Background Urban homeless people have high levels of disease and often present late for healthcare. Despite high rates of active TB in London’s large homeless population, limited data are available regarding the prevalence of latent TB infection (LTBI) and blood borne viruses (BBV) - HIV, Hepatitis B & C. We have undertaken a TB/BBV screening programme to assess the prevalence of LTBI, infection with BBV and co-infection within hard to reach groups (homeless people and substance misusers) in homeless hostels and residential drug services in London.
Method Residents screened for TB on a mobile chest x-ray unit were approached and with consent, blood was drawn for TB IGRA (Quantiferon In-Tube) and BBV. Results were fed back to participants with onward referral as necessary.
Results Of 413 eligible participants, 390 (94%) reported a history of homelessness. Of these 390 participants, 89% were male, 68% were 16–49 years of age and 66% UK born. 17% were IGRA positive, 1% HIV positive (all previously known), and 10% had current and 4% past Hepatitis C. 1% of those screened had current Hepatitis B infection, 10% past infection, 18% had vaccine induced protective levels of immunity and 71% had insufficient or no Hepatitis B immunity. 29% of subjects with Hepatitis C were LTBI co-infected. Multivariate analysis identified increasing age e.g. 30–49 age group (odd ratio [OR], 2.15; 95% confidence interval [CI95], 0.84–5.49) compared to the under 30, foreign birth (OR, 6.59; CI95, 3.50–12.39), smoking hard drugs (OR, 2.19; CI95, 1.02–4.64), and injecting hard drug (OR, 2.36; CI95, 1.08–5.16) such as heroin, crack or cocaine (although 95% of injectors also smoked hard drugs) as risk factors for LTBI. Injecting drug use was the only factor associated with increased risk for Hepatitis C infection (OR, 19.62; CI95, 8.23–46).
Conclusion Extremely high rates of LTBI, Hepatitis C and co-infection are present in our urban study population. Despite targeted Hepatitis B vaccination programmes, a high proportion of participants appear unvaccinated. These levels of unmet need have major implications for public and personal healthcare planning and should be recognised through appropriate targeted health and social policy.