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Contact tracing of TB patients at Birmingham Chest Clinic. Kinza Saeed . Contact Tracing at B irmingham C hest C linic. In the UK TB has risen by more than 1/3 in the past decade In parts of Birmingham TB is at the level of high-incidence countries Around 400 active TB cases every year
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Contact tracing of TB patients at Birmingham Chest Clinic Kinza Saeed
Contact Tracing at Birmingham Chest Clinic • In the UK TB has risen by more than 1/3 in the past decade • In parts of Birmingham TB is at the level of high-incidence countries • Around 400 active TB cases every year • Over 2500 contacts every year
Aims and Objectives • Aim: Evaluate contact investigations at Birmingham Chest Clinic • Objectives: • To outline the existing pathway for contact investigations and compare practice to national guidelines • To assess the outcomes from contact tracing • To make recommendations on how the contact investigation pathway can be improved to increase the completion rate
Methods and Materials • Randomly selected a sample of 345 TB contacts referred in 2012 • Information on if the contact is: - respiratory or non-respiratory - household, non-household or congregate - assessments - final outcome
How are contacts assessed? • The Birmingham Chest Clinic has local protocols of contact investigation, adapted from the National Institute for Health and Clinical Excellence (NICE).
Assessment episodes of TB contacts aged 35 and under • 52% tested for latent TB as first assessment • 33% of contacts DNA their first assessment • 89% completed contact tracing • 75% of respiratory contacts followed correct protocol • 91% of non-respiratory contacts followed correct protocol • NOTE Data are number of contacts (%). CXR, chest X-ray; IGRA, interferon-gamma release assay; TST, tuberculin skin test; DNA, did not attend.
Figure 6 Outcomes of contact tracing for contacts aged 35 years and under in respiratory vs. non-respiratory index cases. Outcomes of contact tracing for contacts aged 35 and under • 44% of respiratory contacts and 62% of non-respiratory contacts had a positive yield • 35% of respiratory contacts defaulted • 42% of non-respiratory contacts defaulted • NOTE Data are number of contacts. An outcome of other was given for contacts who transferred out of the area or declined invitation for contact tracing.
Figure 7 Assessment episodes of TB contacts aged over 35 years Assessment episodes of TB contacts aged over 35 • 50% of contacts received a chest X-ray as a first assessment • 21% of contacts DNA their first assessment • 97% completed contact tracing • 86% of respiratory contacts followed correct protocol • 95% of non-respiratory contacts followed correct protocol • NOTE Data are number of contacts (%). CXR, chest X-ray; IGRA, interferon-gamma release assay; TST, tuberculin skin test; DNA, did not attend.
Figure 8 Outcomes of contact tracing for contacts aged over 35 years in respiratory vs. non-respiratory index cases. Outcomes of contact tracing for contacts aged over 35 • 45% of respiratory contacts and 29% of non-respiratory contacts had a positive yield • 33% of respiratory contacts defaulted • 19% of non-respiratory contacts defaulted • NOTE Data are number of contacts. An outcome of other was given for contacts who transferred out of the area or declined invitation for contact tracing.
Conclusion • The mode first assessment for each contact type was in accordance to the national guidelines • Contacts to respiratory cases have lower adherence to protocols compared to non-respiratory contacts • Contacts require up to five appointments for protocol completion to approach 90%. • Approximately 20-30% fail to attend the first 2 scheduled appointments • 34% of contacts did not complete protocol or defaulted