The Department launched a national tuberculosis (TB) toolkit in June 2007 to support commissioning of TB services best suited to local needs, and recommended that TB services follow the National Institute for Health and Clinical Excellence (NICE) guidelines on tuberculosis. The NICE guidelines make specific recommendations about active screening for TB among homeless people and prisoners and to ensure that people working with these groups have high awareness of the risk and symptoms of TB.
London TB services are funded by the Department to run a pilot study using a mobile X-ray unit (MXU) to screen homeless hostels and prisons. Evaluation of the pilot showed the MXU to be an effective case-finding tool among these populations. In addition, since October 2007, the Department has funded Find & Treat, a small multidisciplinary team of tuberculosis nurse specialists, social and outreach workers, to provide practical support and advice to TB services across London for around 300 patients with complex and challenging needs. Support includes: locating and re-engaging patients who have been lost to follow-up care; providing links between prison health and the MXU to NHS tuberculosis services; organising case conferences and directly observed therapy (DOT) partnerships and engaging relevant allied support services in the community to help patients complete treatment.
The Health Protection Agency (HPA) runs the National Knowledge Service for TB, which provides information resources including cartoon leaflets for prisoners and material targeted at staff working with the homeless, prisoners and problem drug users. Evaluation shows that these have been well received.
The HPA collects data nationally to monitor rates of tuberculosis among the homeless, prisoners and problem drug users, because it recognises the high rates of disease in these populations.
The HPA is undertaking a programme of research, in collaboration with University College London and the Royal Free NHS Trust, to provide the evidence base for interventions to control TB among the homeless, prisoners and problem drug users.
All these initiatives will inform future policy on tackling TB in these groups.