1. 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

2. 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

3. 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

4. TB in Wales
Source: Enhanced TB Surveillance Programme, CDSC Wales
Reaching out to the hard to reach: Community screening for TB

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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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