Chest radiography for active tuberculosis case finding in the homeless: a systematic review and meta-analysis

Int J Tuberc Lung Dis. 2014 Oct;18(10):1231-6. doi: 10.5588/ijtld.14.0105.


Setting: In low-incidence regions, tuberculosis (TB) often affects vulnerable populations. Guidelines recommend active case finding (ACF) in homeless populations, but there is no consensus on a preferred screening method.

Objective: We performed a systematic review and meta-analysis to evaluate the use of chest X-ray (CXR) screening in ACF for TB in homeless populations.

Design: Articles were identified through EMBASE, Medline and the Cochrane Library. Studies using symptom screens, CXRs, sputum sweeps, tuberculin skin tests and/or interferon-gamma release assays to detect active TB in homeless populations were sought. Data were extracted using a standardised method by two reviewers and validated with an objective tool.

Results: Sixteen studies addressing CXR screening of homeless populations for active TB in low-incidence regions were analysed. The pooled prevalence of active TB in the 16 study cohorts was 931 per 100 000 population screened (95%CI 565-1534) and 782/100 000 CXR performed (95%CI 566-1079). Six of seven longitudinal screening programs reported a reduction in regional TB incidence after implementation of the CXR-based ACF programme.

Conclusion: Our data suggest that CXR screening is a good tool for ACF in homeless populations in low-incidence regions.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Databases, Factual
  • Homeless Persons*
  • Humans
  • Incidence
  • Mass Screening / methods
  • Prevalence
  • Radiography, Thoracic / methods*
  • Tuberculin Test
  • Tuberculosis / diagnostic imaging*
  • Tuberculosis / epidemiology*