Background: The aim of this study was to determine the proportion of persons experiencing homelessness (PEH) who converted or reverted a tuberculin skin test (TST) or QuantiFERON Gold-in-tube test (QFT) and examine the risk factors associated with prevalence of latent tuberculosis infection.

Methods: We performed a retrospective cohort study of all PEH screened for latent tuberculosis infection (LTBI) by TST or QFT from 2008-2018 in Fulton County, Georgia.

Results: Out of 16,444 PEH in the study cohort who were screened by TST or QFT, 1603 (9.7%, 95% Confidence Interval [CI] 9.2 – 10.1%) had a positive TB screening. Factors associated with positive results were older age, being male, being Asian, HIV co-infection and history of incarceration. Of those initially negative with a second test (n=3491), 8.5% became positive during a total follow-up period of 102521 person-months, corresponding to an incidence rate of 2.9 cases per 1000 person-months. The rate of conversion was higher among male, older adults and PEH with HIV. Of those initially positive with a second test (n=241), 36.5% reverted to negative during a total follow-up period of 6655 person-months, corresponding to reversion rate of 13.2 cases per 1000 person-months. The rate of reversion was highest among older adults.

Discussion: We found higher rates of QFT/TST conversion and reversion. Targeted QFT/TST screening and LTBI treatment among PEH should be an active strategy to reduce TB morbidity.