Screening Strategy of Active Pulmonary Tuberculosis in Sheltered Homeless People in Marseille, 2019
Authors: Tran Duc Anh Ly
Floriane Holi-Jamovski
Michel Drancourt
Philippe Gautret
Ndiaw Goumballa
Thi Loi Dao
Van Thuan Hoang
Meriem Louni
Journal: Journal of Epidemiology and Global Health (2021)
Discipline: CLINICAL MEDICINE
Keywords: Active pulmonary tuberculosis; GeneXpert MTB/RIF assays; chest X-ray; culture; microscopical testing
Affiliations: Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France., IHU-Méditerranée Infection, Marseille, France., Centres de Lutte Antituberculeuse, Marseille, France., Family Medicine Department, Thai Binh University of Medicine and Pharmacy, Vietnam., VITROME, Campus International IRD-UCAD de l'IRD, Dakar, Senegal., Pneumology Department, Thai Binh University of Medicine and Pharmacy, Vietnam., Aix Marseille Univ, MEPHI, Marseille, France.

Abstract:  We aimed to assess the reliability of a screening questionnaire for Active Pulmonary Tuberculosis (APTB) in a population of sheltered homeless persons (HP). Participants from two homeless shelters completed a questionnaire specially designed to identify patients at high-risk of APTB (available at www.tb-screen.ch), underwent a Chest X-ray (CXR), and provided sputum samples. Computed Tomography (CT) scanning was subsequently performed on those which had images consistent with APTB. Microscopical examination, real-time polymerase chain reaction (qPCR) and culture testing were applied for Mycobacterium tuberculosis complex detection. Additionally, we retrospectively selected 16 HP hospitalised in our hospital between 2017 and 2019 with biologically confirmed tuberculosis and typical CXR images, and retrospectively documented a screening questionnaire by reviewing their medical files. Overall, the population (n = 383 HP) was predominantly migrants (87%). Forty-seven individuals (11.7%) had positive screening questionnaire scores and four (2.4%) displayed abnormal CXR features consistent with APTB. Three of them three underwent CT scanning that ruled out APTB and one was lost to follow-up. None tested positive through microbiological investigation. Fifteen (of 16, 93.8%) hospitalised patients with biologically confirmed APTB had a positive screening questionnaire score. The sensitivity and specificity of questionnaire for confirmed APTB were 93.8% and 87.7%, respectively. Screening questionnaires can be used as a first assessment tool in people arriving at homeless shelters and to refer those screening positive for a CXR. 

Retracted: No

PubPeer comments:
 In this study, homeless persons in Marseille were recruited from shelters, examined, X rays were taken, and sputum was collected for TB detection. I have a question about the IRB approval for this study, since homeless persons might be considered to be a  vulnerable population (i.e., vulnerable to coercion), similar to veterans or prisoners in the US, although IRB rules might differ per country. Surprisingly, the IRB approval number listed in this paper (2010-A01406-33) is used for at least 17 studies, including this one. Although all of them involve homeless persons recruited from Marseille shelters, the studies themselves vary in terms of study protocols and treatment sample collection. The studies vary from collecting lice, treating subjects with drug-impregnated underwear, filling out questionnaires, medical exams, to nasal and pharyngeal sampling, skin swabbing, blood draw, rectal samples, sputum collection, and chest X rays. Moreover, the studies were performed from 2011 to 2020, spanning almost 10 years. Would the authors be willing to share the original 2010 ethical approval application here? Did they get approval for all these different studies spanning 10 years, in one single application? There is also confusion about which institution or ethical board approved the study. Some papers state that the study was approved by  our institutional review board , suggesting that this was a number referring to IRB approval by the Aix-Marseille Universitu00e9 and or Institut Hospitalo-Universitaire Mu00e9diterranu00e9e Infection, both listed as author affiliations. But in other papers, the IRB approval number appears to be an ANSM RCB authorization ID, as per  Informed consent was obtained from these subjects, and the study was approved by the u2018u2018Comitu00e9 de Protection des Personnes Sud Mediterranu00e9eu2019u2019 on January, 12, 2011 (ID RCB: 2010-A01406-33) , e.g. as mentioned in PLoS ONE 8(2): e58088. Either way, it would be of interest to take away any concern whether studies on this vulnerable populations were all performed within the original IRB approval scope. Here is the list of 17 papers that all appear to share the same ethical approval number: * Rezak Drali et al. - Journal of Clinical Microbiology (2012) p. 2229u20132233 - DOI: 10.1128 JCM.00808-12 * Rezak Drali et al. - PLoS ONE 8(2): e58088 (2013) - DOI: 10.1371 journal.pone.0058088 * Samir Benkouiten et al. - JAMA Dermatol. 2014;150(3):273-279 (2014) - DOI: 10.1001 jamadermatol.2013.6398 * Rezak Drali et al - Infection, Genetics and Evolution 39 (2016) 225u2013231 - DOI: 10.1016 j.meegid.2016.02.008 * Tran Duc Anh Ly et al. - Emerging Infectious Diseases (2017) - DOI: 10.3201 eid2311.170516 * Tran Duc Anh Ly et al. - Clinical Microbiology and Infection 25 (2019) 249.e1e249.e6 - DOI: 10.1016 j.cmi.2018.04.032 * Tran Duc Anh Ly et al. - Front. Cell. Infect. Microbiol. 9:86 (2019) - DOI: 10.3389 fcimb.2019.00086 * Tran Duc Anh Ly et al. - Journal of Epidemiology and Global Health (2019) - DOI: 10.2991 jegh.k.190510.001 * Tran Duc Anh Ly et al. - Infection and Drug Resistance 2019:12 1139u20131151 - DOI: 10.2147 IDR.S202048 * Nadia Amanzougaghene et al. - Parasites Vectors (2020) 13:177 - DOI: 10.1186 s13071-020-04036-y * Tran Duc Anh Ly et al. - European Journal of Clinical Microbiology Infectious Diseases (2020) - DOI: 10.1007 s10096-020-03889-6 * Tran Duc Anh Ly et al. - Travel Medicine and Infectious Disease 36 (2020) 101768 - DOI: 10.1016 j.tmaid.2020.101768 * Tran Duc Anh Ly et al. - Vector-Borne and Zoonotic Diseases (2020) - DOI: 10.1089 vbz.2019.2603 * Tran Duc Anh Ly et al. - Acta Microbiologica et Immunologica Hungarica (2021) - DOI: 10.1556 030.2021.01346 * Tran Duc Anh Ly et al. - Journal of Epidemiology and Global Health (2021) - DOI: 10.2991 jegh.k.201009.001 * Tran Duc Anh Ly et al. - Journal of Infection Volume 82, Issue 1, January 2021, Pages 60-66 - DOI: 10.1016 j.jinf.2020.11.026 * Tran Duc Anh Ly et al. - European Journal of Clinical Microbiology Infectious Diseases (2021) - DOI: 10.1007 s10096-020-04127-9 ,