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Authors; Lindsay Ritchie, and Jennifer Horton.
Tuberculosis (TB) is a disease that disproportionately affects certain groups and communities in Canada, including people who are foreign-born and people who encounter specific social barriers (e.g., people experiencing homelessness, people who inject drugs).1 For these people, a less clinical approach to treatment may be required to promote engagement and prevent attrition. The use of support workers (e.g., peer support workers, community support workers, social workers) may be a strategy to help support care in people with TB who are facing barriers.
The purpose of this report is to identify and describe the strategies, and the evidence of their use, that support workers and allied health professionals use to facilitate completion of treatment protocols in people with TB who require additional assistance with care.
This report is not a systematic review and does not involve critical appraisal or include a summary of study findings. Rather, it presents an annotated list of citations and a summary of the key components of TB programs and initiatives used by support workers and allied health professionals to engage populations and people with TB who face barriers to facilitate TB treatment. This report is not intended to provide recommendations for or against a particular intervention.
A limited literature search was conducted by an information specialist on key resources, including MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Database of Systematic Reviews, the International HTA Database, the websites of Canadian and major international health technology agencies, as well as a focused internet search. The search strategy comprised both controlled vocabulary, such as the National Library of Medicine’s MeSH (Medical Subject Headings), and keywords. The main search concepts were support workers and tuberculosis. No filters were applied to limit the retrieval by study type. If possible, retrieval was limited to the human population. The search was completed on November 11, 2022, and was limited to English-language documents published since January 1, 2017.
One reviewer screened literature search results (titles and abstracts) and selected publications according to the inclusion criteria presented in Table 1. Open-access, full-text versions of guidelines, guidance documents, and program evaluations were reviewed when available and the relevant information was summarized; otherwise, full-text publications were not reviewed.
Selection Criteria.
Articles were excluded if they did not meet the selection criteria outlined in Table 1, they were duplicate publications, or were published before 2017. Reports focused on screening and diagnosis of TB and contact tracing were also excluded. If articles reported on included and excluded topics (e.g., strategies used to encourage people who face barriers to complete screening and treatment for TB), the article was included but the excluded topic(s) were not summarized. Additional references of potential interest that did not meet the inclusion criteria are provided in Appendix 1.
Fourteen relevant references about the strategies used by peer support workers, community support workers, or social workers to engage their clients with TB who face barriers were identified for this report.2-15 Guidance describing engagement with people with TB by TB programs were published in reports from Canada,2-5 the UK,8-10 Europe,6,12,13 and globally.7,11 A retrospective cohort study and a descriptive survey study were from the UK14 and Europe,15 respectively.
The information included in this report covered people diagnosed with TB requiring assistance with care from several specific populations, including people who:
The types of support workers and allied health professionals identified included:
The major themes of support identified included:
A total of 14 reports were included in the current report. Guidance documents, including evidence- and consensus-based guidelines and synthesis reports, are summarized in Table 2. Nonrandomized studies are summarized in Table 3. Further details can be found by consulting the individual article citations.
Summary of Included Guidance Documents.
Summary of Included Nonrandomized Studies.
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