1. 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

2. Trend in TB incidence in Birmingham and London 1990 - 2009

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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%

9. 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

11. 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

12. 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

13. 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