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P219 Screening for active tuberculosis in an urban shelter for homeless in Switzerland: a prospective study
Poster Walks Poster Walk 7: Infection/Lung Cancer
P219 Screening for active tuberculosis in an urban shelter for homeless in Switzerland: a prospective study Y.-L. Jackson1, T. Wuillemin1, D. Adler2, J.-P. Janssens2 1 Primary Care Medicine, 2Department of Medical Specialities, Geneva University Hospitals, Geneva, Switzerland Introduction: Whereas high risk groups such as asylum seekers are systematically screened for tuberculosis (TB) upon entry in Switzerland, this strategy does not apply to homeless despite a potentially elevated risk of TB. Geneva City Social Services operate shelters for homeless each winter. Shelters are underground facilities with 10 to 20-bed rooms. Every year, z 1000 persons are accommodated. Geneva Health and Social Authorities implemented a collaborative project to screen for active TB in homeless. We aimed to assess 1/acceptability of the screening program and 2/prevalence of TB in this group. Methods: Prospective study targeting all homeless registering for shelter accommodation in Geneva during the winter of 2015. Applicants were proposed a questionnaire-based screening (www.tb-screen.ch) available in 32 languages, combining written, visual and audio formats to optimize usability, to explore epidemiological and clinical risk factors for active TB. Participants with a positive score ($ 10/26) underwent diagnostic procedures at Geneva University Hospital (clinical assessment, chest X-ray, checked by trained pulmonologists and radiologists). This is standard procedure for asylum seekers in Switzerland since 2006. A combined strategy was used to enhance retention among subjects with a positive score (reminders, free medical care, 20 CHF vouchers for local supermarket).
POSTER WALKS
Results: Overall, 726/832 (87.3%) homeless accepted the screening procedure. Participants originated from 75 countries, 62% from medium to high TB incidence countries. Only 11% had health insurance. Most homeless were young male migrants without access to care. Male gender (adjusted OR: 2.14; 95% CI: 1.27-3.62), age below 25 years (aOR: 4.16; 95% CI: 1.27-13.64) and short duration of homelessness (aOR: 1.75; 95%CI: 1.06-2.87) were predictors of acceptance. Median value of scores was 4 (0 - 18); positive scores (n¼30; 4.1%) were associated with originating from a high incidence country, with a trend for smoking. None of the 24 who underwent further testing had active TB. Surveillance 3 months after study termination did not identify any incident case among homeless in Geneva. Conclusions: TB screening in homeless shelters was well accepted. The participants’ profile and the null TB prevalence highlight the diversity of homeless groups in Europe and the variability of their TB risks. These findings emphasize the need for tailoring preventive and screening strategies to local context. DOI:
http://dx.doi.org/10.1016/j.chest.2017.04.125
Copyright ª 2017 American College of Chest Physicians and Swiss Respiratory Society SGP. Published by Elsevier Inc and Karger. All rights reserved.
118A
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151#5S CHEST MAY 2017
]
P219 Screening for active tuberculosis in an urban shelter for homeless in Switzerland: a prospective study Y.-L. Jackson1, T. Wuillemin1, D. Adler2, J.-P. Janssens2 1 Primary Care Medicine, 2Department of Medical Specialities, Geneva University Hospitals, Geneva, Switzerland Introduction: Whereas high risk groups such as asylum seekers are systematically screened for tuberculosis (TB) upon entry in Switzerland, this strategy does not apply to homeless despite a potentially elevated risk of TB. Geneva City Social Services operate shelters for homeless each winter. Shelters are underground facilities with 10 to 20-bed rooms. Every year, z 1000 persons are accommodated. Geneva Health and Social Authorities implemented a collaborative project to screen for active TB in homeless. We aimed to assess 1/acceptability of the screening program and 2/prevalence of TB in this group. Methods: Prospective study targeting all homeless registering for shelter accommodation in Geneva during the winter of 2015. Applicants were proposed a questionnaire-based screening (www.tb-screen.ch) available in 32 languages, combining written, visual and audio formats to optimize usability, to explore epidemiological and clinical risk factors for active TB. Participants with a positive score ($ 10/26) underwent diagnostic procedures at Geneva University Hospital (clinical assessment, chest X-ray, checked by trained pulmonologists and radiologists). This is standard procedure for asylum seekers in Switzerland since 2006. A combined strategy was used to enhance retention among subjects with a positive score (reminders, free medical care, 20 CHF vouchers for local supermarket).
POSTER WALKS
Results: Overall, 726/832 (87.3%) homeless accepted the screening procedure. Participants originated from 75 countries, 62% from medium to high TB incidence countries. Only 11% had health insurance. Most homeless were young male migrants without access to care. Male gender (adjusted OR: 2.14; 95% CI: 1.27-3.62), age below 25 years (aOR: 4.16; 95% CI: 1.27-13.64) and short duration of homelessness (aOR: 1.75; 95%CI: 1.06-2.87) were predictors of acceptance. Median value of scores was 4 (0 - 18); positive scores (n¼30; 4.1%) were associated with originating from a high incidence country, with a trend for smoking. None of the 24 who underwent further testing had active TB. Surveillance 3 months after study termination did not identify any incident case among homeless in Geneva. Conclusions: TB screening in homeless shelters was well accepted. The participants’ profile and the null TB prevalence highlight the diversity of homeless groups in Europe and the variability of their TB risks. These findings emphasize the need for tailoring preventive and screening strategies to local context. DOI:
http://dx.doi.org/10.1016/j.chest.2017.04.125
Copyright ª 2017 American College of Chest Physicians and Swiss Respiratory Society SGP. Published by Elsevier Inc and Karger. All rights reserved.
118A
[
151#5S CHEST MAY 2017
]