Tuberculosis among the homeless: should we change the strategy?

Dias, Margarida; Gaio, Rita; Sousa, Pedro Ponte e; Abranches, M; Gomes, Margarida F Costa; Oliveira, Olena; Correia-Neves, Margarida; Junior, Eduardo Paulo Ferreira; Duarte, Raquel

doi:10.5588/ijtld.16.0597

Cited by 28 publications

(29 citation statements)

References 17 publications

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“…These results are higher than the reported prevalence in the general population [67]. There are a range of explanations for the observed remarkable difference in the magnitude of schizophrenia between homeless people and general populations: First, the presence of a considerably higher prevalence rates of serious physical health problems such as tuberculosis, HIV/AIDS and other medical conditions possibly could contribute to the greater prevalence of psychiatric disorders including schizophrenia among the homeless people [23, 68–72]; second, evidence shows that homeless people are more likely to experience traumatic events including physical and sexual abuse, which has been linked with greater risks of mental health problems including psychotic disorders in those who are exposed [73–76]; thirdly, the presence of considerably higher magnitude of mental, neurologic and substance use disorders among homeless people including anxiety, depressive, bipolar, and other psychiatric and substance use disorder among homeless people as compared with other populations are the other possible reasons for the observed high prevalence of schizophrenia among the homeless [7, 8, 40, 77].…”

Section: Discussionmentioning

confidence: 92%

The prevalence of schizophrenia and other psychotic disorders among homeless people: a systematic review and meta-analysis

Ayano¹,

2019

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BackgroundSchizophrenia and other psychotic disorders constitute a huge global burden of disease and they are major contributors to disability as well as premature mortality among homeless people. This systematic review and meta-analysis aimed to estimate the pooled prevalence of schizophrenia and other psychotic disorders among homeless people.MethodsPubMed, Embase, and Scopus were searched to identify pertinent studies. We used a fixed- or random-effect meta-analysis to pool data from the included studies depending on the anticipated heterogeneity. A predesigned search strategy, as well as inclusion and exclusion criteria, were used. We also performed subgroup and sensitivity analysis and Cochran’s Q- and the I2 test was employed to compute heterogeneity. Egger’s test and visual inspection of the symmetry in funnel plots were used to assess publication bias.ResultsThirty-one studies involving 51,925 homeless people were included in the final analysis. The meta-analysis showed a remarkably higher prevalence of psychosis [21.21% (95% CI:13.73, 31.29), I2 = 99.43%], schizophrenia [10.29% (95%, CI: 6.44, 16.02), I2 = 98.76%], schizophreniform disorder [2.48% (95% CI: 6.16, 28.11), I2 = 88.84%] schizoaffective disorder [3.53% (95% CI: 1.33, 9.05), I2 = 31.63%,] as well as psychotic disorders not otherwise specified [9% (95% CI: 6.92, 11.62), I2 = 33.38%] among homeless people. The prevalence estimate of psychosis was higher in developing (29.16%) as compared to developed (18.80%) countries. Similarly, the prevalence of schizophrenia was highest in developing (22.15%) than developed (8.83%) countries.ConclusionThis systematic review and meta-analysis revealed that schizophrenia and other psychotic disorders are highly prevalent among homeless people, indicating an urgent need for studies to help develop better mechanisms of prevention, detection as well as treatment of those disorders among homeless people.

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Section: Discussionmentioning

confidence: 92%

The prevalence of schizophrenia and other psychotic disorders among homeless people: a systematic review and meta-analysis

Ayano¹,

2019

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“…The success of previous initiatives and future challenges in TB control strategies are mirrored in the homeless cases. In Portugal, TB incidence among the homeless has been estimated to be 122 per 100,000 homeless, five times higher than in the rest of the population [ 30 ]. While one of the common sources of transmission of TB within this vulnerable group was highlighted as co-transmission during time spent in homeless shelters [ 31 ], measures were taken in Porto that minimize this transmission, including a mandatory test for TB before entrance is granted to the shelters.…”

Section: Discussionmentioning

confidence: 99%

A complex scenario of tuberculosis transmission is revealed through genetic and epidemiological surveys in Porto

Rito

Matos²,

Carvalho

et al. 2018

BMC Infect Dis

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BackgroundTuberculosis (TB) incidence is decreasing worldwide and eradication is becoming plausible. In low-incidence countries, intervention on migrant populations is considered one of the most important strategies for elimination. However, such measures are inappropriate in European areas where TB is largely endemic, such as Porto in Portugal. We aim to understand transmission chains in Porto through a genetic characterization of Mycobacterium tuberculosis strains and through a detailed epidemiological evaluation of cases.MethodsWe genotyped the M. tuberculosis strains using the MIRU-VNTR system. We performed an evolutionary reconstruction of the genotypes with median networks, used in this context for the first time. TB cases from a period of two years were evaluated combining genetic, epidemiological and georeferencing information.ResultsThe data reveal a unique complex scenario in Porto where the autochthonous population acts as a genetic reservoir of M. tuberculosis diversity with discreet episodes of transmission, mostly undetected using classical epidemiology alone.ConclusionsAlthough control policies have been successful in decreasing incidence in Porto, the discerned complexity suggests that, for elimination to be a realistic goal, strategies need to be adjusted and coupled with a continuous genetic characterization of strains and detailed epidemiological evaluation, in order to successfully identify and interrupt transmission chains.

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“…Em conformidade a isso, um estudo realizado em Portugal evidenciou uma taxa de resultados desfavoráveis do tratamento da TB entre a PSR, significativamente, associada ao aumento da idade, uso de drogas injetáveis e coinfecção por HIV 11 , o que contribui para o entendimento da associação destes fatores de risco com os resultados identificados no presente estudo.…”

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População em situação de rua: perfil dos casos de coinfecção tuberculose e HIV

et al. 2021

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OBJETIVO: analisar o perfil da População em Situação de Rua (PSR) com a coinfecção tuberculose (TB)/HIV em Porto Velho-RO, entre 2015 a 2018. MATERIAIS E MÉTODOS: estudo descritivo, transversal com abordagem quantitativa realizado a partir do levantamento das variáveis sociodemográficas, clínica e do tratamento dos casos no Sistema de Informação Nacional de Agravos de Notificação, e posteriormente análise por distribuição de frequência, após atender aos preceitos éticos. RESULTADOS: foram notificados sete casos de TB/HIV entre as PSR. A maioria era do sexo feminino, entre 31 a 38 anos, parda, baixa escolaridade, apresentavam doenças e agravos associados, não eram população especial, notificadas em 2016, na referência terciária, era caso novo ou reingresso após abandono, forma clínica pulmonar, radiografia de tórax suspeito, baciloscopia de escarro negativa, teste molecular rápido para a TB e cultura não realizadas, teste de sensibilidade e controle mensal em branco, até três contatos identificados e nenhum examinado, não realizaram Tratamento Diretamente Observado, tratamento na referência terciária, de 61 a 120 dias e mais do que 181 dias, e elevado percentual de abandono. CONCLUSÃO: torna-se essencial rever as estratégias de acesso aos serviços e ações ofertadas para atender as demandas de saúde da PSR, voltadas para ambos os agravos.

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Tuberculosis among the homeless: should we change the strategy?

Cited by 28 publications

References 17 publications

The prevalence of schizophrenia and other psychotic disorders among homeless people: a systematic review and meta-analysis

The prevalence of schizophrenia and other psychotic disorders among homeless people: a systematic review and meta-analysis

A complex scenario of tuberculosis transmission is revealed through genetic and epidemiological surveys in Porto

População em situação de rua: perfil dos casos de coinfecção tuberculose e HIV

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