Active TB screening among homeless people attending soup kitchens in Verona (Italy)
Keywords:
Hard-to-reach, homeless, screening, active tuberculosis, mobile X-Ray unit, active research, non-profit associationAbstract
Background. The hard-to-reach populations, including the homeless, are particularly vulnerable to the development of active tuberculosis. According to the World Health Organization, tuberculosis rates among the homeless in industrialized Countries are up to 20 times higher if compared with the general population, representing a relevant public health problem. The aim of our study was to describe the results of an active tuberculosis screening applied in order to find out suspected active TB cases among the homeless in Verona.
Methods. As part of a partnership between the non-profit association Medici per la Pace and one of the Local Health Units of Veneto Region (ULSS 9 Scaligera) in 2018, a tuberculosis screening, based on thoracic radiographs, was offered to the homeless guests of two Verona’s soup kitchens.
Results. The studied population included 139 people, and three cases of suspected active tuberculosis, all in males, were observed. Among these, two received a diagnostic confirmation of active tuberculosis (a prevalence of 1.44% - CI: 0,17 – 5,1). Moreover, radiographic patterns of tuberculosis aftermaths were found in six additional subjects.
Conclusions. Interventions specifically dedicated to hard-to-reach populations, can be useful in identifying tuberculosis active cases and controlling the disease in low tuberculosis burden countries. In particular, the active research of subjects, the screening carried out with mobile X-ray, and also the constant caring of the patients with active disease, could be the right method to keep under control this relevant public health problem.
References
1. Word Health Organization Regional Office for Europe/European Centre for Disease Prevention and Control (WHO/ECDC). Tuberculosis surveillance and monitoring in Europe 2019 – 2017 data. Copenhagen: WHO Regional Office for Europe, 2019. Available on: https://www. ecdc.europa.eu/sites/default/files/documents/ tuberculosis-surveillance-monitoring-Europe2019-20_Mar_2019.pdf [Last accessed: 2020, Dec 29].
2. de Vries S, Cremers AL, Heuvelings CC, et al.
Barriers and facilitators to the uptake of tuberculosis diagnostic and treatment services by hard-to-reach populations in countries of low and medium tuberculosis incidence: a systematic review of qualitative literature. Lancet Infect Dis 2017; 17(5): e128-43. doi: 10.1016/S1473-3099(16)30531-X.
3. European Centre for Disease Prevention and Control (ECDC). Guidance on tuberculosis control in vulnerable and hard-to-reach populations. Stockholm: ECDC, 2016. Available on: https://www.ecdc.europa.eu/sites/default/ files/media/en/publications/Publications/TBguidance-interventions-vulnerable-groups.pdf [Last accessed: 2020, Dec 29].
4. Istituto Nazionale Statistica (ISTAT). Le statistiche dell’Istat sulla povertà-anno 2018. Roma: ISTAT, 2019. Available on: https://www.istat.it/ it/files/2019/06/La-povert%C3%A0-in-Italia2018.pdf. [Last accessed: 2020, Dec 29].
5. Janssens JP, Wuillemin T, Adler D, Jackson Y. Screening for tuberculosis in an urban shelter for homeless in Switzerland: a prospective study. BMC Infect Dis 2017; 17(1): 347. doi: 10.1186/ s12879-017-2449-y.
V. Tralli et al.
6. Paquette K, Cheng MP, Kadatz MJ, Cook VJ, Chen W, Johnston JC. Chest radiography for active tuberculosis case finding in the homeless: a systematic review and meta-analysis. Int J Tuberc Lung Dis 2014; 18(10): 1231-6. doi: 10.5588/ijtld.14.0105.
7. Istituto Nazionale Statistica - Ministero del Lavoro e Politiche Sociali Federazione Italiana degli Organismi per le Persone senza dimora - Caritas Italiana. Le persone senza dimora. Anno 2014. ISTAT, 2015.
8. Li J, Driver CR, Munsiff SS, Fujiwara PI. Finding contacts of homeless tuberculosis patients in New York City. Int J Tuberc Lung Dis 2003; 7(12 Suppl 3): S397-404.
9. Mor Z, Leventhal A, Weiler-Ravell D, Peled N, Lerman Y. Chest radiography validity in screening pulmonary tuberculosis in immigrants from a highburden country. Respir Care 2012; 57(7): 1137-44. doi: 10.4187/respcare.01475.
10. Story A, Aldridge RW, Abubakar I, et al. Active case finding for pulmonary tuberculosis using mobile digital chest radiography: an observational study. Int J Tuberc Lung Dis 2012; 16(11):
1461-7. doi: 10.5588/ijtld.11.
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