Disadvantaged TB patients urgently need social support to make medical treatment more effective

Research carried out by TB specialists across London found that the increased concentration of TB in marginalised groups presents new challenges for the agencies trying to halt its spread.

“TB has risen considerably in major European cities in the last 10 years and London is no exception” says lead researcher Dr Gill Craig from The City University’s Institute of Health Sciences.

“Increased migration, poverty, HIV, poor quality and overcrowded housing, homelessness, the failure of TB control in institutionalised populations and lifestyle factors related to drug misuse have all played a role.

“Models of care that can cater for both the social and medical needs of patients are an essential, but often neglected, aspect of TB management and one that needs to be urgently addressed if we are to tackle this growing health issue.”

The study, which covered 250 patients attending one London hospital between January 2003 and January 2005, found that the disease was more common among men (57 per cent) and people aged between 20 and 39 (60 per cent).

Other key findings included:

– 42 per cent of TB patients were from Africa, 27 per cent from Asia, 24 per cent from the UK and 6 per cent from the rest of Europe.

– Just under a third were homeless, with 11 per cent living in a hostel or on the streets and a further 21 per cent staying with friends or relatives. 39 per cent were receiving welfare benefits and 13 per cent had no income.

– 16 per cent weren’t registered with a family doctor, 13 per cent were seeking asylum and 16 per cent did not speak English as their first language.

– More than a third anticipated problems taking their medicine and 30 per cent had no-one to remind them, suggesting a lack of social support.

– 48 per cent were admitted to hospital during their treatment, with hospital admissions for homeless people being longer and costing two and a half times more than admissions for non-homeless people.

– People were most likely to miss appointments if they had previously had TB or misused drugs or alcohol.

– A third of the 81 patients tested for HIV were positive.

“Our study shows that greater emphasis is needed on developing a social model of care, which includes TB link workers to enable access to housing and allied support services and promote partnership working with the statutory and voluntary sectors” concludes Dr Craig.

“That’s why The City University has developed a course to help professionals who deal with TB patients to work together in an effective and co-ordinated way.

“Meanwhile, the challenge for commissioners of TB services will be to link the evidence for social care with health policy and practice in order to re-configure services with an emphasis on social support and prevention.”

The World Health Organization estimates that TB affects 8.8 million people a year and causes 1.6 million deaths.

Provisional figures from the UK’s Health Protection Agency show that London accounted for 42 per cent of all cases reported in England, Wales and Northern Ireland in 2006, with an incidence of 45.8 per 100,000 residents.