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Health Matters: Latent TB toolkit

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The latest edition of Health Matters highlights a number of tools that can help health professionals and local authorities tackle TB in their local area. Mike Mandelbaum, Chief Executive of TB Alert, outlines how their latent TB toolkit, developed in collaboration with PHE, can be used.

When someone breathes in TB bacteria which overpower their immune system, they will not necessarily become ill.

More often they will get latent TB, the sleeping form of TB with which one-third of the world’s population is infected.

For 5-10% of these people, their latent TB will wake up in later years and develop into the ‘active’ disease we usually mean when talking about tuberculosis.

Latent TB can, however, be treated to greatly reduce the chance of it ‘reactivating’ in later years.

While it is impossible on a global scale to identify and treat all those with latent TB, in England – where most TB is seen among people born in high incidence countries – diagnosing and treating latent TB can be a powerful tool.

This is why the Collaborative TB Strategy calls for testing and treating latent TB among people moving to England from countries where TB is more common and where they may have been infected.

This new programme presents a number of challenges for health services, including how to promote the programme to new entrants and how to plan TB services to best support patients throughout the testing and treatment pathway.

TB Alert, the UK’s national TB charity, was therefore asked by NHS England and Public Health England to develop a toolkit to guide health services on these patient-centred issues.

‘Access, testing and treatment: A toolkit for new entrant latent tuberculosis programmes’ provides guidance to help ensure that everyone who is eligible has the chance to be tested and, if they have a positive blood test, successfully treated.

The main section of the toolkit describes how to provide patient-centred services for latent TB, which need to be as seamless as possible to minimise the risk of patients disengaging during the testing and treatment process.

Providers need to consider three stages – access, testing and treatment – and the toolkit describes issues which might arise at each stage and strategies which can help address them.

The toolkit applies social marketing techniques – commercial marketing principles adapted to improve health and reduce health inequalities – to increase the uptake of testing. These need to take into account a host of issues such as:

  • a misbelief that BCG vaccination offers long-term protection
  • a lack of knowledge about the very concept of latent TB
  • the expectation that pre-entry screening (a chest x-ray to rule out active TB) means new entrants have been sufficiently checked for any risk of TB
  • a fear that a positive test could affect their immigration status
  • a reluctance to take medication when not experiencing symptoms of current illness.

The toolkit discusses how to reach new entrant communities through partnerships involving the NHS, local government and third sector organisations.

The comparative advantages of the third sector are highlighted. The third sector can:

  • give their insight into, and understanding of, how to engage different populations
  • harness the trust they have built among the people they support, some of whom will distrust government agencies
  • offer access to the TB affected communities within which they are based

Most of the 59 CCGs eligible for NHS England TB funding have not previously planned or delivered latent TB programmes for new entrants.

This toolkit, which has been very well received by commissioners and providers, is a practical source of assistance and guidance to help ensure the programme is successfully delivered and makes a major contribution to the country’s TB programme.

Health Matters
Health Matters is a resource for professionals which brings together the latest data and evidence, makes the case for effective public health interventions and highlights tools and resources that can facilitate local or national action. Visit the Health Matters area of GOV.UK or sign up to receive the latest updates through our e-bulletin. If you found this blog helpful, please view other Health Matters blogs.

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