Plain English Summary
Background and study aims
Mobile digital X-ray screening for tuberculosis (TB) - a London initiative called 'Find&Treat' - has been shown to be highly clinically and cost-effective in tackling TB in hard-to-reach groups (homeless people, substance misusers and prisoners). However, the overall impact of the intervention is dependent on achieving a high rate of uptake. This presents unique challenges among this population who are often hard to engage. Our preliminary work has shown that use of financial incentives is operationally problematic in this population but trained peer educators, who have direct experience of TB with homeless and / or drug and alcohol addiction, are potentially a valuable health promotion resource and can educate and motivate hard to reach groups to take up the offer of voluntary screening. There is a cost to the use of peer educators and therefore a need to formally evaluate effectiveness. Currently normal practice is to rely on staff from the Mobile X-ray Unit (MXU) to liaise with homeless sector staff to promote uptake which results in about 50% of residents accepting screening. The study aims to determine the effect of peer educator on uptake of MXU screening.
Who can participate?
This is a hostel centred health promotion project, thus residential homeless hostels within London being offered NHS-led mobile X-ray screening for TB are eligible to participate. However, hostels with 80% or more uptake rate from previous screening are excluded.
What does the study involve?
Hostels were randomly allocated on a rolling basis to either the intervention (use of peer educator) or to the control arm (normal practice - use of MXU and hostel staff) by minimisation on using a text messaging randomisation service provided by Sealed Envelope (http://www.sealedenvelope.com). On the day of the screening: the study team observed the screening session and discreetly grade each hostel on the level of support provided by staff to maximise uptake. The hostels were scored on active participation of staff, staff level of awareness that screening is taking place, visible display of posters about screening in communal areas, and evidence that screening information was disseminated to residents prior to screening. Also noted was: overall level of participation of staff allocated to the screening, their efforts to engage with resident and promote uptake such as door knocking at residential hostels; peers were evaluated on their time keeping; external factors likely to influence uptake such as the weather, residents' accessibility to the location of the van, and if incentives were provided by the hostel.
What are the possible benefit and risks of participating?
Peer educators are appropriately trained and highly supported by Groundswell, a professional service user involvement organisation. We have found that their involvement appears not only to increase uptake of tuberculosis screening and heighten awareness of TB, but also has a positive effect on the uptake of other health interventions such as needle exchange and blood borne virus screening. We envisage the risk associated with this study is primarily related to the control arm not accessing peer education. However, there is insufficient evidence to justify the resource necessary to provide peer education to all settings screened.
Where is the study run from?
This TB Reach study has been set up by the Royal Free NHS Foundation Trust in collaboration with 'Find&Treat' under the University College London Hospitals NHS Foundation Trust (UK).
When is the study starting and how long is it expected to run for?
February 2012 to October 2013.
Who is funding the study?
National Institute for Health Research (NIHR) (UK).
Who is the main contact?
Dr Andrew Hayward
Dr Andrew Hayward
Reader Infectious Disease Epidemiology
Research Department of Infection and Population Health
Royal Free Campus
Rowland Hill Street
+44 (0)20 7472 6777
TB Reach Sub-Study 3 : RP-PG-0407-10340 : 10/H0302/51
Cluster randomised controlled trial of peer intervention on uptake of MXU screening for TB among hard-to-reach groups (homeless people and substance misusers).
Using trained peer educators who have direct experience of TB with homelessness and/or substance misuse to educate and motivate hard-to-reach groups is a valuable health promotion resource to increase uptake of mobile digital radiography screening.
Essex 2 NRES Committee East of England - Cambridge, 08/02/2011, ref: 10/H0302/51
Cluster randomised controlled trial
Primary study design
Secondary study design
Cluster randomised trial
Patient information sheet
Not applicable as this is a hostel centred study
Random allocation of homeless residential hostels to either peer or MXU / hostel staff supported mobile digital X-ray TB screening of hard-to-reach groups.
Primary outcome measure
Aggregate data comparing uptake of the offer of screening between intervention and control arm using the bed-list as the denominator.
1. Number of residents eligible for screening will be determined from hostels' records.
2. Number accepting screening will be determined from the MXU screening records.
Secondary outcome measures
Internal and external factors influencing screening such as the active participation of staff and peers, the weather, and the use of incentives by the participating hostel.
Overall trial start date
Overall trial end date
Reason abandoned (if study stopped)
Participant inclusion criteria
Residents of participating homeless hostels within London who have not been screened in the 6 months prior to the scheduled MXU screening session.
Target number of participants
2800 (1400 residents from 20 hostels in each arm) in London
Participant exclusion criteria
Residents of the participating homeless hostels who have been screened within 6 months of the scheduled MXU screening.
Recruitment start date
Recruitment end date
Countries of recruitment
Trial participating centre
University College London
University College London (UK)
c/o David Wilson
Joint Research Office
Maple House Suite B
149 Tottenham Court Road
+44 (0)20 3447 5199
National Institute for Health Research (NIHR) (UK) ref: NIHR PGFAR RP-PG-0407-10340
Funding Body Type
Funding Body Subtype
Results and Publications
Publication and dissemination plan
Not provided at time of registration
Intention to publish date
Participant level data
Not provided at time of registration
Basic results (scientific)
2015 results in: http://www.ncbi.nlm.nih.gov/pubmed/26391630