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11 Octo ber 2011

Reaching out to the hard to reach: Community screening for Tuberculosis in a high-risk population in South Wales. 11 Octo ber 2011. Dr Rhianwen Stiff. What is Tuberculosis?. Infection by Mycobacterium tuberculosis Usually affects lungs Potentially very serious Curable

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11 Octo ber 2011

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  1. Reaching out to the hard to reach: Community screening for Tuberculosis in a high-risk population in South Wales 11 October 2011 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 http://www.wales.nhs.uk/sites3/page.cfm?orgId=457&pid=27952 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 • 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. 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 • Chemoprophylaxis • Clinic held within the community • Fortnightly prescriptions and medication review at local pharmacy • ?Improved compliance • Community minibus • Free, convenient transport to local cottage hospital for further investigations • 100% attendance

  10. 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 4 4 Entrance Exit

  11. Results • 332 people screened • 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

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