Free Content Spot sputum screening: evaluation of an intervention in two homeless shelters

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Abstract:

SETTING: Two homeless shelters in Birmingham, Alabama.

OBJECTIVE: To interrupt tuberculosis transmission and evaluate the utility of spot sputum screening.

DESIGN: Two shelters participated in the study between May 1996 and February 1997. A spot sputum specimen was collected on a given evening from each overnight client. Information was obtained regarding symptoms and tuberculin skin test (TST) status. There were four screenings during two rounds, with TST in round one only.

RESULTS: Of 127 persons involved in the study, 120 (95%) provided specimens, and four tuberculosis cases were identified (4/127, 3.1%). Symptoms were infrequently reported. RFLP analysis (IS6110) confirmed a two-band cluster in three of the four cases; another matching two-band strain was found in a drug rehabilitation client staying in one shelter. Secondary RFLP typing (pTBN12) confirmed the homeless cluster. Costs were $1311 per case identified. Among 92 clients with a prior TST, 40% reported a positive result (37/92). Of 21 PPD tests read, 11 were ≥10 mm (52%).

CONCLUSION: Spot sputum screening is effective in identifying unsuspected tuberculosis cases in shelters. It has acceptable costs, is logistically simple and efficient. Symptom screening was not useful in this general homeless population. RFLP analysis showed cloning of the two-band strain. Given the evidence for ongoing transmission, sputum screening should be considered in shelter settings.

Keywords: homeless persons; polymorphism; restriction fragment length; sputum; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Division of Pulmonary and Critical Care Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA 2: Jefferson County Health Department, University of Alabama at Birmingham, Birmingham, Alabama, USA 3: Department of Microbiology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA; and Department of Pathology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA

Publication date: July 1, 1999

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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