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

1. Yasmin Appleby TB Nurse Specialist – Find and Treat TB Team
yasmin.appleby@nhs.net
Oussanniou Sarr, Genghis Aziz

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. 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. 1:6 Hard to reach
• Delayed diagnosis
• ⅓ all infectious cases
• ½ cases lost to follow up
• 30% DRUG RESISTANT

5. Flawed assumptions
1. Sick people seek healthcare
Early diagnosis
1. Patients follow medical
advice
Complete treatment

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. 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. Detection (1950’s)

10. 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

11. 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)

12. • 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

15. Good food - Fresh air - Hope

16. Treat the
patientProtect the
public

17. 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.

18. What new?

19. Video Observed Treatment

20. DOT options OutreachPeers
GP practices
Key workers
Pharmacist
VOT

21. 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

22. Thanks