Combating the spread

of tuberculosis within ‘hard to reach’

groups
Author(s): Edwin Tapiwa Chamanga
Key words:
Multidisciplinary team working, Drop in centres, Stigma & isolation
Edwin Tapiwa Chamanga critically analyses the needs of hard to reach groups in TB management and
discusses a model of care that can be adopted
Edwin Tapiwa Chamanga RGN, BSc (Hons), Specialist Community Practice (District Nursing),
currently reading for an MSc Skin integrity skills and treatments is a Tissue Viability Nurse Specialist,
City and Hackney Primary Care Trust, London

The resurgence of tuberculosis (TB) remains disturbing and problematic. The disease is a major public
health issue with reports showing that it is on the increase both nationally and internationally (Lewis &
Chihota, 2008; Marcovitch, 2008). The Health Protection Agency (HPA) (2006; 2009) states that in the
past 10 years, TB rates have increased dramatically in European cities. In 2008, the United Kingdom had
a provisional report of 8679 newly diagnosed cases of TB. The Department of Health (DH, 2007), also
noted that TB cases in England have increased to 40 per 100,000 leading to approximately 350 deaths
per year.

Management strategy
Literature suggests that the provision of medical, physical, social and psychological care for
individuals diagnosed with TB in a multidisciplinary (MDT) approach is an effective strategy for TB
management (Williams et al., 2008a; Williams et al., 2008b). The above statement accords with the
bio-psychosocial model. This is a model that aims at supporting individuals with TB in all aspects of
their lives, therefore, increasing the uptake of TB treatment. Integrating the bio-psychosocial model
approach with the introduction of TB advice, support and information drop-in centre can be more
effective in promoting treatment uptake in hard to reach groups (Table 1). Current TB information and
advice for hard to reach groups is usually given in a standard letter from the National Institute for
Health and Clinical Excellence (NICE) (2006). Treatment uptake is very important as it has been
reported that, if a person with active TB of the lungs is left untreated, he/she has the potential of
infecting 10-15 people per year (DH, 2004). Therefore, this article will critically analyse hard to reach
groups as an area of need in TB management, and will discuss a model of care that can be adopted,
and is aimed at mobilizing this group towards successful treatment uptake.
Hard to reach groups are people with no fixed address or are very mobile due to economic and social
factors, for example, immigration status and homelessness (World Health Organization (WHO) 2003;

Journal of Community Nursing, vol. 10, no. 4, September 2009 29

Storey, 2004). Most people diagnosed with TB are socially excluded due to some of the reasons
mentioned above. These individuals experience delayed diagnosis, poor concordance and poor
follow-up care (DH, 2007; Lavcock, 2008).
According to NICE (2006) and Craig et al. (2008), the increase of TB prevalence in England and
Wales is mainly influenced by risk factors such as exposure to active