Screenings for people experiencing homelessness

What NICE says outreach should check

NICE says services should use outreach to identify health problems earlier, for example by supporting access to national screening programmes and assessing people for long-term conditions, infectious diseases and mental health needs. (NICE NG214) It says an assessment should include a comprehensive look at the person's physical and mental health needs, including acute and long-term conditions, and should avoid unnecessary and potentially distressing repetition of their history if it is already on record. (NICE NG214) MedlinePlus lists HIV, lung diseases including tuberculosis, mental health problems and substance use problems among the common health problems people experiencing homelessness may have. (MedlinePlus)

TB and latent TB

In areas of identified need, including major urban centres with a high incidence of TB, NICE says commissioners should run active case-finding using mobile X-ray in places where people who are homeless congregate, including day centres, rolling shelters, hostels and temporary cold weather shelters, with the frequency at each location based on population turnover. (NICE NG33) NICE also says commissioners should consider offering other health checks at the same visit, giving blood-borne virus screening as an example. (NICE NG33) The USPSTF recommends latent TB screening for adults 18 or older at increased risk, which includes persons who live in, or have lived in, high-risk congregate settings such as homeless shelters. (USPSTF latent TB) See latent tuberculosis screening and latent TB test results.

Hepatitis B and C

NICE lists people living in hostels for the homeless or sleeping on the streets among the groups at increased risk of hepatitis C. It says GPs and practice nurses should offer hepatitis B and C testing to adults at increased risk, including people newly registered with the practice who belong to a group at increased risk, and should offer annual hepatitis C testing to people who test negative but remain at increased risk. (NICE PH43) NICE's hepatitis B list names other groups, such as people who have ever injected drugs, rather than homelessness itself. (NICE PH43) In the US, the USPSTF recommends hepatitis C screening for all adults aged 18 to 79. (USPSTF hepatitis C) See hepatitis C screening, hepatitis C test results and hepatitis B screening.

HIV

The USPSTF recommends HIV screening for adolescents and adults aged 15 to 65, and for younger and older people at increased risk. It says repeat screening is reasonable for persons who live or receive medical care in a high-prevalence setting, such as a tuberculosis clinic, correctional facility or homeless shelter. (USPSTF HIV) See HIV screening and HIV test results.

Blood pressure and diabetes

The USPSTF recommends blood pressure screening in adults 18 or older (USPSTF blood pressure) and screening for prediabetes and type 2 diabetes in adults aged 35 to 70 who have overweight or obesity. (USPSTF diabetes) In England, people aged 40 to 74 without certain existing conditions should be invited to an NHS Health Check every 5 years by their GP or local council; it usually includes a blood pressure test and a cholesterol test, and the NHS says people who think they are eligible but have not been invited can contact their GP practice. (NHS Health Check) See blood pressure screening and diabetes screening.

Mental health, alcohol and drug use questions

The USPSTF recommends depression screening in all adults (USPSTF depression) and anxiety screening in adults 64 or younger, (USPSTF anxiety) and recommends asking adults 18 or older about unhealthy alcohol use (USPSTF alcohol use) and unhealthy drug use. (USPSTF drug use) NICE says outreach should include support for people with mental healthcare needs and drug and alcohol treatment needs. (NICE NG214) See mental health screenings by age, alcohol screening (AUDIT-C) and drug use screening questions.

Usual screening on schedule

The sources on this page do not set a different schedule for cancer or other routine screening in people experiencing homelessness, so these follow age and sex. NICE says outreach should support access to national screening programmes. (NICE NG214) Someone who has missed screenings can start from catching up on screenings. See cancer screenings by age, screenings by age and gender and questions to ask your doctor.

Where they differ:

TB. NICE focuses on finding active TB with mobile X-ray in hostels, shelters and day centres in areas of need; (NICE NG33) the USPSTF recommends latent TB screening for adults who live or have lived in high-risk congregate settings such as homeless shelters. (USPSTF latent TB)
Hepatitis C. NICE names living in hostels or sleeping on the streets as a reason to offer the test, with yearly retesting while the risk remains; (NICE PH43) the USPSTF screens all adults aged 18 to 79, with no separate homelessness criterion. (USPSTF hepatitis C)
HIV. The USPSTF names homeless shelters as a setting where repeat HIV screening is reasonable; (USPSTF HIV) the NICE guidance on this page does not set an HIV testing rule for homelessness, and NG33 gives blood-borne virus screening only as an example of a check to offer alongside TB screening. (NICE NG33)

Your doctor decides what your result means for you.

Questions people ask

Which tests are offered to people experiencing homelessness?

NICE says outreach should support access to national screening programmes and assess people for long-term conditions, infectious diseases and mental health needs. NICE and the USPSTF name TB, latent TB, hepatitis C and HIV as checks linked to living in hostels, shelters or on the street, and the usual age-based screening still applies. (NICE NG214) (NICE NG33) (USPSTF latent TB)

Is a TB check offered in hostels and day centres?

In areas of identified need, NICE says commissioners should run active case-finding with mobile X-ray where people who are homeless congregate, including day centres, shelters and hostels, and should consider offering other checks such as blood-borne virus screening at the same visit. (NICE NG33)

Does living in a homeless shelter change the HIV or hepatitis C advice?

The USPSTF says repeat HIV screening is reasonable for people who live or receive care in a high-prevalence setting such as a homeless shelter. NICE lists people living in hostels for the homeless or sleeping on the streets among the groups at increased risk of hepatitis C, and says GPs should offer annual hepatitis C testing to people who test negative but remain at increased risk. (USPSTF HIV) (NICE PH43)

Do the usual age-based screenings still apply?

Yes. The sources on this page do not set a different cancer, blood pressure or diabetes schedule for people experiencing homelessness, so these follow age and sex. NICE says outreach should support access to national screening programmes. (NICE NG214)