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A systematic review of active case-finding strategies for tuberculosis in homeless populations

Hamilton, Kathryn; Tolfree, Robert; Mytton, Julie

A systematic review of active case-finding strategies for tuberculosis in homeless populations Thumbnail


Authors

Kathryn Hamilton

Robert Tolfree



Abstract

© 2018 International Union against Tubercul. and Lung Dis.. All rights reserved. SETTING: Tuberculosis (TB) is prevalent in the homeless population, and can create health inequalities and challenges for eradication. Evidence-based approaches to active case finding (ACF) are needed. OBJECTIVES: To determine the effectiveness of ACF for TB control, and identify strategies to improve uptake of screening and the diagnostic pathway in homeless populations in low- and medium-burden settings. Secondary objectives were to assess the yield of screening and participant characteristics. DESIGN: A systematic search of electronic databases and grey literature sources identified ACF studies that reported population measures (prevalence or incidence) of TB control, and/or uptake and/or yield of screening for latent tuberculous infection (LTBI) or active TB affecting any site. Studies were described using narrative synthesis. RESULTS: Twenty studies met the inclusion criteria. Studies were heterogeneous across multiple elements, including programme design, which likely contributed to variability in outcomes. ACF was associated with reductions in TB rates in three time-trend analyses. The strongest evidence for improving uptake of screening was for incentives, with mixed evidence for peer educators. At the observational level, professional support and mandatory screening may also improve uptake, and additional community support enhanced completion of the diagnostic pathway. Those most likely to be diagnosed with TB appeared less likely to accept screening. Yield of screening was 1.5-57% (41 684 participants) for LTBI, and 0-3.1% (91 771 participants) for active TB. CONCLUSIONS: Observational evidence suggests that ACF is effective. Strategies to improve screening uptake were identified. Variability in uptake and yield necessitates programmes tailored to local populations; areas for further research were identified.

Citation

Hamilton, K., Tolfree, R., & Mytton, J. (2018). A systematic review of active case-finding strategies for tuberculosis in homeless populations. International Journal of Tuberculosis and Lung Disease, 22(10), 1135-1144. https://doi.org/10.5588/ijtld.17.0784

Journal Article Type Review
Acceptance Date May 12, 2018
Publication Date Oct 1, 2018
Deposit Date Jun 20, 2018
Publicly Available Date Mar 28, 2024
Journal International Journal of Tuberculosis and Lung Disease
Print ISSN 1027-3719
Electronic ISSN 1815-7920
Publisher International Union Against Tuberculosis and Lung Disease
Peer Reviewed Peer Reviewed
Volume 22
Issue 10
Pages 1135-1144
DOI https://doi.org/10.5588/ijtld.17.0784
Public URL https://uwe-repository.worktribe.com/output/859409
Publisher URL https://doi.org/10.5588/ijtld.17.0784
Additional Information Additional Information : This is the accepted version of the article published in International Journal of Tuberculosis and Lung Disease. The final published version can be found online: https://doi.org/10.5588/ijtld.17.0784

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