The Evaluation of Novel Approaches to TB Case Ascertainment and Management Dr Martin Dedicoat PhD Mrs Cathy Browne RGN Presented by Dr Christine Burt PhD

Trend in TB incidence in Birmingham and London 1990 - 2009

Introduction - 70% of TB cases in Birmingham - people born overseas - Each new case is reported to the Birmingham Chest Clinic - Each new case of TB is allocated to a specialist nurse - To improve the number of contacts identified for each new case of TB a service evaluation and improvement programme was undertaken by the Birmingham and Solihull TB service - One of the aims of the evaluation was to use social network analysis to investigate clusters of TB patients - This report contains preliminary results for the project

Methods New cases Local database National database Evaluation of the number of notifications and the outcome of their contacts was made by analysing anonymous data

Methods Contact Tracing: Extra Pulmonary TB – screening = close family only Respiratory TB – screening = close family >10% = active/latent TB wider screening This method of contact tracing is known as ‘Stone in the Pond’ tracing

Methods continued - Conventional approaches to contact screening may miss cases - Samples from all cases are sent to the HPA Labs for culture - Samples cultured and isolates typed using variable number tandem repeats (VNTR) of 24 loci - These 24 loci VNTR are used to identify clusters of TB patients - Cluster definition and action taken is based on HPA guidance

Methods continued Many clusters have obvious links between different cases often no link is found In these cases a specialist nurse was tasked to visit and interview patients Data from these interviews was used to construct network diagrams to illustrate links

Results - Between 1990 and 2012 = 43,968 contacts of TB - 22,191 (50.5%) females mean age = 25 - 20,759 (49.5%) males mean age = 19 - Outcomes were available for 92% of cases - Overall 42% did not complete their screening - The proportion of smear positive contacts receiving chemoprophylaxix rose from 4.3% to 9.4%

Results continued - Clusters for further investigation were identified based on several factors: Links between patients were not known The cluster was growing - To date 15 clusters have been investigated

Conclusion Analysis of the contact database revealed 42% of people Identified as contacts TB nursing team taking a more proactive approach in follow up: - Patients who start screening but do not complete it - Patents with latent TB who do not complete treatment The impact of this change will be assessed after one year

Conclusion continued - Using the social network questionnaire a cluster of Eritrean patients were found attending a single place of worship - More still needs to be done - More specific methods are becoming available - An enhanced contact tracing service may contribute to reducing the incidence of TB in Birmingham

Acknowledgements This service evaluation is funded by Heart of Birmingham Primary Care Trust    TB nurses investigating the clusters and managing patients Health Protection Agency – Dr Grace Smith and Dr Jason Evans The health protection unit in Birmingham - Helen Bagnall