LTBI-Latent TB Screening

Our Latent Tuberculosis infection testing and treatment service supports GP practices to identify patients at high risk of latent Tuberculosis and offer them a TB screening blood test, with positive results being picked up in the Lewisham TB service for further management. We are seeing a significant uplift in screening in this target group with positive pick up rate of 13% which positively affirms our approach to targeting patients compared to other boroughs. This project benefits patients through earlier diagnosis, allowing latent treatment to be offered preventing active disease later in life.

Background

Tuberculosis (TB) rates in England remain high and are associated with significant morbidity, mortality and costs. Diagnosis at early stages can help prevent long term impact on patients, late diagnosis are associated with worse outcomes and in pulmonary TB, with a transmission risk. The incidence of TB in England is higher than in most other European countries and four times as high as in the United States. The Collaborative Tuberculosis Strategy for England: 2015 to 2020 recommends LTBI testing and treatment (LTBI screening) for 16 to 35 year olds, who have recently arrived in England from high incidence countries where TB rate is 150/100,000 population or over.  

Lewisham piloted this approach in primary care settings (September 2016 to March 2017) and is mobilising the programme across all 39 GP Practices. Lewisham has a TB incidence of 25.9 per 100,000 population. Following the pilot, in April 2018, OHL was commissioned by Lewisham CCG to provide a centralised service focussed on delivering a population based primary care call recall system for the delivery of a latent tuberculosis testing and treatment service. This service specification complements the centralised OHL call/recall by building on the relationships and trust that GP practices have with their patients.

LTBI within the PHS

The service has been incorporated as part of the Population Health Scheme to reduce the practice workload. The performance of practices will be ascertained and reported regularly through the neighbourhood engagement meetings using the Population Health Scheme dashboard. This will display performance against the indicators and positions of 1) Practices 2) neighbourhoods and 3) the borough. Appropriate EMIS searches will be available to GP practices to support monitoring and performance.  

Monitoring Indicators:  

  • Number of patients screened for LTBI 

  • Number of patients tested positive for LTBI

Practice actions:

We need you to help us by giving our admin team access to your practice’s EMIS to enable us to code consultations to EMIS

Criteria for Screening

The criteria for ‘high risk’ is below, but due to the way that EMIS records patient information, we acknowledge that not all patients will be picked up using EMIS searches and we therefore would support practices to develop local ways of identifying and targeting appropriate high risk patients and stress the importance of recording Country of Origin at registration.  

  • Aged 16-35 – Not previously been tested or treated for TB – Been in England less than 5 years and  

We have created a new Latent TB infection (LTBI) protocol in the Population Manger pop up alert (see image below) to make it easier to identify patients who need screening.  We have also developed a template called LTBI, which explains how to print the patient letter and phlebotomy form. If screening is declined or the patient has results from previous testing, this should be recorded as this includes the correct codes, removing alerts.

Finance

Practices will be remunerated on a 6 monthly basis, receiving £20 per test and if we hit the target of 500 tests across the borough (15 per practice) you will also receive global sum. 

Contact Information

Feedback and complaints:

Aaron HamiltonHead of New Business
e: aaron.hamilton@onehealthlewisham.co.uk

LTBI PHS Enquiries

Elaine AinsworthOperations Manager
E: elaine.ainsworth@onehealthlewisham.co.uk

A Practice Training guide has been producedTo organise training or for queries contact:
e: admin@onehealthlewisham.co.uk

One Health Lewisham

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