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New guidance points the way to tackling tuberculosis among hard-to-reach groups

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Elias Phiri
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Posts: 90
New guidance points the way to tackling tuberculosis among hard-to-reach groups
Posted on: March 23 2012, 08:41 pm

New public health guidance from NICE published today, ahead of World TB day (24 March), 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. The full guidance and background papers, are available now on the NICE website here: http://guidance.nice.org.uk/PH37

The guidance is aimed at commissioners and providers of TB services, including the NHS Commissioning Board and Public Health England, and other statutory and voluntary organisations that work with hard-to-reach groups. The recommendations are wide-ranging and cover, among other things: 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.
Professor Mike Kelly, NICE Director of Public Health, said: "TB is still a serious public health issue, the burden of which falls disproportionately on the most vulnerable groups in our society. 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 which involves seeking evidence of infection or disease among people who might not otherwise present for care in a timely manner. It recommends finding active TB among homeless groups by using mobile X-ray teams in places where they congregate, such as homeless day centres, rolling shelters, hostels and temporary shelters.
"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."
Andrew Hayward, UCL Department of Infection and Population Health and Chair of the Programme Development Group, said: "Although many people think of tuberculosis as a problem of the past, levels of disease are increasing in London and other major cities. The development of multidrug resistant tuberculosis and extremely drug resistant tuberculosis threaten our ability to treat the disease in the future. Tackling the problem requires investment in the development of TB teams so that they can reach out into the community to find tuberculosis in hard-to-reach groups earlier and support patients to take a full course of treatment. The guidance recommends screening for tuberculosis at hostels for homeless people, prisons and drug treatment centres and shows how TB teams can work in partnership with other services to support even the most complex patients to complete their treatment."
Bertie Squire, member of the Programme Development Group and Professor of Clinical Tropical Medicine, Liverpool School of Tropical Medicine, said: "The guidance sets out how services can and must respond to the needs of hard-to-reach populations. 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, including those we would not currently characterise as ‘hard-to-reach'. As an air-borne communicable disease, TB does not stay confined to any given population, even if it disproportionately affects those who are poor and marginalised. The guidance makes it clear how we can work together in a cost-effective way to check and reverse current trends in the UK epidemic of TB."
Elias Phiri, member of the Programme Development Group and Head of Awareness Programmes - TB Alert, said: "Third sector organisations working with hard-to-reach communities, for example homeless people and vulnerable migrants, are key partners in identifying and managing TB. This NICE guidance describes how statutory organisations can effectively work in partnership with the third sector to help manage and control TB amongst hard-to-reach groups, which can help reduce local TB incidence."
Professor Ibrahim Abubaker, member of the Programme Development Group and Head of TB section at the Health Protection Agency said: "Tuberculosis continues to disproportionately affect those in hard-to-reach groups, so it is crucial that we have specific strategies in place to address this. This new guidance provides useful and comprehensive recommendations on the best approaches to identifying TB in vulnerable individuals, as well as ensuring they complete treatment. We welcome the recommendation that puts the responsibility on each local health economy to plan services based on a health needs assessment"
Helen Bromley, member of the Programme Development Group and Speciality Registrar Public Health, Wirral University Teaching Hospital NHS Foundation Trust, said: "The guidance represents an important step in improving the way TB is identified and managed in people who find accessing and/or completing treatment difficult. Based on the current evidence base, the recommendations set out how commissioners, health and social care practitioners, and the voluntary sector can work together to improve TB services. This will speed up diagnosis, treatment and cure, whilst reducing onward transmission to the general population, drug resistance and health inequalities."
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