Screening for latent tuberculosis infection (LTBI) in young adult immigrants: An evaluation of two pilot service models

Principal Investigator: Dr Rakesh Panchal

Other key staff: Dr Gerrit Woltmann, Dr Pranab Haldar, Ms Helen Thuraisingam, Professor Nigel Brunskill, and Dr Philip Shelton

Partners involved: NHS Leicester City, University Hospitals of Leicester NHS Trust,

Summary:
Tuberculosis (TB) rates in the UK have reached their highest for nearly 30 years. Non-UK born individuals make up over 50% of all TB notifications in the UK. Leicester City ranks fourth among Primary Care Trusts in England and second outside London for annual TB case load and case rate. Despite effective implementation of contact screening programmes, the annual incidence of TB is not falling substantially. This suggests other factors, not influenced by these services, are contributing significantly to the annual caseload and likely to be driven primarily by disease that develops in immigrants with latent tuberculosis infection (LTBI) from high prevalence countries.

Analysis of Leicester City TB data and review of the unique demographic suggests that a screening service to identify and treat LTBI may have a major impact on the total TB caseload, protect public health by reducing the number of potential sources of infection and eventually aid the prevention of TB in Leicester.

This feasibility study will evaluate a GP versus hospital based screening model for LTBI in 16-35 year old immigrants to Leicester City from countries with a TB incidence greater that 150/100,00. Observations will be made to determine which is the most efficient and cost-effective strategy to ensure best compliance and participation of immigrants to Leicester City in the screening process.

Aims:

• To develop and pilot two clinical service models to screen for LTBI in 16-35 year old recent immigrants to Leicester City

Further information: If you would like to be involved in this project, or for more information, please contact This e-mail address is being protected from spambots. You need JavaScript enabled to view it    

Start date: 03/2011                                                                                                                          Expected end date: 12/2011

Study outcomes:

• The number and demographic characteristics of high-risk immigrants who have registered with a GP in Leicester city over the last 5 years
• Proportion of immigrants that attend for LTBI screening using the two models
• Cost-effectiveness of the models for LTBI screening in new immigrants
• Overall effectiveness of the models through patient and GP feedback
• Time taken to screen 50 patients in each model
• Cost-effectiveness of IGRA blood tests in screening
• Develop the management skills of translating new entrant LTBI research into practice
• Deliver a LTBI screening service in Leicester through collaborative leadership as prioritised by the Leicestershire TB management board

This pilot project to evaluate GP versus hospital based LTBI screening models will identify the most streamlined, efficient and cost-effective strategy to ensure best compliance and participation of immigrants to Leicester City in the screening process. It is hoped this will inform a formal business case to Leicester City PCT or GP consortia for a more widespread screening programme.