Nationwide Tuberculosis Screening in the Homeless Population of South Korea

초록

RATIONALE: The Korean government implemented a strategy of prevention and early diagnosis in high-risk groups to reduce thetuberculosis (TB) burden. This study aims to investigate the TB epidemics and the gap in understanding TB prevalence amonghomeless individuals by analyzing active TB chest X-ray radiography (CXR) screening in Korea. METHODS: The KoreanNational Tuberculosis Association (KNTA) conducted active TB screening with CXR for homeless groups from January 1 toDecember 31, 2021, involving a total of 17,713 participants. Sputum Acid Fast Bacilli (AFB) smear and cultures were performedfor the subjects with suggestion of TB on CXR. We used the national general health screening results for comparison. RESULTS:Of 17,713 homeless persons, 40 (5%), 3,077 (19%), and 79 (5%) were categorized as suspected TB, inactive TB, andobservation required, respectively. The prevalence of suggested TB in the homeless was significantly higher by 3-5 fold than thatfrom the national general health screening according to age category (P < 0.005). Twenty-nine cases were confirmed as TB,yielding a prevalence of 164 cases per 100,000 individuals; 19 of these 29 cases showed inactive TB on CXR. The body massindex (BMI) (P = 0.0478) and CXR result (P < 0.001) were significant risk factors for confirmed TB according to multivariateanalysis. CONCLUSION: Nutrition status and CXR results, especially inactive TB, should be considered in active TB screeningamong the homeless population, where TB prevalence is higher than in the general population.