11 October 2011 Reaching out to the hard to reach: Community screening for Tuberculosis in a high-risk population in South Wales Insert name of presentation on Master Slide Dr Rhianwen Stiff

What is Tuberculosis? Infection by Mycobacterium tuberculosis Usually affects lungs Potentially very serious Curable May be transmitted from people with active disease in lungs Reaching out to the hard to reach: Community screening for TB

Body’s Response to TB Immediately detects, deals with germ and removes = no problem Unable to deal with germ, develop symptoms = active TB Cannot remove the germ, but can control it = latent TB Reaching out to the hard to reach: Community screening for TB

TB in Wales Source: Enhanced TB Surveillance Programme, CDSC Wales http://www.wales.nhs.uk/sites3/page.cfm?orgId=457&pid=27952 Reaching out to the hard to reach: Community screening for TB

CwmTaf Health Board Reaching out to the hard to reach: Community screening for TB

History of Outbreak Cluster of cases in 1996 Since 1996 Contact tracing and screening undertaken Since 1996 26 cases of active TB 28 cases of latent TB Linked by DNA typing and common contacts Reaching out to the hard to reach: Community screening for TB

Why screen; why now? High risk group within a generally low risk population in South Wales Known, identifiable population Incomplete attendance and compliance during original outbreak Patients tending to present late: smear positive at presentation NICE Guidance introduced Reaching out to the hard to reach: Community screening for TB

Doing it differently Understanding the Community Visited the area Identified Community Leaders Multiple pre-screening meetings Engaged with local, regional and national media Reaching out to the hard to reach: Community screening for TB

Screening moved into community’s centre Doing it differently Identify barriers & facilitators Impoverished Poor public transport Inaccessible district general hospital Poor literacy rates Tight-knit, community focused Strong community networks Tailor communication Written information adapted to community’s literacy abilities Local free-press coverage Regional and national bilingual media Visual and audio media used – TV, radio, printed press and word of mouth Screening moved into community’s centre Multiple dates and times Local, familiar, non-threatening venue Ease of access Attracted opportunistic attendance Staff routinely assisted with reading information and consent form completion Community minibus Free, convenient transport to local cottage hospital for further investigations 100% attendance Chemoprophylaxis Clinic held within the community Fortnightly prescriptions and medication review at local pharmacy ?Improved compliance

Consent Form Completion Screening Room Screening Room 8 8 6 7 Waiting Area Spare Room – could use for confidential discussion with attender Kitchen Comments 2 2 Toilets Reception 9 5 Toilets 5 1 3 4 4 Consent Form Completion Entrance Exit 4 4

Results 332 people screened 76 received BCG 132 invited; 200 self-presenters 76 received BCG 76 referred for chest X-ray Chemoprophylaxis indicated for 20 Heightened awareness 2 further cases presented to GP Reaching out to the hard to reach: Community screening for TB

Outcomes Excellent community engagement Improved understanding of health risks Empowered to actively participate Normalised a process previously seen as stigmatising High degree of accessibility, acceptability and satisfaction Reaching out to the hard to reach: Community screening for TB

Outcomes “I and my family found the whole process very reassuring.” “Very organised. Lots of staff to help and support.” “Very sensitively done. Thanks.” “Excellent service. Job well done.” ... But would we do it again? Reaching out to the hard to reach: Community screening for TB

Acknowledgements The Community Communities First; GPs; local councilors; pharmacist; Pastor; head teachers; school teachers; youth workers; community newspaper; minibus drivers; children who created the welcome sign; community volunteers….. Dr Gwen Lowe (CCDC) and the South East Wales Health Protection Team, Public Health Wales Rhian Williams (TB Nurse), Yvette Evans, Louise Walby and Julie Scudamore (Respiratory Nurses) and the TB Team, Cwm Taf Margaret Munkley (Public Health Team) and Joyce Pegg (Emergency Planner), Cwm Taf Sian Evans (Pharmaceutical Team), Public Health Wales Cwm Taf Health Board Communications Team, Public Health Wales Communicable Disease Surveillance Centre, Public Health Wales Volunteers Reaching out to the hard to reach: Community screening for TB