Scholarship Stories: Birmingham and Solihull Tuberculosis (TB) Service
Scholarship Stories: Birmingham and Solihull Tuberculosis (TB) Service Provides Latent TB Infection Outreach to a New Demographic
With funding from Burdett Trust, Birmingham and Solihull Tuberculosis (TB) Service has been able to carry out weekly clinics for new migrants aged 35-65 years of age, raise awareness of Latent TB Infection, challenge poor compliance and ensure that those who tested positive have been provided with the appropriate treatment.
Who is Maria Cristeta Z. Licas-Labrador?
I am originally from Philippines and specialise in tuberculosis management. I am the TB Team Leader in the Birmingham and Solihull Tuberculosis (TB) Service. I have been working in UK since 2001 and been in TB service for 13 years now. I am a non-medical prescriber so part of my role is holding a nurse-led clinic for latent TB infection (LTBI) patients. While managing my own patients, I also supervise the TB team which comprises of specialist nurses, outreach nurses, support workers and admin staff in the absence of our lead nurse. I also make sure that both our local and national databases are updated with the TB notifications. I work with Mr Vinod Bangardh, a TB support worker, who worked really hard for the success of this project.
What was the focus of your funded project?
To re-evaluate the methods by which Public Health England (PHE) screens new entrants from high TB risk countries. Current screening guidelines aim to screen new migrants aged between 16-35 years and arriving in the UK in the last 5 years. Our project focuses on an older demographic as a high-risk group. Looking at the quality and effectiveness of current treatment protocols and monitoring of LTBI therapy within this key demographic, we also focus on side-effects and compliance.
Why is this important?
With 70% of tuberculosis cases notified in England belonging to non-UK born residents and over 80% of these cases arising within two years of entering the United Kingdom, likely due to LTBI reactivation4, the 2015-2020 Collaborative TB Strategy for England aims to systematically target and screen this population and provide preventive TB therapy with a view to prevent future cases of active TB. Our study expands on the PHE guidelines for screening new entrants by focusing on an elder demographic – those between the ages of 36 and 65 years of age. Despite being more at risk to develop active TB, (7-9) current strategies would not allow systematic targeting of this cohort.
Who does this project help?
By focusing on an older demographic, the remit for targeting and treating latent TB cases is wider. This directly aids new entrants by reducing the risk of them developing active TB. It benefits the NHS in the long run by reducing the number of cases of active TB and any subsequent infections that can result through contact with infected individuals is also prevented.
How did Burdett Trust’s funding help this project?
The funding allowed us to carry out weekly clinics over the course of a year at a local GP practice. We were able to screen over 140 new entrants, almost 30% of whom tested positive and were provided antibiotic treatment. The funding covered the cost of testing individuals but also helped produce a leaflet that informed the patient about LTBI raising the awareness of this disease. In the absence of symptoms, poor compliance is a significant hindrance for completing treatment. Funding was utilised to provide a financial incentive in the form of a voucher given to the patients who successfully completed treatment.
How will this project develop in the future?
The project can continue to monitor and provide chemoprophylaxis treatment within this demographic. It can also continue to monitor the efficacy of treatment regimens within this older population and focus on the development of side-effects of poor compliance. It can be expanded to target migrants from high-risk countries who have lived in the UK longer than 5 years, who despite being at risk of developing the active disease, are currently not screened by PHE guidelines.
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