title: Impact of x-ray screening programmes for active tuberculosis in homeless populations: a systematic review of original studies.
abstract: BACKGROUND
  Tuberculosis prevalence is generally low in industrialized countries, but many cities now operate surveillance programmes to actively screen for tuberculosis in known risk groups including homeless people. While several studies have reported on individual screening programmes, this study is the first known systematic review specifically looking at chest x-ray screening programmes for tuberculosis in homeless populations.
  
  
  METHODS
  Systematic review of relevant studies published in the last 20 years using the PRISMA checklist.
  
  
  RESULTS
  Fourteen studies were reviewed: 12 cross-sectional studies, 1 retrospective cohort study and 1 'data-linkage' study. The studies were heterogenous in terms of the objectives, measured outcomes and methodological quality. Active tuberculosis prevalence was found to be higher in homeless populations and screening programmes appear to identify tuberculosis earlier, reduce prevalence and transmission, and increase treatment compliance.
  
  
  CONCLUSIONS
  Active x-ray surveillance programmes in homeless communities appear to be cost-effective in reducing prevalence within the homeless population particularly in related strains and may have some benefits over passive finding. While there is a need for high-quality research to further assess the impact of these programmes, this study has outlined the benefits and limitations of existing programmes and included recommendations to achieve maximum coverage, uptake and cost-benefit.
authors.affiliation: College of Medicine, University of Swansea, Singleton Park, Swansea SA2 8PP, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Curtis
mesh_terms: D003362:Cost-Benefit Analysis; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006801:Humans; D008403:Mass Screening / Q000191:economics / Q000379:methods*; D015397:Program Evaluation; D011859:Radiography; D014397:Tuberculosis, Pulmonary / Q000000981:diagnostic imaging*
keywords: communicable diseases; management and policy