Mobile X-ray teams should be deployed in areas homeless people congregate to tackle the tuberculosis (TB) disease "more proactively", new guidelines claim.

One in ten TB sufferers have social risk factors that can lead to delayed diagnosis and incomplete treatment, according to the Health Protection Agency.

Those suffering with TB that have drug or alcohol addictions, are homeless, in prison and from migrant communities are most at risk of being out of reach of health services, says the National Institute for Health and Clinical Excellence (NICE).

NICE recommends health professional strengthen their efforts to find patients early and providing intensive clinical and social support to help patients complete TB treatment.

"This draft guidance recommends new ways in which we can help tackle TB among hard to reach groups who are most at risk," said Professor Mike Kelly, director of public health at NICE.

"Evidence shows relying on these groups to present themselves to health services doesn't work, and we need to adopt a more proactive approach to identify and treat this disease."

Commissioners of TB control programmes should seek out active TB among homeless groups by using mobile X-ray teams in places where they congregate - for example, homeless day centres, rolling shelters, hostels and temporary shelters – recommends the NICE's draft guidance.

Prisons that have static digital X-ray facilities should also X-ray all new inmates for active TB if they have not received a chest X-ray in the last six months.

Such new methods should all be underpinned by community-based clinical and social support co-ordinated by a TB case worker.

In addition, NICE recommends all 'hard-to-reach' TB patients should receive community based clinical and social support co-ordinated by their TB case worker. Support should include the observation of treatment and practical help with housing, addiction and other unmet health and social care problems.

The deadline for the submission of comments on the draft guidance is 3 November 2011.  Final guidance is expected in March 2012. 

NICE