Abstract
We aimed to assess the reliability of a screening questionnaire for Active Pulmonary Tuberculosis (APTB) in a population of sheltered homeless persons (HP). Participants from two homeless shelters completed a questionnaire specially designed to identify patients at high-risk of APTB (available at https://doi.org/www.tb-screen.ch), underwent a Chest X-ray (CXR), and provided sputum samples. Computed Tomography (CT) scanning was subsequently performed on those which had images consistent with APTB. Microscopical examination, real-time polymerase chain reaction (qPCR) and culture testing were applied for Mycobacterium tuberculosis complex detection. Additionally, we retrospectively selected 16 HP hospitalised in our hospital between 2017 and 2019 with biologically confirmed tuberculosis and typical CXR images, and retrospectively documented a screening questionnaire by reviewing their medical files. Overall, the population (n = 383 HP) was predominantly migrants (87%). Forty-seven individuals (11.7%) had positive screening questionnaire scores and four (2.4%) displayed abnormal CXR features consistent with APTB. Three of them three underwent CT scanning that ruled out APTB and one was lost to follow-up. None tested positive through microbiological investigation. Fifteen (of 16, 93.8%) hospitalised patients with biologically confirmed APTB had a positive screening questionnaire score. The sensitivity and specificity of questionnaire for confirmed APTB were 93.8% and 87.7%, respectively. Screening questionnaires can be used as a first assessment tool in people arriving at homeless shelters and to refer those screening positive for a CXR.
Highlights
In France, the annual incidence of Active Pulmonary Tuberculosis (APTB) in 2018 was 5.4 per 105 individuals, and the trend of morbidity and mortality regularly decreased over the past 20 years [1,2]
In a preliminary study conducted by our team in 2018, in two Marseille homeless shelters, we showed that the use a short questionnaire aiming at screening for APTB [6] was well accepted by both homeless persons and medical staff during Chest X-ray (CXR)-based TB screening campaigns [3]
We report the results of cross-sectional 1-day surveys conducted at these two Marseille homeless shelters in 2019, where all participants were investigated using questionnaire, chest radiography and microbiological examination of respiratory samples, with the aim of assessing the reliability of this screening questionnaire in a population of sheltered homeless people
Summary
In France, the annual incidence of Active Pulmonary Tuberculosis (APTB) in 2018 was 5.4 per 105 individuals, and the trend of morbidity and mortality regularly decreased over the past 20 years [1,2]. Concentrated epidemics continue to occur among hard-to-reach groups such as homeless people and migrants [1,2]. Over the past two decades, we have seen a change in the sheltered homeless population in Marseille, with a rising proportion of migrants [4]. All of the nine homeless APTB patients hospitalised at our hospital between 2017 and 2018 were migrants [5]. Screening for APTB in homeless people is, of major importance in terms of public health
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