Effectiveness of peer educators on the uptake of mobile X-ray tuberculosis screening at homeless hostels: a cluster randomised controlled trial

Abstract

Trial designCluster randomised controlled trial.ObjectiveTo compare current practice for encouraging homeless people to be screened for tuberculosis on a mobile digital X-ray unit in London, UK, with the additional use of volunteer peer educators who have direct experience of tuberculosis, homelessness or both.Participants46 hostels took part in the study, with a total of 2342 residents eligible for screening. The study took place between February 2012 and October 2013 at homeless hostels in London, UK.InterventionAt intervention sites, volunteer peer educators agreed to a work plan that involved moving around the hostel in conjunction with the hostel staff, and speaking to residents in order to encourage them to attend the screening.RandomisationCluster randomisation (by hostel) was performed using an internet-based service to ensure allocation concealment, with minimisation by hostel size and historical screening uptake.BlindingOnly the study statistician was blinded to the allocation of intervention or control arms.Primary outcomeThe primary outcome was the number of eligible clients at a hostel venue screened for active pulmonary tuberculosis by the mobile X-ray unit.ResultsA total of 59 hostels were considered for eligibility and 46 were randomised. Control sites had a total of 1192 residents, with a median uptake of 45% (IQR 33–55). Intervention sites had 1150 eligible residents with a median uptake of 40% (IQR 25–61). Using Poisson regression to account for the clustered study design, hostel size and historical screening levels, there was no evidence that peer educators increased uptake (adjusted risk ratio 0.98; 95% CIs 0.80 to 1.20). The study team noted no adverse events.ConclusionsThis study found no evidence that volunteer peer educators increased client uptake of mobile X-ray unit screening for tuberculosis. Further qualitative work should be undertaken to explore the possible ancillary benefits to peer volunteers.Trial registration numberISRCTN17270334.

Mobile X-ray outside the Hospital: a scoping review

“…There was a variance in study design, power calculations and the number of patients (n= 69-1.192), but mobile X-ray was compared to hospital X-ray in all studies. The interventions were mobile X-ray and mobile X-ray combined with hospital X-ray (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). The most common X-ray examinations were of chest (17,20,21,22,25,26,27,28), hip and pelvis (17,20,21,22,25,26,27,28), spine (20,21,22,25,26,27,28) and abdomen (20,21,22,25,26,27,28).…”

“…The most common X-ray examinations were of chest (17,20,21,22,25,26,27,28), hip and pelvis (17,20,21,22,25,26,27,28), spine (20,21,22,25,26,27,28) and abdomen (20,21,22,25,26,27,28). Some studies only included chest X-rays (18,19,23).…”

“…As shown in Table 4 the study populations in the included literature were frail elderly (19,22), dementia patients (19), homeless (18,23), drug users (23), asylum seekers (23), and nursing home residents (17,20,21,24,25,26,27,28).…”

“…Improvements of population health are measured by several different outcomes that by proxy may indicate if health status is improved. The outcomes of the 12 studies were delirium measured by confusion assessment method (19), sensitivity and speci city of mobile X-ray to nd tuberculosis (18), patient and health care satisfaction measured by qualitative interviews (24,28) and questionnaires (19,20,21,27), image quality and costs (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28).…”

“…Fewer patients may need transportation to the hospital, and probably fewer patients would become delirious (19,21,22,27). The literature also describes places to use mobile X-ray outside the hospital for instance in nursing homes (17,20,21,24,25,26,27,28) and shelters (18,23).…”