More targeted action is needed to tackle the increasing problem of tuberculosis in hard-to-reach groups, NICE warned today. Its public health guidance calls for commissioners and providers of TB services – as well as those in the voluntary sector who work with vulnerable groups – to identify infected people at an earlier stage, and provide adequate clinical and social support to help them complete their course of treatment.
There has been a further 5% increase in the level of TB infection in the UK over the past year, with 9042 cases reported to the Health Protection Agency in 2011. Almost three-quarters of these were in people born outside the UK, and 40% of all cases reported were in London.
NICE is concerned that people who are homeless, addicted to alcohol or drugs, in prison or who are vulnerable migrants are least likely to recognise the symptoms of TB, and least likely to be able to access diagnostic and treatment services through traditional primary or hospital care. They are also less likely than the general population to complete their treatment, which puts them at risk of relapse and of developing a drug-resistant form of TB. Each untreated person with pulmonary TB can infect a further 10-15 people per year, NICE reports.
The guidance calls for: strategic oversight and commissioning of TB prevention and control activities; local needs assessment; commissioning multidisciplinary TB support; provision of rapid-access TB services; raising and sustaining awareness of TB among hard-to-reach groups, health professionals and those working with hard-to-reach groups; and identifying and managing latent TB among substance misusers and prison populations and identifying pulmonary TB among those accessing homeless or substance misuse services.
Professor Mike Kelly, NICE’s director of public health, said: “The factors that make these groups vulnerable are also those that make them harder to reach through traditional TB services, and also make them less likely to adhere to treatment. This guidance therefore advocates a more proactive approach through, for example, active case-finding...
“The guidance also recommends that all hard-to-reach TB patients should receive community-based clinical and social support co-ordinated by a TB case worker. Support should include directly observing every dose of treatment and providing practical help with housing, addiction and other unmet health and social care problems. TB is curable, so it’s important that people at risk of TB from hard-to-reach groups are able to access services tailored to their needs that allow timely diagnosis and effective treatment.”
Bertie Squire, member of the programme development group and professor of clinical tropical medicine, Liverpool School of Tropical Medicine, said: “In essence it is our services that are currently hard-to-reach for these vulnerable populations, not the people with TB who are hard to reach.
“Unless we change our current mind-set and service delivery model, TB transmission will continue unchecked and will affect an ever-growing number of people.”
Image: Homeless girl, i4lcocl2, Shutterstock.com.