Skip to main content

Advertisement

SpringerLink
Log in

Tuberculosis among drug users and homeless persons: impact of voluntary X-ray investigation on active case finding

  • Clinical and Epidemiological Study
  • Published:
Infection Aims and scope Submit manuscript

Abstract

Background

Illicit drug use and homelessness are major contributors to the incidence of tuberculosis (TB) among inhabitants of major cities.

Objective

The primary objective of this study was to establish a sustainable low-threshold chest X-ray screening programme for pulmonary TB among illicit drug users and homeless persons and to integrate this into the existing public health programme for active case finding. A secondary objective was to estimate the coverage of the programme, assess other risk factors and determine TB rates and treatment outcome in these two groups.

Methods

Illicit drug users and homeless persons were asked to voluntarily participate in an X-ray screening programme. The coverage of the intervention, total number and characteristics of cases and the follow-up of treatment were assessed.

Results

A total of 4,529 chest radiographs were made from 3,477 persons, of whom 66% were homeless and 34% were illicit drug users, between May 2002 and April 2007. Coverage for screening once every 2 years ranged between 18 and 26%. Thirty-nine TB cases (14 drug users, 25 homeless persons) were identified, representing 8.7% of the total case load of 448 notified cases of pulmonary TB in Frankfurt during this period. Among the drug users, human immunodeficiency virus coinfection (10/14) seemed to play a key role in the development of TB. The case-finding rate of 861/100,000 radiographs (1,122/100,000 persons) is as high as that in routine contact investigations (1,078/100,000). Among all individuals with TB, 76% completed treatment.

Conclusion

A novel targeted TB screening approach with voluntary radiographic examination of illicit drug users and homeless persons can be integrated into the existing public TB prevention programme and provides a high case-finding rate.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Hayward AC, Darton T, Van-Tam JN, Watson JM, Coker R, Schwoebel V. Epidemiology and control of tuberculosis in Western European cities. Int J Tuberc Lung Dis. 2003;7(8):751–7.

    PubMed  CAS  Google Scholar 

  2. Moore-Gillon J. Tuberculosis and poverty in the developed world. PD D: Chapman and Hall; 1998.

    Google Scholar 

  3. Hopewell PC. Targeting tuberculosis prevention. Am J Respir Crit Care Med. 2000;162(6):2017–8.

    PubMed  CAS  Google Scholar 

  4. Bennett DE, Courval JM, Onorato I, Agerton T, Gibson JD, Lambert L, et al. Prevalence of tuberculosis infection in the United States population: the national health and nutrition examination survey, 1999–2000. Am J Respir Crit Care Med. 2008;177(3):348–55.

    Google Scholar 

  5. Moonan PK, Weis SE. Assessing the impact of targeted tuberculosis interventions. Am J Respir Crit Care Med. 2008;177(5):557–8.

    Google Scholar 

  6. Story A, Murad S, Roberts W, Verheyen M, Hayward AC. Tuberculosis in London: the importance of homelessness, problem drug use and prison. Thorax. 2007;62(8):667–71.

    Article  PubMed  CAS  Google Scholar 

  7. Haddad MB, Wilson TW, Ijaz K, Marks SM, Moore M. Tuberculosis and homelessness in the United States, 1994–2003. JAMA. 2005;293(22):2762–6.

    Google Scholar 

  8. Pablos-Mendez A, Knirsch CA, Barr RG, Lerner BH, Frieden TR. Nonadherence in tuberculosis treatment: predictors and consequences in New York City. Am J Med. 1997;102(2):164–70.

    Article  PubMed  CAS  Google Scholar 

  9. Diel R, Schneider S, Meywald-Walter K, Ruf CM, Rusch-Gerdes S, Niemann S. Epidemiology of tuberculosis in Hamburg, Germany: long-term population-based analysis applying classical and molecular epidemiological techniques. J Clin Microbiol. 2002;40(2):532–9.

    Article  PubMed  Google Scholar 

  10. Conover C, Ridzon R, Valway S, Schoenstadt L, McAuley J, Onorato I, et al. Outbreak of multidrug-resistant tuberculosis at a methadone treatment program. Int J Tuberc Lung Dis. 2001;5(1):59–64.

    PubMed  CAS  Google Scholar 

  11. Curtis AB, Ridzon R, Novick LF, Driscoll J, Blair D, Oxtoby M, et al. Analysis of Mycobacterium tuberculosis transmission patterns in a homeless shelter outbreak. Int J Tuberc Lung Dis. 2000;4(4):308–13.

    PubMed  CAS  Google Scholar 

  12. Story A, van Hest R, Hayward A. Tuberculosis and social exclusion. Br Med J. 2006;333(7558):57–8.

    Google Scholar 

  13. Reichler MR, Reves R, Bur S, Thompson V, Mangura BT, Ford J, et al. Evaluation of investigations conducted to detect and prevent transmission of tuberculosis. JAMA. 2002;287(8):991–5.

    Google Scholar 

  14. de Vries G, van Hest RA. From contact investigation to tuberculosis screening of drug addicts and homeless persons in Rotterdam. Eur J Public Health. 2006;16(2):133–6.

    Article  PubMed  Google Scholar 

  15. Li J, Driver CR, Munsiff SS, Fujiwara PI. Finding contacts of homeless tuberculosis patients in New York City. Int J Tuberc Lung Dis. 2003;7[12 Suppl 3]:S397–404.

    Google Scholar 

  16. Tulsky JP, Pilote L, Hahn JA, Zolopa AJ, Burke M, Chesney M, et al. Adherence to isoniazid prophylaxis in the homeless: a randomized controlled trial. Arch Intern Med. 2000;160(5):697–702.

    Google Scholar 

  17. Burman WJ, Cohn DL, Rietmeijer CA, Judson FN, Sbarbaro JA, Reves RR. Noncompliance with directly observed therapy for tuberculosis. Epidemiology and effect on the outcome of treatment. Chest. 1997;111(5):1168–73.

    Google Scholar 

  18. Kong PM, Tapy J, Calixto P, Burman WJ, Reves RR, Yang Z, et al. Skin-test screening and tuberculosis transmission among the homeless. Emerg Infect Dis. 2002;8(11):1280–4.

    Article  PubMed  Google Scholar 

  19. Daley CL, Hahn JA, Moss AR, Hopewell PC, Schecter GF. Incidence of tuberculosis in injection drug users in San Francisco: impact of anergy. Am J Respir Crit Care Med. 1998;157(1):19–22.

    PubMed  CAS  Google Scholar 

  20. Southern A, Premaratne N, English M, Balazs J, O’Sullivan D. Tuberculosis among homeless people in London: an effective model of screening and treatment. Int J Tuberc Lung Dis. 1999;3(11):1001–8.

    PubMed  CAS  Google Scholar 

  21. Keizer ST, Langendam MM, van Deutekom H, Coutinho RA, van Ameijden EJ. How does tuberculosis relate to HIV positive and HIV negative drug users? J Epidemiol Community Health. 2000;54(1):64–8.

    Article  PubMed  CAS  Google Scholar 

  22. Broekmans JF, Migliori GB, Rieder HL, Lees J, Ruutu P, Loddenkemper R, et al. European framework for tuberculosis control and elimination in countries with a low incidence. Recommendations of the World Health Organization (WHO), International Union Against Tuberculosis and Lung Disease (IUATLD) and Royal Netherlands Tuberculosis Association (KNCV) Working Group. Eur Respir J. 2002;19(4):765–75.

  23. Bales S, Baumann HG, Schnitzler N. Infektionsschutzgesetz. 2 edn. Stuttgart: W. Kohlhammer GmbH; 2003.

    Google Scholar 

  24. Diel R, Forssbohm M, Loytved G, Haas W, Hauer B, Maffei D, et al. Recommendations for environmental contact tracing in tuberculosis. German Central Committee against Tuberculosis. Gesundheitswesen. 2007;69(8–9):488–503.

    Google Scholar 

  25. Chao A. Estimating the population size for capture-recapture data with unequal catchability. Biometrics. 1987;43(4):783–91.

    Article  PubMed  CAS  Google Scholar 

  26. Rendleman NJ. Mandated tuberculosis screening in a community of homeless people. Am J Prev Med. 1999;17(2):108–13.

    Article  PubMed  CAS  Google Scholar 

  27. Pilote L, Tulsky JP, Zolopa AR, Hahn JA, Schecter GF, Moss AR. Tuberculosis prophylaxis in the homeless. A trial to improve adherence to referral. Arch Intern Med. 1996;156(2):161–5.

    Google Scholar 

  28. Solsona J, Cayla JA, Nadal J, Bedia M, Mata C, Brau J, et al. Screening for tuberculosis upon admission to shelters and free-meal services. Eur J Epidemiol. 2001;17(2):123–8.

    Article  PubMed  CAS  Google Scholar 

  29. Snyder DC, Paz EA, Mohle-Boetani JC, Fallstad R, Black RL, Chin DP. Tuberculosis prevention in methadone maintenance clinics. Effectiveness and cost-effectiveness. Am J Respir Crit Care Med. 1999;160(1):178–85.

    Google Scholar 

  30. Van Hest NA, De Vries G, Smit F, Grant AD, Richardus JH. Estimating the coverage of a targeted mobile tuberculosis screening programme among illicit drug users and homeless persons with truncated models. Epidemiol Infect. 2008;136(5):628–35.

    PubMed  Google Scholar 

  31. van Asten L, Langendam M, Zangerle R, Hernandez Aguado I, Boufassa F, Schiffer V, et al. Tuberculosis risk varies with the duration of HIV infection: a prospective study of European drug users with known date of HIV seroconversion. Aids. 2003;17(8):1201–8.

    Google Scholar 

  32. Cayla JA, Garcia de Olalla P, Galdos-Tanguis H, Vidal R, Lopez-Colomes JL, Gatell JM, et al. The influence of intravenous drug use and HIV infection in the transmission of tuberculosis. Aids. 1996;10(12):1446–7.

    Article  PubMed  CAS  Google Scholar 

  33. Moss AR, Hahn JA, Tulsky JP, Daley CL, Small PM, Hopewell PC. Tuberculosis in the homeless. A prospective study. Am J Respir Crit Care Med. 2000;162(2 Pt 1):460–4.

    Google Scholar 

  34. Reichman LB, Felton CP, Edsall JR. Drug dependence, a possible new risk factor for tuberculosis disease. Arch Intern Med. 1979;139(3):337–9.

    Article  PubMed  CAS  Google Scholar 

  35. Frankfurt Co. Statistisches Jahrbuch. Amt für Statistik: Frankfurt; 2007.

  36. Chaisson RE, Barnes GL, Hackman J, Watkinson L, Kimbrough L, Metha S, et al. A randomized, controlled trial of interventions to improve adherence to isoniazid therapy to prevent tuberculosis in injection drug users. Am J Med. 2001;110(8):610–5.

    Google Scholar 

Download references

Acknowledgments

The authors thank the personnel of the facilities caring for homeless persons and illicit drug users in Frankfurt/Main. Without their dedicated support the intervention programme would not have been successful.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Health, Department of Infectious Diseases, Health Protection Authority, City of Frankfurt am Main, Breite Gasse 28, 60313, Frankfurt am Main, Germany

    U. Goetsch, O. K. Bellinger, K.-L. Buettel & R. Gottschalk

Authors
  1. U. Goetsch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. O. K. Bellinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K.-L. Buettel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R. Gottschalk
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to O. K. Bellinger.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Goetsch, U., Bellinger, O.K., Buettel, KL. et al. Tuberculosis among drug users and homeless persons: impact of voluntary X-ray investigation on active case finding. Infection 40, 389–395 (2012). https://doi.org/10.1007/s15010-011-0238-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s15010-011-0238-x

Keywords

Search

Navigation