In June 2007 we launched a national TB Toolkit to support commissioning of tuberculosis (TB) services tailored to local needs, and reinforce the need for providers to follow the National Institute for Health and Clinical Excellence (NICE) guidelines on treatment of tuberculosis. The NICE guidelines make specific recommendations about active screening for TB infection among high-risk groups including homeless people and prisoners and among people who have been in close contact with someone with TB.
London TB services are funded by the Department to run a pilot study using a mobile X-ray unit (MXU) to screen homeless hostels and prisons. Evaluation of the pilot showed the MXU to be an effective case-finding tool among these populations. In addition, since October 2007 the Department has funded Find and Treat, a small multidisciplinary team of tuberculosis nurse specialists, social and outreach workers, to provide practical support and advice to TB services across London for around 300 patients with complex and challenging needs. Support includes: locating and re-engaging patients who have been lost to follow-up care; providing links between prison health and the MXU to NHS tuberculosis services; organising case conferences and directly observed therapy (DOT) partnerships and engaging relevant allied support services in the community to help patients complete treatment.
The Home Office has a long standing policy of referring passengers from countries with a high risk of TB seeking entry to the UK for more than six months for medical examination at ports of entry. Heathrow and Gatwick have X-ray machines, and any chest X-ray consistent with TB leads to the person being referred to local services.
There is also a programme of pre-entry screening for TB in some countries before a visa can be obtained (Bangladesh, Sudan, Tanzania, Pakistan, Thailand, Kenya and Ghana).
The prevention of tuberculosis relies on the early diagnosis and treatment of those with active disease so that they do not infect others and we are keeping emerging technologies for detection of latent disease under close review.