Background One in six of all notified tuberculosis (TB) cases in London are among homeless people, problem drug and alcohol users and prisoners (hard-to-reach). These groups are at high risk of delayed diagnosis, infectious and drug resistant TB and poor treatment outcomes. The Berlin Declaration (2007) stated that affected communities are essential partners in TB control. While initiatives involving hard-to-reach communities in HIV control have proven effective, evidence to support their contribution to TB control activities is lacking. We aimed to improve service access and uptake of TB screening among hard-to-reach groups by harnessing the authentic voice and experience of former TB patients from these affected communities.
Method Seven former TB patients with a history of homelessness and drug/alcohol dependence were recruited and trained as peer educators to work alongside TB clinics and a mobile x-ray screening service. Qualitative and quantitative methods were used to evaluate their impact on service access and screening uptake.
Results Peers recruited 3200 hard-to-reach clients at 101 screening sessions resulting in 45 hospital referrals between May 2009 and February 2010. Following TB peer training of homeless shelter hostel workers, screening uptake increased from 44% to 75%. Subsequent structured interviews with service users highlighted the importance of peer educators in raising TB awareness and promoting service access.
Conclusion Our evaluation demonstrated that trained peer educators can improve service access and TB screening uptake in the short and medium term in hard-to-reach groups. The success of this approach argues for greater peer educator involvement in strategies to control metropolitan TB.
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Funding This project was supported by the Department of Health.