A mobile X-ray unit, which identifies people with TB infection in hard to reach communities is providing a cost-effective way of treating people with TB in London.
The service travels to locations where people at high risk of TB can be found, including drug treatment services, hostels or day centres for the homeless. People are screened on a voluntary basis and, crucially, if they are infected they are followed up closely alongside hospital teams to support them in completing the necessary sixmonths of treatment. It is important to encourage individuals to complete treatment increases the risk of onward transmission as well as encouraging antibiotic resistance in the TB bacteria. A total of 9,040 cases of TB were reported in the UK in 2009 with the majority of disease concentrated in urban areas. London accounted for 38% of cases, with 3,440 cases reported to the HPA, equating to a rate of 44 per 100,000. The London-based “find and treat” intervention costs around £6,400 to £10,000 for every year of life in good health, which it provides to the targeted population. Typically, the NHS funds interventions that cost less than £20,000 for every extra healthy year of life they provide. Dr Peter White, a study author who is head of modelling and economics at the HPA and has an academic appointment at Imperial College London, said: “With TB numbers remaining high in London, the ‘find and treat’ programme was identified as a potential method of tackling the problem in these high risk populations. It has proved to be successful in identifying and offering treatment to those unaware they were infected with TB.” Research from 2003 found that hard-toreach groups in London such as homeless people, problem drug users and prisoners were about 10 to 30 times more likely than the general London population to have TB. Since 2007, the service has, on average, identified 16 people with TB in this hard-to-reach population, who may not have been identified and treated and also manages and supports the treatment for a further 100 or more cases. The National Institute for Health and Clinical Excellence (NICE) has recently issued new draft guidance on this issue, recommending strengthening of efforts to find patients early and providing intensive clinical and social support to help patients complete TB treatment. It is calling for targeted action to prevent the spread of TB and ensure treatment success among patients who have difficulty recognising symptoms, accessing health services and taking medication.
