Tuberculosis infection and homelessness in Melbourne, Australia, 1995-1996

OBJECTIVE: To describe tuberculosis infection among persons experiencing ho melessness in inner Melbourne, Australia. DESIGN: Homeless people were surveyed during late 1995 and early 1996. In s tage one of the study 284 homeless people from crisis and long-term accommo dation sites were recruited by means of stratified, systematic, random samp ling. In stage two a convenience sample of 100 homeless people from squats and the streets were recruited. Participants completed a questionnaire and Mantoux testing was performed. RESULTS: A past history of tuberculosis was reported by 3%. Thirty-seven pe r cent had a Mantoux greater than or equal to 10 mm; 21% greater than or eq ual to 15 mm; and 11% greater than or equal to 20 mm. A Mantoux greater tha n or equal to 15 mm was independently associated with being aged greater th an or equal to 40 years, coming from the accommodated sample, overseas birt h, and a past history of tuberculosis. Using logistic regression modelling, a Mantoux greater than or equal to 15 mm was predicted by being aged great er than or equal to 40 years, overseas birth, and past history of tuberculo sis. CONCLUSION: Mantoux test results suggest that this group of homeless people had a high prevalence of infection with the tubercle bacillus. Many aspect s of the physical and social circumstances of homeless people predispose to reactivation and have the potential to enhance rapid spread should latent infection become active disease.