To compare current practice for encouraging homeless people
to be screened for tuberculosis on a mobile digital X-ray unit in London, UK,
with the additional use of volunteer peer educators who have direct experience
of tuberculosis, homelessness or both.
46 hostels took part in the study, with a total of 2342
residents eligible for screening. The study took place between February 2012
and October 2013 at homeless hostels in London, UK.
At intervention sites, volunteer peer educators agreed to a
work plan that involved moving around the hostel in conjunction with the hostel
staff, and speaking to residents in order to encourage them to attend the
screening.
Cluster randomisation (by hostel) was performed using an
internet-based service to ensure allocation concealment, with minimisation by
hostel size and historical screening uptake.
Only the study statistician was blinded to the allocation of
intervention or control arms.
The primary outcome was the number of eligible clients at a
hostel venue screened for active pulmonary tuberculosis by the mobile X-ray
unit.
A total of 59 hostels were considered for eligibility and 46
were randomised. Control sites had a total of 1192 residents, with a median
uptake of 45% (IQR 33-55). Intervention sites had 1150 eligible residents with
a median uptake of 40% (IQR 25-61). Using Poisson regression to account for the
clustered study design, hostel size and historical screening levels, there was
no evidence that peer educators increased uptake (adjusted risk ratio 0.98; 95%
CIs 0.80 to 1.20). The study team noted no adverse events.
This study found no evidence that volunteer peer educators
increased client uptake of mobile X-ray unit screening for tuberculosis.
Further qualitative work should be undertaken to explore the possible ancillary
benefits to peer volunteers.
Below: Maps of London by local authority detailing: rates of tuberculosis (A); total eligible clients at all homeless hostels (B); total number of clients screened at hostels as part of the study (C).
Full article at:
By:
- 1Institute of Health Informatics, University College London, London, UK The Farr Institute of Health Informatics Research.
- 2Royal Free London NHS Foundation Trust, London, UK Centre for Clinical Microbiology, Division of Medicine, University College London, London, UK.
- 3Division of Infection and Immunity, Centre for Clinical Microbiology, University College London, London, UK.
- 4University College London Hospitals, London, UK.
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