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

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.