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TB screening for hostel residents

May 22 2009
Windish: Windish:
With TB on the rise, the idea of compulsory screening in hostels is being discussed Hostels and other homeless services could face new policies that will introduce mandatory tuberculosis screening, The Pavement has learned. The Department of Local Government and Communities and the Department of Health have been in discussion over how best to increase screening uptake among hostels throughout the capital. Potential routes could include screening prior being accepted at a hostel, or mandatory checks before being allowed to move to another residence, it is understood. Currently, it is up to individual charities to decide whether to impose checks before admitting anyone. However, health experts have warned that the risk of contracting TB is "significantly higher" among rough sleepers or people living in crowded accommodation: one in five TB cases in London is diagnosed in people who are vulnerably housed, drug users or ex-prisoners. According to figures from the UK charity TB Alert, London is the only West European capital city where rates of TB are on the increase. A spokesman for the Department of Health would not confirm the specific details of the talks or what potential outcomes were being considered. However, he said: "Both departments are working together to support access to the Mobile X-Ray Unit (MXU, pictured opposite) as outlined by the National Institute of Health and Clinical Excellence, and discussions are ongoing with providers over how best to achieve this." Phil Windish, an outreach worker with TB initiative Find & Treat, which works with the MXU, said he would welcome increased pressure from the government to improve the rate of screening: "We are very keen to maximise take up, but there is no policy or formal requirement at the moment." Mr Windish acknowledged there could be issues involved such as "the rights of the individual to move freely", but stressed the importance of screening as many people as possible in the city. "There are incentivised programmes, but there is still a lack of awareness and motivation to do anything about it," he said. "We would welcome any policy directives, but nothing yet has been crystallised." Mr Windish's project, which uses the mobile screening unit to offer on-the-spot checks around London's hostels, is funded by the Department of Health. The MXU has been running in the capital for three years, but many people sleeping rough or in hostels have not yet been tested. Mr Windish said take up so far had been dependent on both staff's and residents' opinions, and the numbers of people screened varied from hostel to hostel as a result. He highlighted the King George's hostel, based in Victoria, as a residence with a particularly strong response. More than 90 per cent of the current residents have been tested: none carried the disease. "When we do succeed, it tends to be because there was a lot of input from the staff ‚Äö?Ñ?¨ those who are highly motivated to get the job done. "We also use peer educators, people who have gone through the experience and can honestly explain why it is so vital, as service users can be buoyed up by this idea," he added. "In some cases, using incentives such as giving out gifts ‚Äö?Ñ?¨ TVs, for example ‚Äö?Ñ?¨ has worked really well. That is what we have to work with: it's more about using the carrot than the stick." Steve Davies, the support manager at King George's, agreed the take-up was mostly down to the relationship between staff and residents. "We prioritised TB above other agendas. We had 'TB month', when we dropped everything else ‚Äö?Ñ?¨ and we reminded them constantly when it would be 'TB time'," he said. "We also used contingency management, where everyone was given ¬¨¬£5 Sainsbury vouchers," he added, although stressed this method had not worked as well at other hostels. "There was not much resistance to the idea: only four of our 68 residents have not been screened. People understood TB is a killer, and understood the idea behind herd immunity." But he said King George's would not be making tests compulsory. "People will be encouraged to understand the problems surrounding TB," he said. "It is a killer." Next month the hostel is hoping to replicate their results. The screening process is painless and takes one minute to conduct, giving off harmless levels of radiation. After taking the x-ray, the on-site radiographer will look for signs of TB. More often than not, there will be no problem. If, however, the person has an abnormal X-ray, there is a nurse or worker on hand to give advice and provide an escort to the nearest TB clinic. A timetable for where and when the MXU will be is in The List at the back of The Pavement.
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