The public health management of tuberculosis among the single homeless: is mass miniature x ray screening effective?

STUDY OBJECTIVE The aim was to test the assumption that mass miniature x ray screening of the single homeless (hostel residents) is a cost-effective means of controlling pulmonary tuberculosis. DESIGN The study was a prospective experimental screening exercise to identify new cases of active tuberculosis completing treatment. SETTING The setting was eight hostels in south London. A mobile x ray screening facility was set up outside the hostels. SUBJECTS Subjects were 547 single homeless residents in the hostels. They were encouraged to attend for chest x ray, and for active follow up of abnormal x rays. MAIN RESULTS No new cases of active tuberculosis were found. CONCLUSIONS Mass miniature x ray is ineffective in controlling tuberculosis because of its unacceptability and increasing inaccessibility to this population.