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The E valuation of Novel A pproaches to TB Case A scertainment and Management

The E valuation of Novel A pproaches to TB Case A scertainment and Management. Dr Martin Dedicoat PhD Mrs Cathy Browne RGN Presented by Dr Christine Burt PhD. Trend in TB incidence in Birmingham and London 1990 - 2009. Introduction.

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The E valuation of Novel A pproaches to TB Case A scertainment and Management

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  1. The Evaluation of Novel Approaches to TB Case Ascertainment and Management Dr Martin Dedicoat PhD Mrs Cathy Browne RGN Presented by Dr Christine Burt PhD

  2. Trend in TB incidence in Birmingham and London1990 - 2009

  3. Introduction - 70% of TB cases in Birmingham - people born overseas - Each new case is reported to the Birmingham Chest Clinic - Each new case of TB is allocated to a specialist nurse - To improve the number of contacts identified for each new case of TB a service evaluation and improvement programme was undertaken by the Birmingham and Solihull TB service - One of the aims of the evaluation was to use social network analysis to investigate clusters of TB patients - This report contains preliminary results for the project

  4. Methods Localdatabase New cases National database Evaluation of the number of notifications and the outcome of their contacts was made by analysing anonymous data

  5. Methods Contact Tracing: Extra Pulmonary TB – screening = close family only Respiratory TB – screening = close family >10% = active/latent TB wider screening This method of contact tracing is known as ‘Stone in the Pond’ tracing

  6. Methods continued - Conventional approaches to contact screening may miss cases - Samples from all cases are sent to the HPA Labs for culture - Cluster definition and action taken is based on HPA guidance - Samples cultured and isolates typed using variable number tandem repeats (VNTR) of 24 loci - These 24 loci VNTR are used to identify clusters of TB patients

  7. Methods continued Many clusters have obvious links between different cases often no link is found In these cases a specialist nurse was tasked to visit and interview patients Data from these interviews was used to construct network diagrams to illustrate links

  8. Results - 22,191 (50.5%) females mean age = 25 - Between 1990 and 2012 = 43,968 contacts of TB - 20,759 (49.5%) males mean age = 19 - Outcomes were available for 92% of cases - Overall 42% did not complete their screening - The proportion of smear positive contacts receiving chemoprophylaxix rose from 4.3% to 9.4%

  9. Results continued Links between patients were not known - Clusters for further investigation were identified based on several factors: The cluster was growing - To date 15 clusters have been investigated

  10. Conclusion Analysis of the contact database revealed 42% of people Identified as contacts TB nursing team taking a more proactive approach in follow up: - Patients who start screening but do not complete it - Patents with latent TB who do not complete treatment The impact of this change will be assessed after one year

  11. Conclusion continued - Using the social network questionnaire a cluster of Eritrean patients were found attending a single place of worship - More still needs to be done - More specific methods are becoming available - An enhanced contact tracing service may contribute to reducing the incidence of TB in Birmingham

  12. Acknowledgements This service evaluation is funded by Heart of Birmingham Primary Care Trust TB nurses investigating the clusters and managing patients Health Protection Agency – Dr Grace Smith and Dr Jason Evans The health protection unit in Birmingham - Helen Bagnall

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