New public health guidance from the National Institute for Health and Clinical Excellence (NICE) provides a blueprint for improving the way tuberculosis (TB) is identified and managed among groups of people who are hard to reach through traditional health care services.
The guidance sets out how commissioners and providers of TB services and other statutory and voluntary organisations that work with hard-to-reach groups can achieve better outcomes through targeted action to find patients early, and by providing intensive clinical and social support to help them complete TB treatment.
According to provisional figures published today by the Health Protection Agency (HPA), in 2011 there were 9,042 reported cases of TB in the UK (an increase of 5% from new cases reported in 2010), almost 75% of which were among people born outside the UK. Most cases were reported in London, which as a result has been a focus of TB control efforts.
Although TB is curable in virtually all cases, treatment with antibiotics is usually lengthy and the likelihood of people in hard-to-reach groups not completing treatment is high, compared to the general population. Patients who do not complete treatment are at risk of a relapse. They may also develop a drug-resistant form of the disease, which is more difficult and slower to treat – and which can also be transmitted to other people.
The recommendations are wide-ranging and cover strategic oversight and commissioning of TB prevention and control activities; local needs assessment; commissioning multidisciplinary TB support; the 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.
