Tuberculosis Awareness Service

The London Borough of Ealing wishes to tender for a contract for the provision of a Tuberculosis (TB) Awareness Raising service in Ealing. Providers are asked to register an interest on the London Tenders Portal.  

It is envisaged that subject to governance the TB Awareness Raising contract will commence on the 1st of October 2023 for a period of 3 years with the possibility of one two (2) year extension. The annual value is £48,000 per annum with a total value of £240,000 (if all extensions used). The service should provide awareness raising for residents through in-person events, stalls, and social media. This will also include community awareness taking place in a variety of settings such as libraries, faith settings, education areas, and NHS venues. The service should provide both in-person and online training for professionals who work with Ealing residents, so they themselves can raise awareness and signpost residents to services. This includes council staff, housing staff, voluntary and community sector groups, drug & alcohol teams, pharmacists, and primary care.

The TB Awareness Service prevents an exacerbation of the disproportionate effects that TB has on vulnerable populations. Ealing currently has the 2nd highest TB incidence in London, and the 3rd highest in the country In 2011, Ealing was the 3rd most diverse borough in England & Wales with: • Largest Polish population (21,507) • Highest number of Afghans (6,789) • Highest number of Serbians (441) • 2nd highest number of Iranians (2,981) • 3rd highest Somali population (2,835), with a further 535 Somalilanders • 4th highest number of Arabs (10,076) In 2018, 82% of Ealing residents with TB were born outside of the UK, but the majority had been in the UK for a long time.

Ealing is one of the highest London boroughs providing support for people seeking asylum, with Southall having the highest number of asylum seekers with no recourse to public funds. In terms of deprivation, a high risk factor for TB, Ealing is the 2nd highest employment/income deprived borough in West London. Four areas within Ealing are in the 10% most deprived areas in the country. Ealing Foodbank is the 4th busiest in England, with 56% of clients mainly from 6 wards: Southall Green, Southall Broadway, Norwood Green, Acton Central, Dormers Wells, and Lady Margaret. In 2018, 16% of Ealing residents had a social risk factor (homelessness, prison history, drug and alcohol misuse), compared to the London average of 13.3%.

People with diabetes are known to have a 2-3 times higher risk of TB than people without diabetes. TB can worsen diabetic glucose control, and diabetes can worsen the clinical course of TB and increase risk of adverse treatment outcomes. In 2020/21 the QOF prevalence of diabetes (17+) was 9.0% (32,936), an increasing trend since 2012/13. Ealing ranks 2nd in London and 7th in England for this indicator. Service Description • The service provider should deliver the programme across Ealing, with targeting of specific areas and sub-groups of the population which have higher rates of TB prevalence. These areas could be identified through use of the Whole Systems Integrated Care (WSIC) system. The 2022 Public Health Ealing TB Resident survey will be used to identify resident knowledge gaps regarding TB, and the provider is expected to review examples of other TB and health communications to inform development (as per 2.7.1 in the 2021 UKHSA TB Action Plan). • Information should be tailored to Ealing residents. Messages will be culturally competent, reducing stigma and tackling myths and misconceptions. Key languages include Polish, Punjabi, Arabic, Tamil, Gujarati and Somali (from ONS data for main language spoken at home in Ealing). • Work delivered should help reduce health literacy barriers for Ealing residents.

The TB community champions network should be used as a form of peer-support for addressing health literacy amongst targeted population groups. The health literacy ‘teach-back’ method should be incorporated into work delivered. Information provided should be clear and accessible, and residents should leave outreach sessions with the knowledge and confidence to access further advice or treatment for TB. • Training sessions for professionals working in Ealing will be expected to be informed from the 2022 Public Health TB Stakeholder survey, including on identified gaps in knowledge and feedback as well as review of other examples of TB communications. Training requirements will include delivery to local GPs and primary care teams, so providers will require a robust and current working knowledge of the clinical course of TB, and the local pathways for clinical identification, treatment, and services available to support treatment adherence for TB. • Training sessions for professionals will be delivered in a hybrid approach, through online mechanisms and through face-to-face sessions, to maximise opportunities for professionals to attend. The provider will also explore feasibility of sustainable methods of training delivery, such as development or use of existing e-learning methods, for training that professionals can complete in their own time. It is expected that information provided will include knowledge and overview of TB within Ealing, including locality and population-based areas of unmet need, plus messages on how the disease is spread, signs and symptoms, investigations, the curable nature of the condition, how to access treatment, importance of compliance and completion of treatment. Messages will align with NICE guidance on tuberculosis (Section 1.1.1 raising and sustaining awareness of TB,).

Aims and Objectives of Service Aim: To raise awareness of TB within Ealing residents, particularly those from key at-risk groups (section 3.3) to help reduce the incidence and spread of TB cases within Ealing. This project will include delivery of information on symptoms, how it is spread, diagnosis, treatment, how to access treatment and support, and prevention within the population and within stakeholders working with Ealing residents. The service will raise awareness of latent TB amongst residents so they are familiar with what it is and its risk factors and raise awareness of latent TB with professionals so they can sign post residents accordingly. Objectives: • Raise TB awareness (active and latent TB) in local population, particularly in higher risk groups and populations who are underserved, through outreach work. There should be a minimum of 8 outreach sessions (stalls) per quarter to better engage local communities. Sessions should raise awareness and also help challenge stigma associated with TB in communities. They should be held in various settings (places of worship, gyms, community centres, youth associations). • To develop and sustain a borough led TB community champion network (based on a train the trainer model), including recruiting participants from a wide range of communities and creation of staff TB champions in organisations which interact with Ealing residents, such as CVS organisations, community pharmacies, housing providers etc.

The provider will recruit three new TB community champions (based in Ealing Borough) per quarter and hold a quarterly TB champion meeting to update knowledge, training, and provide mentoring for community champions. • Utilise social media to further engage residents with TB awareness, with a mixed media approach of YouTube, Facebook, Twitter, and Instagram. A minimum of 400 people should be engaged per quarter through social media. • Provide 6 TB/latent TB awareness education events (group sessions) per quarter amongst stakeholder groups working in Ealing (such as primary care, community pharmacists, CVS organisations, Ealing Council staff, housing services, criminal justice services and drug and alcohol teams).

A minimum of 60 people should be engaged per quarter. Pre- and post-questionnaires should be used to assess knowledge levels before and after sessions. These sessions should include robust clinical information on the course of TB and can be delivered either face-to-face, online, or in a hybrid approach. • 80% of total attendees attending the education session feel confident that they would be able to recognise symptoms of TB and know where to signpost residents for advice and treatment. • The provider should be able to access information on ward level/locality population incidence, to effectively target their work with residents to integrate their offer within local pathways, to generate referrals to primary care/chest clinic • Promote national TB awareness campaigns as required by the commissioner (World TB Day).