40582. Active Case Finding of Tuberculosis using Chest Radiography in Homeless Populations: A Systematic Review and Meta-Analysis
Session: Poster Abstract Session: Medical Student Poster Session
Friday, October 4, 2013
Room: Yerba Buena Ballrooms
Background: In low-incidence nations, tuberculosis (TB) predominantly affects vulnerable populations. Major guidelines recommend active case finding in homeless and under-housed populations. There is currently no consensus as to the preferred screening regimen.  The primary endpoint was to evaluate the utility of chest radiography (CXR) screening in active case finding for tuberculosis in the homeless and under-housed populations. Other endpoints included performing a qualitative systematic review of the literature and estimating the utility of additional screening methods to chest radiography based programs.

Methods: Articles were identified through data sourcing of EMBASE, Medline, and the Cochrane Library through November 10, 2012.  Studies that assessed the utility of symptom screens, CXRs, sputum sweeps, tuberculin skin tests, or interferon gamma release assays to detect TB in homeless and under-housed populations were sought. 346 articles were obtained after removing duplicates. 16 studies addressed the screening potential of chest radiographs for active TB in low incidence nations and were ultimately analysed for this publication. Nine articles were utilized in the final quantitative analysis, providing a combined sample size of 51312 CXRs.  Data were extracted using a standardized method by 2 independent reviewers, and then were reviewed by a third independent reviewer.

Results: Of the 51,212 screening CXR performed in the representative cohorts, 412 new cases of TB were diagnosed, for a case finding rate of 804 per 100,000 CXRs. The prevalence of TB in the homeless ranged from 8.4-3300 per 100 000. Six of the seven screening programs that ran longitudinally noted a decrease incidence of TB over time.

Conclusion: Our data suggests that chest radiography is a good tool for active case finding and should be incorporated into TB screening programs in homeless and under-housed populations.

Katryn Paquette, M.D., C.M.1, Matthew Pellan Cheng, M.D., C.M.2, Matthew J Kadatz, M.D.2 and James Johnston, MD3, (1)Pediatrics, University of British Columbia, Vancouver, BC, Canada, (2)Internal Medicine, University of British Columbia, Vancouver, BC, Canada, (3)British Columbia Centre for Disease Control, Vancouver, BC, Canada


K. Paquette, None

M. P. Cheng, None

M. J. Kadatz, None

J. Johnston, None

Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.