London is now the TB capital of Europe and has more cases annually than the Netherlands, Belgium, Greece and Norway combined. TB is curable in virtually all cases and can be effectively controlled provided cases are found early and patients can complete treatment.
Find&Treat are a specialist outreach team that work alongside over 200 NHS and third sector front-line services to tackle TB among homeless people, drug or alcohol users, vulnerable migrants and people who have been in prison. TB is a disease of poverty and inequality and these groups have the highest rates of TB rates and greatest risk of onward transmission. Their lifestyle can often mask the symptoms of TB and they have problems accessing hospital based diagnostic services and completing a minimum of six months daily drug treatment.
The Find&Treat team are very multidisciplinary and include former TB patients who work as Peer advocates, TB nurse specialists, social and outreach workers, radiographers and expert technicians. Our job is to take TB control into the community, find cases of active TB early and support patients to take a full course of treatment and get cured.
Our service spans the TB pathway from detection, to diagnosis and onward care. To ‘Find’ TB cases early we raise awareness among service users and frontline professionals and screen almost 10,000 high risk people every year using a mobile digital x-ray unit as recommended by the National Institute of Health and Clinical Excellence. The screening service covers every London Borough and supports Public Health England to manage outbreaks of TB nationally.
TB clinics and frontline third sector partners across London and nationally refer around 300 complex and socially vulnerable patients a year to the outreach team. The most common reasons for referral include:-
- Locating patients who have stopped TB treatment before completing the full course. This can result in relapse, onward transmission and drug resistance.
- Setting up and supporting Directly Observed Treatment (DOT) in the community. Our DOT options are tailored to individual patient needs and include Video Observed Treatment using web based solutions.
- Providing practical assistance and advice on accommodation. We work in partnership with the St John of God Hospitalier to provide residential TB treatment and care for homeless and destitute patients.
In partnership with Groundswell we recruit, train and support former TB patients who have experienced homelessness to work as Peer advocates in our multidisciplinary team. The Peers are an authentic voice to other service users and professionals and can increase screening uptake, support people to get cured, improve awareness and tackle stigma.
Through our NIHR supported research at UCL we have pioneered the use of state of the art point of care diagnostics and internet technologies to support TB patients. Our programme of research and continuous service improvement is embedded in all aspects of our work. We are now initiating an ambitious new programme of Department of Health funded research into our work to improve the management of Hepatitis And Latent TB (HALT Study) in partnership with UCL and the Hep C Trust.
Both the National Institute for Health and Clinical Excellence and the Health Protection Agency have independently evaluated our service and demonstrated Find&Treat to be highly cost effective and potentially cost saving.
Our work has demonstrated that the people we support are at high risk of multiple morbidity and that their journey through the health system can be hard to navigate. We work with the person not the pathogen to address the underlying determinants of disease and improve health outcomes. Our research has demonstrated that the people we screen and support have a very high burden of TB infection that can be treated to prevent active disease and co-infection with Hepatitis C, B and HIV. We are currently working with Public Health England, the Inclusion Health Board and the Faculty of Homeless and Inclusion Health to design a better outreach service around the needs of the people we serve. This will include expanding our work outside London, incorporating screening for other important infections using point of care tests and ensuring that people are vaccinated and protected.