TY - JOUR
T1 - Tuberculosis in UK cities
T2 - Workload and effectiveness of tuberculosis control programmes
AU - Bothamley, Graham H.
AU - Kruijshaar, Michelle
AU - Kunst, Heinke
AU - Woltmann, Gerrit
AU - Cotton, Mark
AU - Saralaya, Dinesh
AU - Woodhead, Mark A.
AU - Watson, John P.
AU - Chapman, Ann L.N.
PY - 2011
Y1 - 2011
N2 - Background: Tuberculosis (TB) has increased within the UK and, in response, targets for TB control have been set and interventions recommended. The question was whether these had been implemented and, if so, had they been effective in reducing TB cases. Methods. Epidemiological data were obtained from enhanced surveillance and clinics. Primary care trusts or TB clinics with an average of > 100 TB cases per year were identified and provided reflections on the reasons for any change in their local incidence, which was compared to an audit against the national TB plan. Results: Access to data for planning varied (0-22 months). Sputum smear status was usually well recorded within the clinics. All cities had TB networks, a key worker for each case, free treatment and arrangements to treat HIV co-infection. Achievement of targets in the national plan correlated well with change in workload figures for the commissioning organizations (Spearman's rank correlation R = 0.8, P < 0.01) but not with clinic numbers. Four cities had not achieved the target of one nurse per 40 notifications (Birmingham, Bradford, Manchester and Sheffield). Compared to other cities, their loss to follow-up during treatment was usually > 6% (x 2 = 4.2, P < 0.05), there was less TB detected by screening and less outreach. Manchester was most poorly resourced and showed the highest rate of increase of TB. Direct referral from radiology, sputum from primary care and outreach workers were cited as important in TB control. Conclusion: TB control programmes depend on adequate numbers of specialist TB nurses for early detection and case-holding.
AB - Background: Tuberculosis (TB) has increased within the UK and, in response, targets for TB control have been set and interventions recommended. The question was whether these had been implemented and, if so, had they been effective in reducing TB cases. Methods. Epidemiological data were obtained from enhanced surveillance and clinics. Primary care trusts or TB clinics with an average of > 100 TB cases per year were identified and provided reflections on the reasons for any change in their local incidence, which was compared to an audit against the national TB plan. Results: Access to data for planning varied (0-22 months). Sputum smear status was usually well recorded within the clinics. All cities had TB networks, a key worker for each case, free treatment and arrangements to treat HIV co-infection. Achievement of targets in the national plan correlated well with change in workload figures for the commissioning organizations (Spearman's rank correlation R = 0.8, P < 0.01) but not with clinic numbers. Four cities had not achieved the target of one nurse per 40 notifications (Birmingham, Bradford, Manchester and Sheffield). Compared to other cities, their loss to follow-up during treatment was usually > 6% (x 2 = 4.2, P < 0.05), there was less TB detected by screening and less outreach. Manchester was most poorly resourced and showed the highest rate of increase of TB. Direct referral from radiology, sputum from primary care and outreach workers were cited as important in TB control. Conclusion: TB control programmes depend on adequate numbers of specialist TB nurses for early detection and case-holding.
UR - http://www.scopus.com/inward/record.url?scp=82155186115&partnerID=8YFLogxK
U2 - 10.1186/1471-2458-11-896
DO - 10.1186/1471-2458-11-896
M3 - Article
C2 - 22122757
AN - SCOPUS:82155186115
SN - 1471-2458
VL - 11
JO - BMC Public Health
JF - BMC Public Health
M1 - 896
ER -
