Factors associated with the presence of anti-Leptospira spp. antibodies in persons experiencing homelessness in Brazil

Introduction: Homelessness has been considered one of the most vulnerable situations worldwide, alongside people private of liberty (incarceration) and country displacement (refugees). Structural inequality and exposure to diseases such as leptospirosis may be aggravated by individual issues including drug addiction, mental disorders and improper healthcare. Methods: The present study has accessed persons experiencing homelessness to <i>Leptospira</i> spp. exposure by microscopic agglutination test (MAT) for 30 serovars. This study was conducted in São Paulo city in southeastern Brazil and São José dos Pinhais city, belonging the eighth biggest metropolitan area of Brazil in Southern region. Results: In total, 21/243 (8.6%; 95% CI = 5.6-13.1%) persons experiencing homelessness were seropositive in the MAT. Location, condom use, and flea infestations were identified as statistically significant associated risk factors for exposure. Discussion: The presence of multiple <i>Leptospira</i> spp. serovars may indicate bacterial diversity, even in urban settings. The results herein found for persons experiencing homelessness were not a surprise, as Brazil has been historically recognized as an endemic country for leptospirosis, with 3,810 leptospirosis cases on average per year and the majority living in densely populated urban areas. Multidisciplinary efforts and integrated policies may be crucial to mitigate leptospirosis and other infectious diseases in persons experiencing homelessness, as social neglection may impact on their fundamental rights to dignity and access to personal health.