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Tuberculosis
Original article
High prevalence of latent tuberculosis and bloodborne virus infection in a homeless population
  1. Robert W Aldridge1,2,
  2. Andrew C Hayward1,2,3,
  3. Sara Hemming1,2,4,
  4. Susan K Yates1,2,4,
  5. Gloria Ferenando1,2,4,
  6. Lucia Possas1,2,4,
  7. Elizabeth Garber1,2,4,
  8. John M Watson1,
  9. Anna Maria Geretti5,
  10. Timothy Daniel McHugh6,
  11. Marc Lipman4,7,
  12. Alistair Story8
  1. 1Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
  2. 2Department of Infectious Disease Informatics, The Farr Institute of Health Informatics Research, London, UK
  3. 3Institute of Epidemiology and Health Care, University College London, London, UK
  4. 4Royal Free London NHS Foundation Trust, London, UK
  5. 5Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
  6. 6Centre for Clinical Microbiology, Division of Infection and Immunity, University College London, London, UK
  7. 7UCL Respiratory, Division of Medicine, University College London, London, UK
  8. 8Find&Treat, University College London Hospitals, London, UK
  1. Correspondence to Dr Andrew C Hayward, Research Department of Infectious Disease Informatics, Farr Institute of Health Informatics Research, University College London, London NW1 2DA, UK; a.hayward{at}ucl.ac.uk

Abstract

Introduction Urban homeless populations in the UK have been shown to have high rates of active tuberculosis, but less is known about the prevalence of latent tuberculosis infection (LTBI). This study aimed to estimate the prevalence of LTBI among individuals using homeless hostels in London.

Methods We performed a cross-sectional survey with outcome follow-up in homeless hostels in London. Our primary outcome was prevalence of LTBI. Recruitment for the study took place between May 2011 and June 2013. To estimate an LTBI prevalence of 10% with 95% CIs between 8% and 13%, we required 500 participants.

Results 491/804 (61.1%) individuals agreed to be screened. The prevalence of LTBI was 16.5% (81/491; 95% CI 13.2 to 19.8). In UK-born individuals, a history of incarceration was associated with increased risk of LTBI (OR 3.49; 95% CI 1.10 to 11.04; P=0.018) after adjusting for age, length of time spent homeless and illicit drug use. Of the three subjects who met English treatment guidelines for LTBI at the time of the study, none engaged with services after referral for treatment. Prevalence of past hepatitis B infection was 10.4% (51/489; 95% CI 7.7 to 13.1), and 59.5% (291/489; 95% CI 55.1 to 63.9) of individuals were non-immune. Prevalence of current hepatitis C infection was 10.4% (51/489; 95% CI 7.8 to 13.1).

Conclusions This study demonstrates the high prevalence of LTBI in homeless people in London and the associated poor engagement with care. There is a large unmet need for LTBI and hepatitis C infection treatment, and hepatitis B vaccination, in this group.

  • clinical epidemiology
  • tuberculosis
  • respiratory infection

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/thoraxjnl-2016-209579

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    Footnotes

    • Contributors ACH and AS proposed the hypothesis and idea for the study. All authors contributed substantially to the conception, design and acquisition of data. RWA performed the analyses and wrote the first draft of the report. All authors helped interpret the data and revised and edited the manuscript, had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.

    • Funding This work presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (reference no RP-PG-0407-10340). RWA is funded by a Wellcome Trust research training fellowship (097980/Z/11/Z). We also acknowledge the support from The Farr Institute of Health Informatics Research. The Farr Institute is supported by a 10-funder consortium: Arthritis Research UK, the British Heart Foundation, Cancer Research UK, the Economic and Social Research Council, the Engineering and Physical Sciences Research Council, the Medical Research Council (K006584/1), the National Institute of Health Research, the National Institute for Social Care and Health Research (Welsh Assembly Government), the Chief Scientist Office (Scottish Government Health Directorates) and the Wellcome Trust.

    • Competing interests AS is the clinical lead for the Find and Treat service including the mobile digital X-ray unit. Other authors have no competing interest to declare.

    • Patient consent Obtained.

    • Ethics approval East of England— Essex National Research Ethics Service Committee (no 10/H0302/5).

    • Provenance and peer review Not commissioned; externally peer reviewed.