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

Abstract

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.

Preliminary Feasibility Study of Questionnaire-based Active Pulmonary Tuberculosis Screening in Marseille Sheltered Homeless People, Winter 2018

“…A study conducted in Paris, France, among recent migrants consulting in a primary care medical centre dedicated to people living in precarious conditions has revealed that only 31% of eligible migrants underwent TB screening by chest radiography [7]. An alternative screening method based on a questionnaire has been proposed in Geneva, Switzerland, in the setting of homeless shelters [8]. We conducted a cross-sectional 1-day survey at a Marseille homeless shelter aiming to assess the feasibility of conducting such questionnaire-based screening program.…”

Screening Strategy of Active Pulmonary Tuberculosis in Sheltered Homeless People in Marseille, 2019

“…In this cross-sectional 1-day survey, adult homeless people housed in shelters A and B in Marseille were recruited on a voluntary basis during three campaigns conducted in March, May, and December 2019. Participants were systematically asked to provide basic demographic information and information on their smoking habits, and to complete a questionnaire specially designed to identify patients at a high risk of APTB [ 6 ]. Mobile CXR were systematically performed on site at enrolment and analysed by a pneumonologist.…”

“…The questionnaire is designed to identify patients at high risk of APTB, based on their country of origin, clinical data, history of TB, and contact with TB patients ( www.tb-screen.ch , version 4.3.1 updated 3 January 2018) [ 6 ]. The questionnaire comprised nine closed simple questions available in 32 differences languages (together with visual and audio formats) that takes a short time to complete.…”

“…In a preliminary study conducted by our team in 2018, in two Marseille homeless shelters, we showed that the use a short questionnaire aiming at screening for APTB [ 6 ] was well accepted by both homeless persons and medical staff during Chest X-ray (CXR)-based TB screening campaigns [ 3 ]. In this paper, we report the results of cross-sectional 1-day surveys conducted at these two Marseille homeless shelters in 2019, where all participants were investigated using questionnaire, chest radiography and microbiological examination of respiratory samples, with the aim of assessing the reliability of this screening questionnaire in a population of sheltered homeless people.…”

Active case finding and treatment adherence in risk groups in the tuberculosis pre-elimination era

“…Few studies have attempted to report coverage of screening programmes, which remains challenging to quantify in hard-to-reach groups due to the frequently mobile nature of these populations 48,57 . Acceptance and uptake of screening are also rarely reported, with uptake ranging from 14-87% in the absence of specific incentives 40,41,43,[58][59][60][61] . Uptake is likely to be better with mobile (rather than off-site) screening programmes, though evidence for specific strategies to improve uptake is currently limited.…”