Tuberculosis in London: the convergence of clinical and social complexity

Anderson, Charlotte; Anderson, Sarah R.; Maguire, Helen; Hayward, Andrew; Story, Alistair

doi:10.1183/13993003.00749-2016

Cited by 7 publications

(7 citation statements)

References 8 publications

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“…One of the limitations of the study is that we focused on the anthropological approach and didn't conduct an associated epidemiological study to perform a precise description of the studied population (including their geographical origin, spoken language and detailed social condition). However, our observations were in line with results of the quantitative studies carried out in this city (2, 3, 7) and similar to findings from other major European cities (8, 9). The treatment management options recommended by the WHO in its guidelines are currently applied well in Spain [in Barcelona, for example, the percentage of cured bacillary pulmonary cases or those who have completed treatment is as high as 92.5% (3)], except for the administration of DOTS (performed in 30.4% of patients, reaching 71% in users of injected drugs (UDI) and 90% in homeless people, although rarely via telematics) and the lack of uniformity in terms of supply.…”

Section: Discussionsupporting

confidence: 93%

Specific Interventions for Implementing a Patient-Centered Approach to TB Care in Low-Incidence Cities

Pujol-Cruells

Vilaplana

2019

Front. Med.

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Background: According to the latest Guidelines from the World Health Organization, there is an increasing need for patient-centered tuberculosis disease management given the socio-economic factors influencing the tuberculosis epidemic. In the present study, we aimed to study TB in Barcelona city from an anthropological point of view and to devise a series of specific proposals to implement a patient-centered approach in our setting.Methods: We carried out a qualitative study using an anthropological approach in Barcelona in the period between November 2017 and November 2018 and proposed specific interventions based on our observations.Results: In practice, in our environment (a low-incidence European country where tuberculosis tends to present in patients with multiple social problems), and despite the goodwill of the care teams, there are no established and stable circuits, or specific tools to ensure that this is done routinely. Based on our observations, we have devised a series of specific proposals to implement a patient-centered approach. With these interventions we aim to (a) directly ameliorate TB patients well-being in any diagnostic/healthcare management center and (b) at more general level, to increase TB detection and treatment adherence.Conclusions: The patient-centered TB management recommended by the WHO might be essential for patients' well-being, but there is a lack of circuits or working protocols that ensure its implementation in a regulated manner. In the present manuscript we explain the various concrete measures that we propose in our region and which could be put into practice in other cities or geographic regions with similar epidemiological characteristics.

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Section: Discussionsupporting

confidence: 93%

Specific Interventions for Implementing a Patient-Centered Approach to TB Care in Low-Incidence Cities

Pujol-Cruells

Vilaplana

2019

Front. Med.

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“…In the UK, TB is a statutorily notifiable disease and LTBR collects data on patient demographics, disease factors such as site, drug sensitivities and previous TB treatment history, and social risk factors for all cases diagnosed or managed by TB clinics in London. 24 , 25 Data are entered to LTBR by clinic staff. Data on drug resistance is added directly from reference laboratory reports.…”

Section: Methodsmentioning

confidence: 99%

Outcomes of a residential respite service for homeless people with tuberculosis in London, UK: a cross-sectional study

Crosby¹,

Lewer

Appleby

et al. 2022

Perspect Public Health

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Background: Many countries are seeking to eliminate tuberculosis (TB), but incidence remains high in socially excluded groups such as people experiencing homelessness. There is limited research into the effectiveness of residential respite services (RRS), which provide accomodation and social and clinical support for homeless people with active TB. Methods: We used a register of all cases of TB diagnosed in London between 1 January 2010 and 3 October 2019 to compare characteristics and outcomes of patients treated in an RRS with patients receiving standard care. The primary outcome was successful treatment completion. We used logistic regression to compare likelihood of completing treatment, and simulation to estimate the absolute change in treatment completion resulting from this service. Results: A total of 78 homeless patients finished an episode of TB treatment at the RRS. Patients treated in the RRS were more likely than patients treated in standard care to have clinical and social risk factors including drug resistance, history of homelessness, drug or alcohol use, and need for directly observed therapy. After adjusting for these factors, patients treated in the RRS had 2.97 times the odds of completing treatment (95% CI = 1.44–6.96). Treatment ended in failure for 8/78 patients treated in the RRS (10%, 95% CI = 5%–20%). We estimated that in the absence of the RRS, treatment would have ended in failure for 17/78 patients (95% CI = 11–25). Conclusion: The residential respite service for homeless TB patients with complex social needs was associated with better treatment outcomes.

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“…Most studies on TB treatment outcomes in underserved populations in England have been done in London [ 9 , 10 ], however this may not be representative of the national picture. A knowledge gap exists for the health priorities of underserved populations in other urban settings with a high TB burden [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

Vulnerability and tuberculosis treatment outcomes in urban settings in England: A mixed-methods study

Berrocal-Almanza,

Lima,

Piotrowski

et al. 2023

PLoS ONE

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Background Evidence on factors contributing to poor treatment outcome and healthcare priorities in vulnerable populations affected by tuberculosis (TB) in urban areas of England other than London is needed to inform setting-specific prevention and care policies. We addressed this knowledge gap in a cohort of TB patients and healthcare providers in Birmingham and Leicester, UK. Methods A mixed-methods study was performed. Logistic regression was used to identify TB patients more likely to have poor treatment outcomes according to clinical and demographic characteristics and social risk factors (SRFs) in a 2013–18 cohort. 25 semi-structured interviews were undertaken in purposely selected individuals (9 patients and 16 healthcare professionals) to glean insights on their healthcare priorities and the factors that contribute to poor treatment outcome. Results The quantitative cohort comprised 2252 patients. Those who were ≥ 55 years of age, foreign-born from Central Europe, East Asia and Sub Saharan Africa and with MDR-TB were more likely to have poor treatment outcomes. According to patients and healthcare professionals, the factors that contribute to vulnerability to develop TB and poor treatment outcomes include poor working and living conditions, inadequate or absent welfare protection, poor primary healthcare responsiveness, treatment duration and side effects. These factors could be addressed by increased networking, partnership and integration between healthcare and social services and better integration between primary and secondary healthcare. Conclusions In both cities, being ≥ 55 years of age, having MDR-TB and being of foreign-birth are predictors of unfavourable treatment outcome. Risk of poor treatment outcome and vulnerability seem to be multidimensional. A better understanding of specific vulnerabilities and how they affect patient care pathway is needed to design adequate support programmes.

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Tuberculosis in London: the convergence of clinical and social complexity

Cited by 7 publications

References 8 publications

Specific Interventions for Implementing a Patient-Centered Approach to TB Care in Low-Incidence Cities

Specific Interventions for Implementing a Patient-Centered Approach to TB Care in Low-Incidence Cities

Outcomes of a residential respite service for homeless people with tuberculosis in London, UK: a cross-sectional study

Vulnerability and tuberculosis treatment outcomes in urban settings in England: A mixed-methods study

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