North West TB Control Board Stakeholder Event · · 2015-07-16North West TB Control Board...

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North West TB Control Board

Stakeholder Event

TB is increasing. Lets make the North West TB free

http://en.wikipedia.org/wiki/NHS_England

Graham Urwin Director of Commissioning and Operations, NHS England – Greater Manchester and Lancashire

Welcome



Products

• Highlight the importance of the TB agenda and the need for a system wide approach

• Celebrate the work already underway

• Introduce the National TB strategy and the role of the North West TB Control Board

• Outline our priority work programmes

• Offer an opportunity to discuss and shape work going forward.

Purpose of the day


Jane Rossini

Acting Deputy Centre Director

North West PHE Centre

TB in the North West – Why it matters?




The Global Picture

Products

• The incidence of TB in England is higher than most other Western European countries and more than four times as high as in the US.

• In 2013 there were 7,290 TB cases reported, an incidence of 13.5 cases per 100,000

• Rates of the disease have not shown a sustained reduction in recent years

The burden of TB in England


Products

• .

• .

Tuberculosis numbers and rates by region, England, 2013


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TB case reports and incidence by region, 2013


Incidence of TB in the North West

742 700 734 733 799 810 823 777 716 0.0

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TB counts and incidence in the North West, 2013

North West Count North West Rate England Rate


Incidence of TB in the North West


TB mortality in the North West and England 1993-2010

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Incidence of TB in the North West for those aged 0-4

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Three year average

TB incidence in the 0-4 years age group

Cheshire and Merseyside Cumbria and Lancashire Greater Manchester North West


Ethnicity of cases

28 45 29 2 5

160 59

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25 30 102

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Ethnic Group

Ethnic profile of North West TB cases by country of birth, 2005-2014

UK Born Non-UK Born


TB rates and deprivation in the North West

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Q1 - 0-20% most deprivedquintile

Q2 - 20-40% second mostdeprived quintile

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Q4 - 60-80% second leastdeprived quintile

Q5 - 80-100% leastdeprived quintile

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Deprivation profile of North West TB cases, 2013

TB case reports Incidence

Products

• The epidemiology of TB in the North West shows a unique picture

• We have seen a drop in numbers over the last two years

• The work undertaken over recent years has given us an in-depth understanding of the disease

• We need to ensure that we continue to tailor our prevention and control strategies towards the most vulnerable groups

Summary


Katie Dee Deputy Centre Director,

Cheshire and Merseyside Centre, Public Health England

The North West TB Summit



The Challenge

o Rising numbers in adults and children

o Little awareness of the issue beyond TB experts

o PCT level planning too small for TB

o Lack of granular understanding of epidemiology and impact on communities

o No collective view on the best action

to take

The Challenge

1907 1857 1785 1893 2021 2187 2177 2275 2352 2438 0

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Trend in incidence of TB - rolling three year average showing 95% confidence intervals

North West (number) North West (rate) England (rate)

Source: ETS, HPA

Serious Concerns

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Three year average

TB incidence for those aged 0-4 years

Cheshire & Merseyside Cumbria & Lancashire

Greater Manchester North West

The Solution

o The expertise is within the North West

o We have demonstrated success in other areas – and can apply these techniques to TB

o Create momentum

o Establish the TB Summit

Our Initial priorities

o Get TB on peoples agendas

o Tell the story

o Develop a sense of urgency

o Mobilise action

o Scope key issues

o Dig further into the data

Reducing the incidence of TB in the North West

Goal:

Primary Drivers: Secondary Drivers:

Social determinants

BCG Vaccination

Early Detection

Quality of Clinical care

Treatment Completion

Screening for Latent Disease

Factors that increase risk of disease progression

Poverty, migration, overcrowding

Identifying eligible babies Vaccinate all eligible babies

Audit, understand status quo

Get TB onto Local Authority agenda, into all policies

Implementing Cohort Review

Improving diagnostic services

Improving clinical recognition Reducing late presentation

Improving access to, and delivery of DOT

Addressing TB Nursing

Implementation of IGRA testing

HIV Co-infection

Smoking Alcohol, drug use

Nutrition, diabetes

Improved contact tracing

Up to date workforce database Sharing best practice

Paediatric TB Audit, understand status quo

Communicating the Summit

All children seen by specialist services

Creating a network

Collaborative design

Regular updates on early successes (bulletins)

Facilitating NW consultation on policy and papers

Scoping…

TB SUMMIT

Implementing Cohort Review

Strengthening the TB Nursing

Workforce

Developing the role of Local Authority in TB Prevention

and Control Improving service delivery and coverage of

neonatal BCG Vaccination

Developing a model of care for children with TB

Communicating the work of the

TB Summit

Workstreams


Successes

o Cohort Audit – only area in the UK delivering on this scale

o Children – reviewed care pathway and developed new hub and spoke model

o Workforce – annual survey for last three years

o Community engagement – detailed insight work in two communities

Successes

o TB is on everyone's agenda

o Communicated the importance of TB through bulletins, website, Twitter, patient stories, annual conference, vision & brand etc.

o Reviewed the Neonatal BCG vaccination programme and published an assurance tool kit

What will success look like?

Ultimate success = Reverse the trend

(numbers coming down)

Success in other ways:

Strategy tailored to local circumstances Improvements in how patients/contacts are managed All eligible children receiving BCG vaccination Robust workforce model for TB nursing TB as a core part of the inequalities agenda

Graham Urwin Director of Commissioning and Operations, NHS England – Greater Manchester and Lancashire

Transitioning to a North West TB Control Board



Products

‘To bring together best practice in

clinical care, social support and

public health to strengthen TB

control, with the aim of achieving

a year on year decrease in

incidence, a reduction in health

inequalities and, ultimately, the

elimination of TB as a public

health problem in England’

Our shared ambition


Products

Nine TB Control Boards

Products Why is it a priority?

• Thought of as a ‘disease of the past’, but has been steadily

increasing over the past 25 years

• The vast majority of cases are curable if detected early

• Not evenly spread across the population – higher rates in

more deprived communities

• The Chief Medical Officer has identified the inequalities

associated with TB, and rising levels of antimicrobial

resistance, as an important priority for England .

• Even in high incidence areas: TB is a rare disease.

Collective action at scale is needed to deliver a reduction in

cases.


Products

National TB Strategy 2015-20

1. Improve access to services and ensure early diagnosis 2. Provide universal access to high quality diagnostics 3. Improve treatment and care services 4. Ensure comprehensive contact tracing 5. Improve BCG vaccination uptake 6. Reduce drug-resistant TB 7. Tackle TB in under-served populations 8. Systematically implement new entrant latent TB screening 9. Strengthen surveillance and monitoring 10. Ensure an appropriate workforce to deliver TB control


Products

.

Establishment of TB Control Board

In process of transition from NW TB Summit to NW TB

Control board:-

• Scope out the requirements of the Board and

identify appropriate membership

• Establish clear governance and reporting

arrangements between national and local groups

• Understand the funding flows to support

implementation of the national strategy

• Agree our action plan for the first year.


Products

Proposed future reporting and governance arrangements


Cheshire & Merseyside TB Network

Cumbria & Lancashire TB Network

Greater Manchester TB Network

National TB Board


Products What will success look like?

• TB control board established with clear

governance across the North West system

• Strong system leadership to join up health,

social care, voluntary and third sectors

• An annual work plan with measurable outcomes

• Ultimately - a year on year reduction in TB

incidence TB is increasing. Lets make the North West

TB free

Grainne Nixon

Lancashire and Cumbria Health Protection Team

TB Strategy Structures for Cumbria and

Lancashire: 2015/16



Products

• Arrangements for Lancashire and Cumbria…

• Cumbria and Lancashire TB Stakeholder Group (established clinical network)

• North West TB Cohort Review/Audit since 2012 (NWTB Summit)

• Lancashire TB Service Improvement Group convened 2013

Background


Products

• The TB Stakeholder Group Cumbria and Lancashire TB Clinical Reference Group (CRG)

• TB Service Improvement Group Strategic TB Commissioning Board

• Obtain support from the Lancashire CCG Collaborative Commissioning Board

• Integration of Cumbria CCG into new structures

Build on existing structures


Products

.

Governance and Interdependency


Figure 2: Lancashire Strategic TB Commissioning Board. Governance and Interdependency Organogram

National TB Programme Board

Lancashire Strategic TB

Commissioning Board

NW TB Control Board Health and Justice (PHE)

FES (PHE)

Lancashire and Cumbria TB

Clinical Reference Group

Cumbria and

Lancashire LA

Public Health

Leadership

Group Health and

wellbeing

boards

Lancashire Collaborative

Commissioning Board

NHSE area team

Immunisation leads

TB Cohort review/s TB Service providers

Cumbria

CCG (tbc)

Products

• Expert understanding of clinical aspects of TB (reports, research, guidance and statutory responsibilities related to the delivery of TB services)

• Maintain strong communication links across all providers

• Horizon scanning, identifying and prioritising potential innovations

• Reviewing local intelligence against TBC Board Benchmarks

• Sense checking and fine-tuning new strategies and commissioning proposals

Functions of the TB clinical reference group


Products

• To act on behalf of the Lancashire (CCG) Collaborative Commissioning Group (and Cumbria CCG)

• To identify local commissioning priorities for prevention, detection and treatment of TB infection for Cumbria and Lancashire.

• To work with Local Authority, NHSE and PHE partners around commissioning priorities outside CCG remit (e.g. prisons, substance misuse)

• To provide a co-ordinated structure for reporting to the NW TB Control Board

• To allow Health and Wellbeing Board oversight via the C&L Public Health Leadership Group

Lancashire and South Cumbria TB Strategic (Commissioning) Board. Objectives:


Products

1. Convene and agree ToRs for CRG and C&L TB Commissioning Board

2. Review existing systems and identify priority areas for implementation of new LTBI screening systems.

3. Identify mechanisms and cost of bringing existing TB services in line with locally or nationally agreed service specifications

4. Review of existing diagnostic methods and services

Priorities for 2015/16


Graham Urwin, Jane Rossini,

Katie Dee, Grainne Nixon

Panel Discussion


@TBSummitNW

#NWTBCB


Please return to your seats for 11am

Thank you

Refreshment Break


@TBSummitNW

#NWTBCB


Priority Workstreams




Professor Mark Woodhead Professor of Respiratory Medicine, Central Manchester

University Hospitals NHS Foundation Trust Chair, NW TB Cohort Audit Steering Group

North West TB Cohort Audit



•Systematic review of every TB case reported in the NW

•16 face to face meetings per year

•Chaired by Senior Clinicians and TB Nurse Specialists

•Open, non-judgemental discussion

Process

Process

North West Totals Year 1 Year 2 Year 3

1 100% of patients will have a SRA carried out 93% 99% 99%

2 At least 5 contacts identified for smear +ive cases 57% 56% 56%

3 At least 90% of identified contacts of smear +ive are assessed 85% 86% 86%

4 100% of child contacts are assessed (any site of disease) 88% 90% 93%

5 100% of cases will be offered an HIV test 66% 80% 92%

6 At least 85% of non drug resistant cases will complete in 12 months 86% 87% 86%

7 Less than 2% of cases will be reported as lost to follow up 3% 3% 1.4%

8 100% of cases will be logged onto ETS within 5 working days 71% 88%

9 100% of cases will be categorised with an ECM level 0-3 100% 100%

ECM Levels – Breakdown across the Levels 0 - 3

ECM 0 39% 36%

ECM 1 27% 33%

ECM 2 20% 18%

ECM 3 14% 12%

Year 3 figures are provisional

Success of Cohort – NW Outcomes

Changing Practice through TB Cohort Audit in the NW: Qualitative Evidence of Impact – presented to the BTS Winter Conference,

December 2014

– A vibrant, unique and valued Community of Practice has been developed

– Interchange of experience and ideas across a large number of teams and professionals leading to enhanced mutual respect between different roles and a shared sense of purpose

Success of Cohort – Qualitative Research

Changing Practice through TB Cohort Audit in the NW: Qualitative Evidence of Impact – presented to the BTS Winter Conference,

December 2014

– A vibrant, unique and valued Community of Practice has been developed

– Interchange of experience and ideas across a large number of teams and professionals leading to enhanced mutual respect between different roles and a shared sense of purpose

– This multidisciplinary regional approach to TB cohort audit has promoted local and regional team working, exchange of good practices and local initiatives to improve care.

– There is a very strong ownership of the process from Public Health, Nurses and Clinicians and they want it to continue

– TB Cohort audit is seen as a tool for quality improvement that improves patient safety.

Success of Cohort – Qualitative Research

• Equitable delivery and outcomes of tuberculosis treatment and care in the North West of England: analysis of North West TB Cohort Audit data – The Union World Conference on Lung Health 2015

– Despite high levels of socioeconomic deprivation, TB patients in the most deprived group had similar care to more affluent individuals, suggesting that access to, and delivery of TB care in the North West of England is equitable. The extent to which the cohort audit process contributes to, and sustains this standard of care deserves further study.

Success of Cohort – Additional Research

• Equitable delivery and outcomes of tuberculosis treatment and care in the North West of England: analysis of North West TB Cohort Audit data – The Union World Conference on Lung Health 2015

– Despite high levels of socioeconomic deprivation, TB patients in the most deprived group had similar care to more affluent individuals, suggesting that access to, and delivery of TB care in the North West of England is equitable. The extent to which the cohort audit process contributes to, and sustains this standard of care deserves further study.

• Introduction of Cohort Audit in the North West of England – ARNS Conference 2014

– Success reflected in; maintenance of high compliance with contract tracing; significant improvement in HIV testing in areas where compliance previously low; timely recording of active TB onto ETS

– The introduction of ECM levels providing better understanding of impact on workforce of treating ECM cases.

• Defining “Enhanced Case Management” (ECM) in relation to cohort reviews of tuberculosis cases in North West England – FIS Conference 2013

– Unique development and introduction of ECM levels in the North West invaluable

Success of Cohort – Additional Research

TB control boards will have

the following responsibilities:

• to ensure TB cohort review is undertaken

every 3–4 months and fed back to the TB

control board, commissioners, TB service

provider management and the local

directors of public health; and that

appropriate action is taken as a result of

cohort review

TB Strategy

Dr Fran Child Consultant in Paediatric Respiratory Medicine

Royal Manchester Children’s Hospital Paediatric Representative NW TB Summit

TB in Children

North West Region



>1500 children/year assessed or screened for latent or active TB

40-70 cases TB disease / year

6% NW TB cases are children

70% paediatric cases are in Greater Manchester

3 deaths and 8 cases TB meningitis in last 5 years

Scale of the problem

Children < 16 years NW Region

Following TB infection, children progress to TB disease more quickly than adults

(typically within 12 months)

Measure of TB transmission in the community

Why is TB in Children Important?

Age Disseminated

TB / TB

Meningitis

Pulmonary

TB

No Disease

< 1 yr 10-20% 30-40% 50%

1-2 yrs 2-5% 10-20% 75-80%

2-5 yrs 0.5% 5% 95%

5-10 yrs <0.5% 2% 98%

>10 yrs <0.5% 10-20% 80-90%

Marais et al Int J Tub Lung Dis 2004

Risk of disease following primary

infection

“ Either a paediatrician with experience and training in the treatment of TB or a general paediatrician with advice from a specialised clinician should investigate and manage TB in children and young people”

NICE TB guideline 2015 (consultation)

How should care for children with TB be

provided?

Cumbria and Lancashire

Cheshire and Merseyside

Annual TB Notifications by CCG in Northwest 2009-14 Children aged < 16 years

Total cases = 40-70/yr

< 5 cases

6-15 cases

16-25 cases

26-35 cases

36-45 cases

46-55 cases


Greater Manchester




Annual TB Notifications by CCG in Northwest 2009-14 Children aged < 16 years

Total cases = 40-70/yr 25 DGH

2 Tertiary Centres

< 5 cases

6-15 cases

16-25 cases

26-35 cases

36-45 cases

46-55 cases



Greater Manchester

Royal Manchester Children’s Hospital

AlderHey Children’s Hospital

Shared Expertise

Better Outcome

Contacts < 16yrs assessed (%)

0102030405060708090

100

Cases who had an HIV test (%)

0102030405060708090

100

NW Cohort Review Year 2 April 2014-April 2015

n=1434 n=87

NW Cohort Audit

Paediatric Outcomes



Northwest Region 2012: Hospital care for children with TB disease

Outside North West Region

DGH +/- RMCH

RMCH

DGH – Blackburn

AlderHey

TB notifications in children aged <16 yrs Northwest region 2001-15

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50

60

70

Number of cases

RMCH

Rest of Greater Manchester

Rest of NW region

*2015 data estimated from actual number of cases to May 2015 at RMCH and RMCH seeing 52% cases in NW region

• 209 cases of TB disease (205 children)

• 92 (44%) symptoms, 117 (56%) screening

• 23% culture positive, 0% HIV positive

• 192 (92%) completed treatment

• 14 (7%) transferred out

• 3 (1%) lost to follow-up

• Significant long term sequelae in 13/92 (14%) with symptoms but 0/117 (0%) screening

RMCH Children’s TB Service 2003-13

1. Variable patterns and standards of care

2. 30% GM cases potentially preventable

3. Delays in diagnosis and treatment

4. Incomplete assessment and follow-up

5. Solo clinicians and TB nurses

6. Difficulties providing surge capacity

7. Long travelling distances for patients

8. Incomplete data capture

Key Messages

Consistently high standards

Multidisciplinary expertise

Access to specialist investigations and support

Rapidly and readily accessible

Surge capacity

Regular review of performance and outcome

Best Model of Care

North West TB Summit Stakeholders around NW

Hub and Spoke Model 4 levels of DGH +/- tertiary care determined by expertise / patient numbers

Agreed evidence based care pathway and assessment proforma Defined points of integration between secondary and tertiary care

Clear roles and responsibilities Quality measures

Pilot in 3 DGHs in Greater Manchester

Endorsed by Greater Manchester, Lancashire and Cumbria Strategic Clinical Network Group for Children

Networked care endorsed by NICE 2015 (consultation)

What have we done so far?

Formal mandate for a paediatric TB network across the North West

Appropriate commissioning

Regular audit of clinically important paediatric outcomes across the NW

Next Steps

Professor Bertie Squire Consultant Physician, Liverpool School of Tropical Medicine and Royal Liverpool & Broadgreen University Hospital Trust

TB Nursing Workforce



Products

Royal College of Nursing:

• 1 Nurse: 40 standard patients

• 1 Nurse: 20 patients with enhanced case management (ECM)

• PLUS full clerical support

Workforce Guidelines


Products

• Workforce data available for all NW TB Services

• Last survey carried out in November 2014

• Can compare against notification numbers

TB Nurse workforce annual survey


Products Monitoring SCM/ECM


Year 2 Year 3

Standard Case Management

ECM 0 39% 36%

Enhanced Case Management

ECM 1 27% 33%

ECM 2 20% 18%

ECM 3 14% 12%

• North West figures.

• Variation across the footprints

• All record a percentage of cases requiring ECM greater than 50%

Products

• 7/17 services below the recommended RCN levels

• Cover for leave and sickness often not available

• Clerical support absent or patchy in many TB Services

• Rapid increase is possible in EFFECTIVE TB nurse numbers at low cost by DEDICATED admin staff (? Band 3) to free up Band 6-7 Nurses

Survey Overview


Products

• Qualitative data collection, 2014

• Purposive sampling

• Themes were triangulated with 8 key

informants from the TB Cohort Audit

Steering Group

Qualitative Review


Products

• …..

Qualitative Review - Results


Products

Community of Practice

Qualitative review - Conclusions


Interchange of experience and ideas

Shared sense of purpose

Multidisciplinary regional approach

Promoted local and regional team working, exchange of good practices and local initiatives to improve care.

Strong ownership of the process from Public Health, Nurses and Clinicians

Products • Each TB control board to develop a workforce

strategy in line with the National Quality Board guide to staff capability and capacity

• Commissioners should specify in contracts the outcomes and quality standards required and actively seek assurance that there are sufficient numbers of nursing and support staff capable to meet these

• Provide the TB workforce with a career framework; continued professional development and opportunities to influence policy at a local and national level

National Strategy


Products

TB Control Board to establish a workforce group to:

• Consider impact of LTBI Screening introduction on workforce

• Improve workforce planning

• Develop standardised job descriptions/skills passport etc.

• Link with national workstream

What Next?


Dr Alison Giles

Chief Executive, Our Life

Engaging with Communities



Products

• Engagement specialists

• A focus on wellbeing and health issues

• Supporting local authorities, housing, and NHS

Who we are


Products Why are we involved in TB?


Engagement

Social housing TB

Public Health

Products

• To include representation from PHE, NHS England, CCGs, DsPH, DASS, NHS, patient advocates, third sector

• To ensure an appropriate workforce strategy is developed and implemented

What about the housing sector?

TB Control Board responsibilities


Products There is a need for training and practical resources to:

• Understand linkages between housing and TB

• Prevent TB spread through housing and homelessness statutory duties

• Build links between health and housing workforces through the Workforce Strategy

• Build housing-related outcomes into the TB Service Specification

• Ensure NICE Guidance PH37 is delivered including accommodation

From our work

Products

• To ensure the needs of under-served populations are addressed and health inequalities are reduced

• To ensure appropriate TB awareness-raising in collaboration with the third sector, local authorities and other organisations who provide this

TB Control Board responsibilities


Products

“How to ensure that TB does not become a lightning conductor for existing social

prejudices is a serious question”

To be ‘appropriate’, we need to make community engagement a priority and support communities to co-

design and co-produce the activities

Make community engagement a priority


Products By training and supporting frontline workers and community members to lead peer-research, we have:

• Raised awareness of the facts about TB among the communities concerned e.g. White working class, South Asian Heritage

• Reduced stigma and discrimination

• Created community champions who can spread information, support case-finding, and support adherence to treatment

From our work


Products

[email protected]

0161 233 7500

www.ourlife.org.uk

@AlisonGiles2

Contact us


mailto:[email protected]

http://www.ourlife.org.uk/

Mike Mandelbaum

Chief Executive, TB Alert

Engaging with Communities:

Commissioning the Third Sector



Products

• Why has TB increased in the UK

– Migration patterns

– Overly focused on bio-clinical aspects

• The complexity of TB…

– Prevention – Access – Diagnosis – Treatment and Care – Control

The complexity of TB


Products

• TB Control Boards should work closely with the third sector and include representation from patient advocates and the third sector A1. Improve access and early diagnosis

• Raise awareness and tackle stigma

• Train voluntary agencies working with migrants / signposting

A3. Improve treatment and care services • Community-based DOT providers

• Fast track to social care

A4. Contract tracing • Community outreach workers

The third sector in the Strategy (1)


Products A6. Drug-resistant TB

• Tackle social risk factors • Community-based DOT providers

A7. Tackle TB in under-served populations • Multi-disciplinary case management and support involving

third sector • Primary care registration among vulnerable migrants

A8. New entrant screening • Awareness and health education (non-primary care models)

A10. Workforce development • Multi-disciplinary teams involving third sector and

potentially trained lay workers

The third sector in the Strategy (2)


Products

• Should the third sector – Deliver occasional local projects on the fringes, or

– Fulfil its potential by mainstreaming and working to scale

• To impact to scale – It must be commissioned

– The evidence base needs continual strengthening

Fringe or mainstream?


Products

• To establish the role of the third sector as commissioned service providers – Guidance, evidence and good practice, monitoring

tools

– Advice, commissioning support and training • Work with TBCBs in four regions

• Local advice and commissioning support

• Range of training programmes for statutory and third sectors

– Network of organisations tackling the

socio-economic and cultural aspects of TB • Stop TB UK

TB Alert 2015 – 2018


Products

• Reflects WHO’s Engage-TB operational guidance on integrating community-based tuberculosis activities into the work of non-governmental and other civil society organisations

Engage-TB


Peter Ormerod

Chair BTS Joint TB Committee

Latent TB Screening



Products

• 75% of TB cases in E&W are in the foreign-born

• Only 10% of cases occur within 2 years of first entry

• Therefore many cases potentially preventable by treating those with latent TB infection (+ve IGRA blood test)

• 15% of adults and >20% children with LTBI will develop active in their lifetime without treatment

• LTBI treatment reduces TB by 60-65% IN ADULTS and 80-90% IN CHILDREN

Why is New Entrant Screening Important?


Products

• R124 : New Entrant Screening should be incorporated within larger Health Screening programme for new immigrants, linked with local services

• R125 : Assessment for, and management of TB in New Immigrants should consist of the following:- Risk assessment for HIV (if appropriate)

If IGRA +ve assess for active TB

Treat latent TB (LTBI) if under 35

Consider BCG if Mantoux negative

Current NICE recommendations


Products

• R126 : New Entrants should be identified from:- Port of Arrival Reports

New registrations with primary care

Entry to Education, including University

Links with Statutory and Voluntary Groups working with New Entrants.

• These are the responsibility of the CCG (previously PCT), rather than the individual GP.

NICE Recommendations (2)


Products

• Draft guidance just issued

• 'Screening' New Entrants not covered as not in scope

• Opportunistic LTBI screening mentioned

• Up to age 65; LTBI treatment unless concerns re hepatotoxicity

• Also links to Hep B , C and HIV Testing (R119-124)

NICE 2015


Products The effect of introducing systematic LTBI treatment in East Lancashire

What happens with systematic LTBI treatment?


Products

• One of the 10 aims within the PHE/NHSE national strategy is to:

“Systematically implement new entrant latent TB screening”

• LTBI screening for new entrants from TB high incidence areas is an effective and cost effective public health intervention and is recommended by NICE .

• While systematic LTBI screening requires an initial resource investment, it has been shown that the prevention of cases will yield budget savings after about four years

National Strategy


Products

• New entrants (16 – 35 years old) who were born or lived in Sub Saharan Africa, or countries with an estimated TB incidence of greater than 150 per 100,000 and who arrived in the England within the last five years.

• Ensure robust policies for LTBI screening for other high risk population groups where this is NICE recommended (such as in patients with immunosuppression)

Eligibility

Products

• LASCA producing data for Greater Manchester and Lancashire/South Cumbria

• Need to check who is doing what and how

• Secondary or primary care?

• Skin test (Mantoux) based?

• Blood test (IGRA) based?

• Latter could be moved to primary care

Key Analysis Needed


Products

• Superficially looks as if active case numbers down 50% therefore less workforce needed

• However TB nurses (covering BwD and East Lancs) now looking after approx 150 LTBI cases p.a. from contact tracing and NI screening

• These need support/monitoring

• ? 2 LTBI equivalent to 1 case without ECM

Impact on the workforce


Sue Henry Facilitator

Round Table Discussions



Jane Rossini Acting Deputy Centre Director

North West PHE Centre

Closing Remarks and Next Steps



Products

• Finalise roles and responsibilities for the Board

• Set out governance structure

• Refresh Terms of Reference and membership

• First meeting of the Board in September (interim governance in place until this point)

• Input from today to be written up and circulated to attendees

Next Steps


North West TB Control Board Stakeholder Event · · 2015-07-16North West TB Control Board...

Documents

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