1 / 28

Screening for Latent Tuberculosis Infection (LTBI) in a Local Remand Prison: Findings and Lessons Learnt

This study discusses the findings and lessons learned from a pilot project on screening for latent tuberculosis infection (LTBI) in a local remand prison in Wales. The study explores the prevalence and risk factors of LTBI, as well as the acceptability of interferon-gamma release assay (IGRA) testing among prisoners. Preliminary treatment outcomes are also discussed.

patsyt
Download Presentation

Screening for Latent Tuberculosis Infection (LTBI) in a Local Remand Prison: Findings and Lessons Learnt

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Screening for latent tuberculosis infection (LTBI) in a local remand prison: findings and lessons learnt Dr Stephanie E Perrett Lead Nurse for Health & Justice 1st February 2019 RCGP Health and Justice Summit, Liverpool

  2. Introduction TB in Wales NICE guidance on TB in prisons Pilot objectives Overview of the pilot Results • Prevalence and risk • Acceptability of IGRA (for men in prison and prison health services) • Treatment outcomes (preliminary) Lessons learnt

  3. Rate of TB per 100,000 population in the UK, 2017* *Tuberculosis in Wales Annual Report 2018: Data to the end of 2017

  4. TB in Welsh prisons 1-2 cases each year Often late presenting, more likely to be infectious Complex social factors making treatment outside of prison challenging Can result in lengthy, complex contact tracing Anxiety amongst prison staff

  5. NICE Guidance on TB (2016) “In high incidence areas (and at prisons that receive from high incidence areas), prison health services should offer an interferon-gamma release assay (IGRA) for TB to inmates younger than 65 years who are in regular contact with substance misuse services or other support services. This is provided arrangements have been made for this support to continue after release” “prison health services should incorporate IGRA testing with screening for hepatitis B, hepatitis C and HIV” “If the IGRA is positive…offer treatment for latent TB infection”

  6. Why latent TB? BMJ 2018; 362: k2738 doi: 10.1136/bmj.k2738 (Published 23 August 2018) Latent infection may develop into active disease • Risk of reactivation is not linear, most infections occur within 2 years of acquisition Identification and treatment of LTBI has the potential to protect the health of the individual Identification and treatment of LTBI has the potential to protect the health of the public

  7. Pilot objectives What is the prevalence of LTBI in a prison population in Wales? • Do we have enough infection to justify universal screening? What treatment outcomes can we achieve? • How robust are our treatment pathways?

  8. Project plan for an LTBI prison pilot Funding from Welsh Government (30k) 584 men tested alongside BBV screen • T-spot blood test (OxfordImmunotech) CXR on all LTBI positives • Using London based Find and Treat mobile service Referral into specialist TB services for all LTBI positive

  9. HMP Cardiff Local category B remand prison Operational capacity of 830 men High turnover Healthcare team of GPs, 20 nurses, 6 HCAs Screening 30% of admissions for BBVs Good relationship with local TB specialist team

  10. Resources required to implement LTBI screening Allocated 2 nurses and 3 HCAs Men screened the morning after admission to prison Participation voluntary Initial target of 12 samples per day, changed to 20 samples per day Resource intensive – clinical and administration time Medical hold until X-ray Support from prison to facilitate Find and Treat bus X-ray screening

  11. Study Population In the period (1 February – 28 March 2018), there were 699 new admissions to HMP Cardiff 584 males were screened within 48 hours (83.5% sample rate) • Risk assessment/questionnaire • Blood Sample 17 records could not be verified This analysis focusses on the sample of 567 men

  12. Demographics Median age 31 years [18-69 years] Majority of men identified themselves as White ethnicity (82.7%) Deprivation • Majority provided a postcode in either Quintile 1 or 2 (most deprived; n=316) • A number of men (n=79) stated that they currently had no fixed abode • Those who identify with no fixed abode do not necessarily identify themselves as homeless, and vice versa

  13. Overview of IGRA and BBV prevalence *5 men declined the BBV screening, 4 samples were invalid, 80 results were not reported (83 HIV) †One case of active respiratory TB infection identified via CXR

  14. Risk Factors (all men)

  15. Risk Factors (IGRA Positive vs. Non Positive)

  16. Risk Factors (Hep C Antibody Positive vs. Non-Positive)

  17. Logistic Regression Model (IGRA Positive)

  18. Logistic Regression Model (Hep C Antibody Positive)

  19. Treatment outcomes (preliminary)

  20. Treatment observations Of the 10 who completed treatment, 8 completed whilst in prison The two men still on treatment are within the community (including active case) All 10 awaiting referral were originally ‘lost’ on release (lack of contact details). They have since been found (7 are in Wales and 3 in England) Patients have been followed up in Leicestershire, Leeds, Nottingham, Birmingham and Bristol

  21. Lessons learnt We found more cases of LTBI than expected Those at risk of TB and HCV are two different groups sharing prison as a risk factor IGRA is acceptable to men in prison There are significant workload implications to consider The more mobile the patient the greater the challenge to complete treatment Focus future resources on active case finding?

  22. Discussion Does your service offer LTBI screening? What challenges do you face in delivering this service? Differences in remand and long stay facilities? How can we improve outcomes for those who move between prisons and between prison and community? Experience of active case finding?

  23. Thank you https://doi.org/10.1093/pubmed/fdy219 Stephanie.Perrett@wales.nhs.uk Acknowledgements Cardiff and Vale University Health Board staff HMPPS UCL Find and Treat Service Public Health Wales Welsh Government

  24. Latent TB Pilot South Eastern Health and Social Care Trust

  25. HMP Maghaberry • Adult Males • Sentenced & Remand • High Security • Integrated & Separated conditions • Population – 818 (Dec ’18) 356 remand/348 sentenced • No. of Committals – 256 (Dec ’18) Pilot Cohort • Sentenced Group • Minimum 6 months remaining to serve • Funding for 75 Igra tests NORTHERN IRELAND PRISON SERVICE

  26. OUTCOME: WE ENJOY LONG, HEALTHY, ACTIVE LIVESLatent TB Screening Pilot: Maghaberry Prison A screening, testing and treatment service for Latent TB was established in June 2018 to detect Undiagnosed cases of Latent TB. How much did we do? Outcome of Screening Reporting Period: August to November 2018 29 75 104 clients were screened

  27. How well did we do it? • Of the 104 screened, 7 identified positive • All 7 positive patients offered a chest x-ray Reporting Period: August to November 2018 7 6.75% (of population screened) Number of IgRAs declined Number of IgRAs carried out 97 Is Anyone Better Off? • Requiring a chest x-ray accepted • Offered screening where given information and advice about Latent TB • With a positive Latent TB diagnosis had an onward referral to a TB nurse specialist for treatment • 6 people completed treatment and one in treatment 100% 3 of patients 72

More Related