prevalence of positive IGRA in homeless persons in Poland (36.7%), USA (12–40%), Japan (50.6%) and South Korea (75.9%) in non-outbreak settings [12–16].…”

Section: Introductionmentioning

confidence: 90%

Prevalence of latent tuberculosis in homeless persons: A single-centre cross-sectional study, Germany

et al. 2019

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PurposeHomeless persons have a high risk for tuberculosis. The prevalence of latent tuberculosis infection and the risk for a progression to active tuberculosis is higher in the homeless than in the general population. The objective was to assess the prevalence and risk factors of tuberculosis/latent tuberculosis infection in a homeless population in Germany.MethodsHomeless individuals (n = 150) were enrolled in a cross-sectional study at three shelters in Münster, Germany (October 2017–July 2018). All participants were screened using an ELISPOT interferon-γ release assay (IGRA). Those participants tested positive/borderline by IGRA provided three sputa for microbiological analysis (line probe assay, microscopy, culture) and underwent a chest X-ray to screen for active pulmonary TB. Risk factors for tuberculosis/latent tuberculosis infection were analysed using a standardized questionnaire.ResultsOf the 142 evaluable IGRA, 21 (15%) were positive and two (1%) were borderline. No participant with a positive/borderline IGRA had an active tuberculosis as assessed by chest X-ray and microbiology. A negative IGRA was associated with a citizenship of a low-incidence country for tuberculosis (according to WHO, p = 0.01), low-incidence country of birth (p<0.001) or main residence in a low-incidence country in the past five years (p = 0.002).ConclusionsThe prevalence of latent tuberculosis infection (diagnosed by a positive/borderline IGRA) was 16%; no active tuberculosis was detected. The highest risk for latent tuberculosis infection was found in patients from high-incidence countries. This population at risk should be either treated for latent tuberculosis infection or need to be monitored to early detect a progression into active disease.

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“…Previous studies in other high-income countries (including Italy, Japan, South Korea and the USA) have reported latent tuberculosis infection prevalence in homeless populations and found rates varying from 16% to 75.9%. 5,[19][20][21][22] A meta-analysis of active tuberculosis and blood-borne virus prevalence in homeless populations internationally found that hepatitis C virus (HCV) infection ranged from 3.9% to 36.2%, and HIV infection ranged from 0.3% to 21.1%. 23 None of the studies testing for HIV was conducted in the UK, but one hepatitis C study, which recruited individuals experiencing homelessness from shelters, special projects and medical centres in Oxford, found 26.5% of individuals to be HCV infection positive using oral fluid testing.…”

Section: Discussionmentioning

confidence: 99%

Management and control of tuberculosis control in socially complex groups: a research programme including three RCTs

Story

Garber

Aldridge

et al. 2020

Programme Grants Appl Res

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Background Socially complex groups, including people experiencing homelessness, prisoners and drug users, have very high levels of tuberculosis, often complicated by late diagnosis and difficulty in adhering to treatment. Objective To assess a series of interventions to improve tuberculosis control in socially complex groups. Design A series of observational surveys, evaluations and trials of interventions. Setting The pan-London Find&Treat service, which supports tuberculosis screening and case management in socially complex groups across London. Participants Socially complex groups with tuberculosis or at risk of tuberculosis, including people experiencing homelessness, prisoners, drug users and those at high risk of poor adherence to tuberculosis treatment. Interventions and main outcome measures We screened 491 people in homeless hostels and 511 people in prison for latent tuberculosis infection, human immunodeficiency virus, hepatitis B and hepatitis C. We evaluated an NHS-led prison radiographic screening programme. We conducted a cluster randomised controlled trial (2348 eligible people experiencing homelessness in 46 hostels) of the effectiveness of peer educators (22 hostels) compared with NHS staff (24 hostels) at encouraging the uptake of mobile radiographic screening. We initiated a trial of the use of point-of-care polymerase chain reaction diagnostics to rapidly confirm tuberculosis alongside mobile radiographic screening. We undertook a randomised controlled trial to improve treatment adherence, comparing face-to-face, directly observed treatment with video-observed treatment using a smartphone application. The primary outcome was completion of ≥ 80% of scheduled treatment observations over the first 2 months following enrolment. We assessed the cost-effectiveness of latent tuberculosis screening alongside radiographic screening of people experiencing homelessness. The costs of video-observed treatment and directly observed treatment were compared. Results In the homeless hostels, 16.5% of people experiencing homelessness had latent tuberculosis infection, 1.4% had current hepatitis B infection, 10.4% had hepatitis C infection and 1.0% had human immunodeficiency virus infection. When a quality-adjusted life-year is valued at £30,000, the latent tuberculosis screening of people experiencing homelessness was cost-effective provided treatment uptake was ≥ 25% (for a £20,000 quality-adjusted life-year threshold, treatment uptake would need to be > 50%). In prison, 12.6% of prisoners had latent tuberculosis infection, 1.9% had current hepatitis B infection, 4.2% had hepatitis C infection and 0.0% had human immunodeficiency virus infection. In both settings, levels of latent tuberculosis infection and blood-borne viruses were higher among injecting drug users. A total of 1484 prisoners were screened using chest radiography over a total of 112 screening days (new prisoner screening coverage was 43%). Twenty-nine radiographs were reported as potentially indicating tuberculosis. One prisoner began, and completed, antituberculosis treatment in prison. In the cluster randomised controlled trial of peer educators to increase screening uptake, the median uptake was 45% in the control arm and 40% in the intervention arm (adjusted risk ratio 0.98, 95% confidence interval 0.80 to 1.20). A rapid diagnostic service was established on the mobile radiographic unit but the trial of rapid diagnostics was abandoned because of recruitment and follow-up difficulties. We randomly assigned 112 patients to video-observed treatment and 114 patients to directly observed treatment. Fifty-eight per cent of those recruited had a history of homelessness, addiction, imprisonment or severe mental health problems. Seventy-eight (70%) of 112 patients on video-observed treatment achieved the primary outcome, compared with 35 (31%) of 114 patients on directly observed treatment (adjusted odds ratio 5.48, 95% confidence interval 3.10 to 9.68; p < 0.0001). Video-observed treatment was superior to directly observed treatment in all demographic and social risk factor subgroups. The cost for 6 months of treatment observation was £1645 for daily video-observed treatment, £3420 for directly observed treatment three times per week and £5700 for directly observed treatment five times per week. Limitations Recruitment was lower than anticipated for most of the studies. The peer advocate study may have been contaminated by the fact that the service was already using peer educators to support its work. Conclusions There are very high levels of latent tuberculosis infection among prisoners, people experiencing homelessness and drug users. Screening for latent infection in people experiencing homelessness alongside mobile radiographic screening would be cost-effective, providing the uptake of treatment was 25–50%. Despite ring-fenced funding, the NHS was unable to establish static radiographic screening programmes. Although we found no evidence that peer educators were more effective than health-care workers in encouraging the uptake of mobile radiographic screening, there may be wider benefits of including peer educators as part of the Find&Treat team. Utilising polymerase chain reaction-based rapid diagnostic testing on a mobile radiographic unit is feasible. Smartphone-enabled video-observed treatment is more effective and cheaper than directly observed treatment for ensuring that treatment is observed. Future work Trials of video-observed treatment in high-incidence settings are needed. Trial registration Current Controlled Trials ISRCTN17270334 and ISRCTN26184967. Funding This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 8, No. 9. See the NIHR Journals Library website for further project information.

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Active pulmonary tuberculosis and latent tuberculosis infection among homeless people in Seoul, South Korea: a cross-sectional study

Cited by 25 publications

References 20 publications

Regional differences in the incidence of tuberculosis among patients with newly diagnosed diabetes mellitus

Regional differences in the incidence of tuberculosis among patients with newly diagnosed diabetes mellitus

Prevalence of latent tuberculosis in homeless persons: A single-centre cross-sectional study, Germany

Management and control of tuberculosis control in socially complex groups: a research programme including three RCTs

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