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Heterogeneity exists in infectious disease prevalence rates in homeless people
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Data from a systematic review and meta-analysis suggest that there is heterogeneity in the prevalence rates of tuberculosis, hepatitis C and HIV among homeless people — highlighting a need for local data to develop appropriate health services for this population.
“We found high rates of tuberculosis, HIV and hepatitis C in the homeless, and in the case of tuberculosis and hepatitis C, the rates are many times higher than in the general population,” Seena Fazel, MD, of the department of psychiatry at the University of Oxford in England, told Infectious Disease News. “As these infections are contagious, any targeted measures to prevent and treat these and other infections could have pronounced effects on public health.”
Fazel and colleagues searched databases for the evaluation of the prevalence of these diseases in the homeless population. A total of 43 studies, which included 59,736 homeless people, were included. There were 17 studies of TB, 12 studies of hepatitis C and 22 studies of HIV.
Prevalence of TB ranged from 0.2% to 7.7% across the studies. The random-effects pooled prevalence was 1.1% (95% CI, 0.8-1.5). Prevalence was higher in studies that used chest radiograph for diagnosis as opposed to other methods.
For hepatitis C, the prevalence ranged from 3.9% to 36.2%. The random-effects pooled prevalence was 20.3% (95% CI, 15.5-25.2). The prevalence of HIV ranged from 0.3% to 21.1%. The random-effects pooled prevalence was 4.7% (95% CI, 3.6-5.8).
“We tried to descriptively summarize risk factors in the individual studies, but it was difficult to be certain about these factors as the studies did not consistently report or test possible associations,” Fazel said. “One factor that did emerge was injection drug use, which seems to be associated with higher rates of infections in the homeless. Other factors that could be important include not being able to access treatment, not adhering to treatment, not having good sanitation, malnutrition and high levels of drug and alcohol abuse.”
In an accompanying editorial, Didier Raoult, MD, PhD, of Aix-Marseille University in Marseille, France, said homeless people are susceptible to communicable diseases because they frequently live in groups, and life expectancy of homeless people is shorter than in the general population. He calls for actions such routine screening at shelters, vaccination and needle exchange programs to assist in preventing disease transmission among homeless people.
“The risks of epidemics of infectious diseases in homeless populations remain significantly higher than those in the general population in the same country,” Raoult wrote. “These increased risks are a public health challenge for the population as a whole. Implementation of specific strategies to reduce these risks is crucial.”
Disclosure: The researchers and Dr. Raoult report no relevant financial disclosures.
References:
Beijer U. Lancet Infect Dis. 2012;doi:10.1016/S1473-3099(12)70177-9.
Raoult D. Lancet Infect Dis. 2012;doi:10.1016/S1473-3099(12)70186-X.
Disclosures:
Drs. Fazel and Raoult report no relevant financial disclosures.