Tuberculosis can infect anyone, but predominantly affects the poor, write Alistair Story and colleagues. In
Recently published guidance from the National Institute of Health and Clinical Excellence (NICE) recommends chest X-ray screening for homeless people and entry screening for prisoners. Mobile X-ray units targeted at high risk groups are also being evaluated in
The guidance also suggests hospital admission for homeless people and those with clear socioeconomic need, allocation of a named key worker for all patients, and risk assessment to identify those patients unlikely to adhere to treatment. Directly Observed Therapy (DOT where a health worker or other responsible adult observes the patients taking their medication) is also recommended to improve adherence to treatment.
Most tuberculosis patients are not infectious, readily access health services, and complete treatment successfully without DOT, say the authors. As a result, they make only limited demands on services and pose little public health risk.
By contrast, many socially excluded patients are at risk of delayed presentation, poor adherence and loss to follow-up. A major and persistent outbreak including more than 200 linked drug resistant cases disproportionately affecting homeless people, prisoners and problem drug users in London clearly illustrates the urgent need to strengthen tuberculosis control among socially excluded groups.
The occurrence of tuberculosis in
Tuberculosis cannot be controlled unless the disease is tackled effectively among socially excluded groups. This demands coordinated action beyond established control strategies that will require significant and sustained investment, they conclude.
Source: British Medical Journal