Tackling TB among hard-to reach groups in London

The Peer-to-peer TB education project

Background to project

Funded by the Department of Health, Find & Treat and Homeless Link developed the Peer-to-Peer project in response to research in London that showed that rates of tuberculosis are highest among hard to reach populations, especially people that are homeless and who use drugs and alcohol.

The Peer-to-Peer project recognises that people with a personal experience of TB and homelessness and/or problematic drug or alcohol use have a unique ability to convey the messages about the importance of screening, diagnosis and adherence to treatment to people in similar situations. The project has been set up to recruit, train and support former TB patients with these experiences to become peer educators, delivering awareness-raising sessions in hostels, day centres, and drug services. So far 5 former TB patients have been recruited.

From March 2009 Groundswell took over the project management of the Peer-to-Peer project from Homeless Link. Groundswell is the UK’s leading user involvement and self-help organisation working in the field of homelessness. For more information about Groundswell, please go to www.groundswell.org.uk/

Aims of the peer-to-peer project

•Raise awareness of TB among hard to reach groups

•Raise awareness of TB and of the needs of hard-to-reach groups among housing providers and health care teams of the needs of hard to reach groups

•Encourage take-up on the Mobile X-Ray Unit (MXU)

•Increase number of hard to reach patients that complete relevant investigations and treatment

•Gain an understanding of the myths and barriers hard to reach groups experience around TB


Role of a Peer Educator

To work directly alongside the Find and Treat team to promote awareness, encourage screening uptake on the MXU and offer direct support to homeless TB patients.


Work includes:

•MXU screening –peers work alongside staff of the MXU and staff of the venue being screened (hostel, day centre, substance misuse service) encouraging uptake and providing assistance

•Raising awareness sessions– in partnership with Find and Treat, peers deliver awareness sessions at residents meetings, staff meetings, health meetings and conferences/forum. Sessions consist of either a joint presentation (with someone from Find and Treat), question and answer session or speaking about your own personal experiences. Peers have spoken at a variety of settings including: hostels, day centres, drop-ins, soup-runs, hospitals, universities and at national health and homelessness conferences. Peers have also spoken at the Houses of Parliament.

•Supporting TB patients – peers have recently been asked to share their experience with individual patients that are having difficulty managing treatment

•Raising awareness through publicity – peers are regularly asked to contribute to articles and newsletters (so far peers have been interviewed for the Big Issue Magazine and the Pavement Magazine)

•Working groups and forums – peers have been asked to join health forums and working groups, providing personal experiences and contributing to development of services


On average peers are involved in activities once a week.

Support and Training


Preparation to deliver sessions - Peers receive training on public speaking and presentation giving and learn how to use their own skills, experience and knowledge to help others and contribute to limiting spread of TB among hard-to-reach groups in London.  Peers also receive training on TB and medication.

Peers will receive additional training areas that will support their development as peer educators and support interest in health, homelessness or involvement issues. The regularity and costs of such training will be decided by Find and Treat.


Financial payments

The Project works with the Involvement Helpline (Milton Keynes Citizen Advice Bureau) to ascertain how much, if anything peers are able to earn for their involvement. Depending on type of benefit being claimed, peers are able to earn £20 per week for their involvement. For those on Job Seekers Allowance it is less. The Involvement Helpline works to ensure there is no impact on benefits for participants.

Go to www.mkweb.co.uk/Citizens_Advice/documents/The_Involvement_Helpline1.pdf for more information.

What do you get out of being a peer?

•Participating in a project to help others who may be at risk of TB, and to reduce the spread of the disease

•Experience of presenting to a range of audiences and developing skills in facilitation and training

•Additional training sessions or courses according to your development plans and training needs

•Support in using computer packages

•Work alongside Find and Treat and the MXU

•Travel and telephone top ups

•Lunches provided for



The Recruitment process

If you would like to know more about the Peer-to-Peer project or are interested in becoming a peer you should contact Joe Hall (or speak with your key worker or nurse). See contact details at end of this section.

The project is for people that have had TB and who are have had experience of homelessness or drug/alcohol dependence, and whose support needs are not high and can be met by the project.

We can arrange a time and place to meet and talk further about project and what you hope to get out being involved in the project.


What do peers say about being involved in the project?

“I know more about TB and the medical side of it too.”

“Now I’m a peer educator consultant – I’m being approached by other agencies such as TB alert, I have new links I can pursue after this project”


Some benefits of peer education highlighted by service users include:

“Sitting down with somebody who knows about it, discussing it with me”

“The best is hearing from the person who has already had it.  They know, they know the beginning symptoms, they know what treatment you need to get, they know where you should go and get it”

“If you had people who had actually experienced it…someone that’s actually been there”


What a manager of a hostel thinks about peer educators

“The peers are much more confident (than staff) in the reasons for needing to get screened, and are able to articulate this in a succinct and non-alarming way.”


Want to know more?

If you are interested in becoming a peer educator or would like to know more about the project, please contact:

Joe Hall (TB Social Worker) joehall@nhs.net

    Tel: 0207 734 2972