Tuberculosis screening among people who experience homelessness in Brno: a 20-year public health intervention, Czechia, 2005 to 2024.

INTRODUCTIONTuberculosis (TB) is curable and preventable, yet remains a health concern in vulnerable populations. Individuals experiencing homelessness are at increased risk owing to medical, environmental and social factors.AIMWe aimed to evaluate a 20-year TB screening programme in people experiencing homelessness in Brno, Czechia (2005-2024), and analyse additional TB diagnoses in this population made outside the project, to inform public health strategies for TB control in vulnerable groups in a low-incidence country.METHODSClinical examination and chest X-ray screening were offered to people without stable housing, incentivised by meal vouchers. Individuals with pathological findings underwent further diagnostic evaluation and treatment. Demographic and clinical data were collected. Additional TB diagnoses made in this population through other detection methods were analysed for comparison.RESULTSBetween 2005 and 2024, of 3,918 individuals approached, 2,664 participated in screening (average participation rate: 68.0%), and 18 were diagnosed with TB through the project. Another 132 individuals experiencing homelessness were diagnosed with TB through other pathways, yielding 150 diagnoses, representing 19.3% of TB notifications in Brno. The estimated TB incidence among people experiencing homelessness was 24.4 times higher than in the general population (95% confidence interval: 20.5-28.9). Despite a citywide decline in TB incidence, the proportion of TB diagnoses among people who experience homelessness increased over time.CONCLUSIONHomelessness is a risk factor for TB in low-incidence settings. This long-term screening initiative proved feasible and valuable, demonstrating how outreach-based screening can support early detection and contribute to TB prevention among socio-economically marginalised populations.