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Yasmin Appleby TB Nurse Specialist – Find and Treat TB Team
yasmin.appleby@nhs.net
Oussanniou Sarr, Genghis Aziz
What is Find & Treat?
• NHS funded pan London service
• Multi-disciplinary team of TB nurses, Social
worker, Outreach work...
Hard to Reach Groups
• Problem drug and alcohol user
– Where addiction affects service access and
treatment
• Homeless
– R...
1:6 Hard to reach
• Delayed diagnosis
• ⅓ all infectious cases
• ½ cases lost to follow up
• 30% DRUG RESISTANT
Flawed assumptions
1. Sick people seek healthcare
Early diagnosis
1. Patients follow medical
advice
Complete treatment
What we do
1. Active case finding (MXU)
2. Case management support
3. Locate and re-engage LFU patients
4. Link prison hea...
MXU
• Screen 8-10,000 per annum
• Rolling pan-London six month programme (winter and summer circuits)
• Target sites ident...
Detection (1950’s)
Primary purpose
• To find undetected TB and prevent onward
transmission - targeted screening, outbreak management
– Refers...
Primary purpose
• To protect frontline staff teams from TB
• To raise awareness about TB and link allied
services with loc...
• 10,000 screens per year
• Detection rate 250 per 100,000
• 1 in 4 referred start TB treatment
• Two-thirds less likely t...
Good food - Fresh air - Hope
Treat the
patientProtect the
public
TB in London
• Highest rates of TB in Western Europe [1]
• 3,500 new cases a year - More cases annually than
Belgium, Denm...
What new?
Video Observed Treatment
DOT options OutreachPeers
GP practices
Key workers
Pharmacist
VOT
Conclusions
• Appropriate accommodation is prerequisite to
TB treatment
• Intensive psychosocial care changes lives
• Inte...
Thanks
Find and Treat TB
Find and Treat TB
Find and Treat TB
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Find and Treat TB

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Yasmin Appleby from Find and Treat TB talking about the service to the London Network of Nurses and Midwives Conference 17th April 2015

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Find and Treat TB

  1. 1. Yasmin Appleby TB Nurse Specialist – Find and Treat TB Team yasmin.appleby@nhs.net Oussanniou Sarr, Genghis Aziz
  2. 2. What is Find & Treat? • NHS funded pan London service • Multi-disciplinary team of TB nurses, Social worker, Outreach worker, Peers advocates • Work alongside MXU, TB clinics and 220 allied services • Working directly with frontline services across London to tackle TB amongst Hard-to-reach groups. – (Homeless people, problem drug & alcohol users, destitute migrants, prisoners)
  3. 3. Hard to Reach Groups • Problem drug and alcohol user – Where addiction affects service access and treatment • Homeless – Rough sleepers, Hostel residents, NFA • Prisoner – Sentenced or on remand • Non adherent & lost to follow-up cases – Including non-HTR groups
  4. 4. 1:6 Hard to reach • Delayed diagnosis • ⅓ all infectious cases • ½ cases lost to follow up • 30% DRUG RESISTANT
  5. 5. Flawed assumptions 1. Sick people seek healthcare Early diagnosis 1. Patients follow medical advice Complete treatment
  6. 6. What we do 1. Active case finding (MXU) 2. Case management support 3. Locate and re-engage LFU patients 4. Link prison health and TB services 5. Specialist training and advice (national) 6. Peer Education programme 7. Specialist accommodation (Olallo)
  7. 7. MXU • Screen 8-10,000 per annum • Rolling pan-London six month programme (winter and summer circuits) • Target sites identified in London • Hostels, Emergency shelters, Prison • Day centres / Homeless drop-in / Soup kitchens • Community drug and alcohol projects
  8. 8. Detection (1950’s)
  9. 9. Primary purpose • To find undetected TB and prevent onward transmission - targeted screening, outbreak management – Refers approx. 1% for further TB investigations – 1 in 4 of those referred start TB treatment – Overall detection rate of approx. 300 per 100,000
  10. 10. Primary purpose • To protect frontline staff teams from TB • To raise awareness about TB and link allied services with local NHS providers (Collaboration and Integration)
  11. 11. • 10,000 screens per year • Detection rate 250 per 100,000 • 1 in 4 referred start TB treatment • Two-thirds less likely to be infectious
  12. 12. Good food - Fresh air - Hope
  13. 13. Treat the patientProtect the public
  14. 14. TB in London • Highest rates of TB in Western Europe [1] • 3,500 new cases a year - More cases annually than Belgium, Denmark, Greece, Netherlands and Norway combined [1] • 10% of cases are now drug resistant [2] • Significant increase in MDRTB [2] [1] European Centre for Disease Prevention and Control/WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2012. Stockholm: European Centre for Disease Prevention and Control, 2012. http://ecdc.europa.eu/en/publications/Publications/1203-Annual-TB-Report.pdf [2] Tuberculosis in London: Annual report (2011 data). Health Protection Agency London Regional Epidemiology Unit, September 2012.
  15. 15. What new?
  16. 16. Video Observed Treatment
  17. 17. DOT options OutreachPeers GP practices Key workers Pharmacist VOT
  18. 18. Conclusions • Appropriate accommodation is prerequisite to TB treatment • Intensive psychosocial care changes lives • Inter-agency collaboration to meet unmet needs • London needs hostel based intermediate care beds for TB patients with high health and social care needs - likely to increase • Financial and public health arguments stack up
  19. 19. Thanks

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