title: Effectiveness of peer educators on the uptake of mobile X-ray tuberculosis screening at homeless hostels: a cluster randomised controlled trial.
abstract: METHODS
  Cluster randomised controlled trial.
  
  
  OBJECTIVE
  To 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.
  
  
  METHODS
  46 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.
  
  
  METHODS
  At 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.
  
  
  METHODS
  Cluster randomisation (by hostel) was performed using an internet-based service to ensure allocation concealment, with minimisation by hostel size and historical screening uptake.
  
  
  METHODS
  Only the study statistician was blinded to the allocation of intervention or control arms.
  
  
  METHODS
  The primary outcome was the number of eligible clients at a hostel venue screened for active pulmonary tuberculosis by the mobile X-ray unit.
  
  
  RESULTS
  A 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.
  
  
  CONCLUSIONS
  This 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.
  
  
  BACKGROUND
  ISRCTN17270334.
authors.affiliation: Institute of Health Informatics, University College London, London, UK The Farr Institute of Health Informatics Research.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Aldridge
authors.affiliation: Institute of Health Informatics, University College London, London, UK The Farr Institute of Health Informatics Research.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Hayward
authors.affiliation: Institute of Health Informatics, University College London, London, UK The Farr Institute of Health Informatics Research.
authors.forename: Sara
authors.initials: S
authors.lastname: Hemming
authors.affiliation: Institute of Health Informatics, University College London, London, UK The Farr Institute of Health Informatics Research.
authors.forename: Lucia
authors.initials: L
authors.lastname: Possas
authors.affiliation: Institute of Health Informatics, University College London, London, UK The Farr Institute of Health Informatics Research.
authors.forename: Gloria
authors.initials: G
authors.lastname: Ferenando
authors.affiliation: Institute of Health Informatics, University College London, London, UK The Farr Institute of Health Informatics Research.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Garber
authors.affiliation: Royal Free London NHS Foundation Trust, London, UK Centre for Clinical Microbiology, Division of Medicine, University College London, London, UK.
authors.forename: Marc
authors.initials: M
authors.lastname: Lipman
authors.affiliation: Division of Infection and Immunity, Centre for Clinical Microbiology, University College London, London, UK.
authors.forename: Timothy D
authors.initials: TD
authors.lastname: McHugh
authors.affiliation: University College London Hospitals, London, UK.
authors.forename: Alistair
authors.initials: A
authors.lastname: Story
mesh_terms: D016000:Cluster Analysis; D005260:Female; D006703:Ill-Housed Persons / Q000193:education*; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008952:Mobile Health Units; D009017:Morbidity / Q000639:trends; D010353:Patient Education as Topic / Q000379:methods*; D013902:Radiography, Thoracic / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D014397:Tuberculosis, Pulmonary / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000517:prevention & control; D014505:Urban Population