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Free Content Tuberculosis among homeless people in London: an effective model of screening and treatment

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SETTING: Hostels and day centres for homeless people in south London.

OBJECTIVE: To develop an appropriate and effective method of screening for pulmonary tuberculosis (TB) among the homeless.

DESIGN: Observational study evaluated for acceptability, yield of cases and completion of treatment. The screening included a symptom questionnaire, a Heaf test and a chest X-ray, developed and read on site.

RESULTS: Ten clients (0.5%) were identified as having active pulmonary TB; seven of these were white men over the age of 50. The symptom questionnaire was seldom helpful. Nine of the cases were initially identified by chest X-ray, however only three of the 10 had a Heaf test performed. Eight of the 10 clients with active TB completed therapy; five additional clients were started on chemoprophylaxis. All of these had strongly positive Heaf reactions and normal chest X-rays.

CONCLUSIONS: Chest X-ray screening is the most useful screening method and is effective if it is targeted. The use of incentives seems to increase the uptake of screening. Heaf testing is useful for the identification of those clients needing prophylactic treatment or BCG immunisation. Good compliance can be achieved provided clients are case managed appropriately.

Keywords: homeless; screening; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Three Boroughs Primary Healthcare Team, London, UK 2: Department of Public Health, UMDS, London, UK 3: Department of General Practice, UMDS, London, UK 4: Lambeth, Southwark & Lewisham Health Authority, London, UK

Publication date: November 1, 1999

More about this publication?
  • 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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