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Tb update 14 6-2016 for fph conf
- 1. Tackling TB in the South East 14 June 2016 Dr Bernadette Purcell CCDC and TB lead
- 2. Key discussion points Background: key drivers Local TB Control Board (South England) Proposed delivery plan for Collaborative TB strategy TB networks and cohort review PHE role – examples of local cases 2 TB Update: Tackling TB in the South East
- 3. Why TB and Why now? 1. TB incidence in England was rising… 3 TB Update: Tackling TB in the South East
- 4. 4 TB Update: Tackling TB in the South East 2. TB is unequally distributed
- 5. Rate of TB by deprivation , England 2014 5 TB Update: Tackling TB in the South East
- 6. TB case notifications and rates by place of birth, England 2000-2014 6 TB Update: Tackling TB in the South East
- 7. 3. Drug resistance 7 TB Update: Tackling TB in the South East
- 8. TACKLING DRUG-RESISTANT INFECTIONS GLOBALLY :FINAL REPORT AND RECOMMENDATIONSTHE REVIEW ONANTIMICROBIAL RESISTANCE JIM O’NEILL MAY 2016 8 TB Update: Tackling TB in the South East
- 9. Collaborative TB strategy for England: 2015-2020 9 TB Update: Tackling TB in the South East
- 10. TBCB - South Chaired by Dr Jenny Harries OBE – RD South of England - PHE Good representation from – DDs of PHE (South), DPHs (SE&SW), Lead CCGs representatives, TB clinicians, lead nurses, paediatrician, microbiologist, CCDCs, and national TB leads. Agreed – ToRs and strategic plan Meets quarterly and provides; an over-arching support to six local TB networks in planning, overseeing, supporting and monitoring all aspects of local TB control. an accountability structure for TB control supported by the National TB office. 10 TB Update: Tackling TB in the South East
- 11. SE network Thames Valley Wessex Surrey & Sussex Kent 11 SW networks Devon, Cornwall & Somerset Bristol, North Somerset, South Glos Bath & North East Somerset, Gloucestershire, Swindon and Wiltshire PHE TB Co-ordination Board TB Strategy time limited working groups TB Delivery Board Chaired by Head of TB Strategy Implementation PHE National Executive National TB Programme Board Co-chaired by PHE and NHS England director NHS England National Executive SE TB consultant lead SW TB consultant lead South of England TBCB Chaired by Regional Director, PHE South Structure & Governance of SoE TBCB SW TB networks SE TB networks
- 12. Special features of South TBCB 1- Large geographical patch – 49 CCGs and multiple LAs • South has the highest number of TB cases of any region outside London • Some key hotspots such as Slough, Reading, Oxfordshire and Bristol. • Raising TB as a priority for low prevalence areas/CCGs and hospitals. 2- Unique epidemiology (2014) • Over 50% of the cases were pulmonary • 60% of SW and 55% of SE cases were among males. • Majority of the cases were among young population 30-40 years (mobile). • 47% of SW and 24% of SE cases were from white ethnic background. • 12 TB Update: Tackling TB in the South East 2011-2013
- 13. Our Delivery Plan SE …………………………………………………………………………. SW 1. Surrey and Sussex 2. Kent 3. Thames Valley 4. Wessex 1. Devon, Cornwall & Somerset 2. Bristol, North Somerset, South Glos 3. Bath & North East Somerset, Gloucestershire, Swindon and Wiltshire HNA HNA HNA HNA HNA HNA HNA Gaps, needs, strengths identified Collaborative TB strategy with 10 recommendat ions Collaborative TB strategy with 10 recommendat ions + + = = 1. local Action /Priority 2.local Action /Priority 3. local Action /Priority 1. local Action /Priority 2.local Action /Priority 3. local Action /Priority Quarterly progress reports for the board Quarterly progress reports for the board Formation of Task and finish groups for large action requiring collective work btw networks + Quarterly progress reports for the national teams as per their matrixes + + Quarterly progress reports for the national teams as per their matrixes April/May 2016 May/June 2016 + Formation of Task and finish groups for large action requiring collective work btw networks June/July 2016 Ongoing activities - Cohort Review + Specific audits at regional or local level + Internal & External communications Gaps, needs, strengths identified Localriskregistertoidentifyanyrisksand issues TB Update: Tackling TB in the South East13
- 14. Progress of the board so far; TB Update: Tackling TB in the South East Bristol CCG 7 CCGs met eligibility for LTB screening programme Southampton - CCG West Sussex CrawleyCCG Combined Reading and Slough CCGs Oxfordshire CCG North East Hampshire and Famham CCG HNA – Good progress and expected to complete with recommendations in next 6-8 weeks Collaboration with national delivery team and participation on national T&F Groups Established Cohort Reviews and network meetings Bids approved, funds received and screening started in three areas already Building strong relationships with health and social care partners (LA, CCG, 2ndary care and 3rd sector organisations) 14
- 15. Plans for coming months • Development of TB indicators for monitoring local progress • Development of TB indicators for monitoring TBCB’s progress • Quarterly monitoring/reporting of these indicators at both network/TBCB • Complete Health Needs Assessments • Development of T&FGs based on specific gaps/themes identified via HNA • TBCB to support local networks with any issues reported by them • Improve communication, co-ordination, management of information.s- C • Cross- cutting areas: e.g. prisons and detention centres, homelessness, asylum- seekers • CCG, Primary care and patient engagement • Ideas/ suggestions? • ross- cutting areas: e.g. prisons and detention centres, homelessness, asylum seekers15 TB Update: Tackling TB in the South East
- 16. TB networks and cohort reviews • Four well established across the South East • Cohort reviews running 3-6 monthly since 2012 • Guest chair, external speakers, CPD • Improving measurable indicators (treatment completion, losses to follow up, HIV testing, contact screening) • Peer support, mutual aid, morale and career development for TB nurses • Quarterly review of TB Clusters across South East TB Update: Tackling TB in the South East 16
- 17. Managing TB situations: example TB screening among homeless in Hastings after a TB related death, 2015 112 people were assessed and x-rayed 5 with abnormal CXRs 45 IGRA tested 3 positive t- spot Keep under surveillance TB cluster strain Good feedback from those screened- raised awareness Neighbourhood police fully engaged. TB Update: Tackling TB in the South East 17
- 18. Managing challenging cases… • Non- compliant, poor discharge, intentionally homeless, behavioural issues +++ • Multiple agencies involved over 15 months • 10 Part 2A Orders in total (each order costs £1k-£6k- LA funded TB Update: Tackling TB in the South East 18
- 19. It’s a team effort… NHS TB nurses and clinicians, microbiologists, network members PHE SE TB network leads (Muhammad Abid, Clare Humphreys, Anand Fernandes, Karthik Paranthaman, Angeline Walker) HP nurses (Sara Blake, Jen Duffy, Ann Black, Alexis Stevens) surveillance and information officers (Nigel Bainton, Nigel Freeman, Sue White, David van Santen,) Kevin Carroll, Trish Mannes TBCB members, inc CCG leads, primary care, 3rd sector TB Update: Tackling TB in the South East 19
- 20. TB Update: Tackling TB in the South East 20
Editor's Notes
- Since the 1980s -steady rise in cases of active TB – Now familiar graph- England came to have one of the highest TB rates in Western Europe. The incidence of TB in England - four times higher than that of the US –) predicted if current trends continue, England would have more TB cases than in the whole of the US put together. London–accounting for almost 40% of all cases.
- TB unequally distributed- certain groups disproportionally affected- - new migrants, -those with social risk factors Therefore if we want to tackle inequalities in health- TB is a good place to start..
- nearly one in ten TB cases in 2014 had at least one social risk factor, and there has been no reduction in the number of cases with social risk factors over the past five years o a higher proportion of those with social risk factors have drug resistant TB and worse TB outcomes, which highlights the added importance of tackling TB in this group, including through targeted outreach services
- the past three years there has been a year on year decline in the number of TB cases in England, down to 6,520 in 2014, a rate of 12.0 per 100,000 mainly due to a reduction in cases in the non-UK born population, which make up nearly three-quarters of all TB cases in England o reflect recent declines in the number of migrants from high TB burden countries and the impact of pre-entry TB screening o the majority of non-UK born cases (86%) are now notified more than two years after entering the UK, and are likely to be due to reactivation of latent TB infection o there has been no downward trend in the incidence of TB in the UK born population in the past decade, o 15% of cases in the UK born population had at least one social risk factor, The most vulnerable- rates are not decreasing over last decade- e/g/ insecure or overcrowding- substance misuse/ alcohol issues- more likely to become infected- more likely to develop disease and complications- less easy to complete treatment- therefore more likely to have complications – be infectious for longer- also transmit the infection
- We are concerned to reduce the possibility of multi-drug resistant TB from taking hold- much harder to treat- and worse outcomes for patients and communities. Estimated 3 billion of the worlds population exposed to TB- so large pool of latent infection exists..
- The final recommendations of the Review on Antimicrobial Resistance (AMR) led by Lord Jim O’Neill and commissioned by David Cameron were released last week, warning that AMR infections such as drug-resistant tuberculosis will kill 10 million people annually without an urgent expansion of new resources and funds. The report highlights drug resistant tuberculosis as a 'cornerstone of the global AMR challenge', highlighting that one-quarter of the potential ten million annual AMR deaths by 2050 outlined in the report could be caused by drug-resistant tuberculosis without urgent action, which equates to one MDR-TB death every 12 seconds.
- PHE’s Collaborative TB Strategy with NHS . Context- WHO stop TB targets (WHO launched the “Global Plan to End TB 2016-2020: The Paradigm Shift” please find it at: http://www.stoptb.org/global/plan/) Exciting , new, first time for England- launched in parliament last year with full support of NHSE Ambitious: Aims to Bring down the incidence year on year, tackle inequalities in health and (eventually eliminate TB as public health problem) 10 point action plan- from new diagnostics- to better access to services Key focus on vulnerable- underserved-those who need enhanced management to get through and complete their treatment. 7 boards for TB control- monitor progress across every area of the country.
- It was evident that the people being assessed were co-operative and appreciative. This was also a very good opportunity to further raise awareness and give information about TB, and in this both the TB nurse and the ‘peer educators’ from Find and Treat were invaluable.