Research and analysis

HPR volume 10 issue 36: news (21 October)

Updated 16 December 2016

1. New resource for health professionals on reducing the burden of TB in England

PHE has released a new summary resource for health professionals describing the TB strategy for England, launched in 2015, progress achieved in its implementation, and the roles of different players involved, ie: local authorities, CCGs, TB Control Boards, TB clinical teams and charitable organisations.

“Health matters: reducing the burden of tuberculosis” [1] is the ninth of a series of Health Matters packages of resources relating to particular public health challenges faced by public health professionals and local authorities. They comprise background facts, infographics, interviews with PHE experts, invitations to join social media groups, and references to key source documents. Previously-released Health Matters packages have dealt with tobacco packaging, physical activity, bowel cancer, “early years”, dementia, alcohol, antimicrobial resistance and smoking [2].

The burden of tuberculosis remains high in England, with incidence being among the highest in western Europe. Actions that different groups of health professionals can take to help further reduce incidence are described in the resource.

TB is more common among those born abroad and can be seen as a barometer of health inequality across England. Those disproportionately affected include the homeless, the prison population, those who misuse drugs or alcohol (or have a history of misuse) and those who are immunocompromised. The new resource is intended to facilitate local authority and NHS involvement in implementation of the Collaborative TB Strategy for England and, as a result, the reduction of health inequalities across the country. It aims to raise awareness of the national strategy through signposting to continuing professional development courses for healthcare staff in primary and secondary care, and raising awareness among GPs and other health and social care professionals in high-incidence areas about local epidemiology, how TB presents and is diagnosed, and where cases should be referred for treatment.

A key strand of the strategy is expansion of a programme of latent TB testing and treatment, as the majority of active cases diagnosed in England are a result of reactivation of latent TB. The national roll-out of this programme started in April 2015 and is prioritised in 59 high-TB-burden clinical commissioning groups across England. A recently-launched LTBI Alert toolkit providing practical guidance and support to those involved in related programmes is one of the resources available within the new package of resources.

PHE is encouraging:

Local Authorities to:

• support TB awareness-raising in professionals working with under-served populations, and in under-served populations themselves
• ensure commissioning of appropriate access to housing and social care support to enable patients to complete treatment
• use the PHE TB Fingertips tool to assess their local TB burden to support needs assessments, HWBs and appropriate commissioning and monitoring

CCGs to:

• support TB awareness raising among healthcare workers by utilising the resources on the TB Alert website
• raise awareness of the RCGP TB e-learning module in primary care
• commission and support targeted case finding and prevention activities, which focus on high-risk groups
• commission appropriate access to services, treatment and support to enable patients to complete treatment
• drive forward the roll-out of the latent TB programme in priority CCGs, invite people for testing and encourage those with latent TB to consider treatment
• support healthcare staff to use the LTBI toolkit to enhance the delivery of LTBI programmes

TB Control Boards to:

• continue their work providing over-arching support to local TB control and overseeing local implementation of the TB Strategy’s 10 areas for action
• support and improve local TB clinical networks, and in due course consider the need for regional multidrug resistant TB multidisciplinary teams
• work with CCGs to encourage use of the national TB service specification to commission local TB services
• continue working with CCGs to facilitate the roll-out of latent TB programmes, and complete their gap-analysis of local services against the national TB service specification
• use the soon-to-be-launched under-served populations TB resource to support local action

TB Clinical Teams to:

• raise awareness of TB among healthcare workers by utilising resources on the TB Alert website, in particular the TB resources for patients
• obtain diagnostic samples wherever possible
• continue their excellent case management and support to complex TB patients, and to offer directly observed treatment where indicated
• discuss each multidrug resistant TB case with the British Thoracic Society MDR-TB Advisory Service

Third Sector organisations to:

• represent communities and non-statutory organisations on TB control boards to encourage them to support local action including the commissioning of appropriate support from local non-statutory organisations
• support CCGs, local authorities and TB control boards to raise awareness of TB among affected communities.

1.1 References

1. PHE website guidance (20 October). Health matters: reducing the burden of tuberculosis.
2. PHE website collection. Health matters: public health issues

2. Infection reports in this issue of HPR

The following infection reports are published in this issue of HPR. The links below are to the relevant webpage collections or publications.

• Voluntary surveillance of bacteraemia caused by Enterobacter spp., Serratia spp. and Citrobacter spp. in England: 2011-2015

• Surveillance of Proteus, Morganella and Providencia species causing bacteraemia in England: 2015.