Contact tracing of TB patients at Birmingham Chest Clinic Kinza Saeed

Contact Tracing at Birmingham Chest Clinic In the UK TB has risen by more than 1/3 in the past decade In parts of Birmingham TB is at the level of high-incidence countries Around 400 active TB cases every year Over 2500 contacts every year

Aims and Objectives Aim: Evaluate contact investigations at Birmingham Chest Clinic Objectives: 1.To outline the existing pathway for contact investigations and compare practice to national guidelines 2.To assess the outcomes from contact tracing 3.To make recommendations on how the contact investigation pathway can be improved to increase the completion rate

Methods and Materials Randomly selected a sample of 345 TB contacts referred in 2012 Information on if the contact is: - respiratory or non-respiratory - household, non-household or congregate - assessments - final outcome

How are contacts assessed? The Birmingham Chest Clinic has local protocols of contact investigation, adapted from the National Institute for Health and Clinical Excellence (NICE).

Assessment episodes of TB contacts aged 35 and under 52% tested for latent TB as first assessment 33% of contacts DNA their first assessment 89% completed contact tracing 75% of respiratory contacts followed correct protocol 91% of non-respiratory contacts followed correct protocol NOTE Data are number of contacts (%). CXR, chest X-ray; IGRA, interferon-gamma release assay; TST, tuberculin skin test; DNA, did not attend.

Figure 6 Outcomes of contact tracing for contacts aged 35 years and under in respiratory vs. non-respiratory index cases. 44% of respiratory contacts and 62% of non- respiratory contacts had a positive yield 35% of respiratory contacts defaulted 42% of non-respiratory contacts defaulted NOTE Data are number of contacts. An outcome of other was given for contacts who transferred out of the area or declined invitation for contact tracing. Outcomes of contact tracing for contacts aged 35 and under

Figure 7 Assessment episodes of TB contacts aged over 35 years 50% of contacts received a chest X-ray as a first assessment 21% of contacts DNA their first assessment 97% completed contact tracing 86% of respiratory contacts followed correct protocol 95% of non-respiratory contacts followed correct protocol NOTE Data are number of contacts (%). CXR, chest X-ray; IGRA, interferon-gamma release assay; TST, tuberculin skin test; DNA, did not attend. Assessment episodes of TB contacts aged over 35

Figure 8 Outcomes of contact tracing for contacts aged over 35 years in respiratory vs. non-respiratory index cases. 45% of respiratory contacts and 29% of non-respiratory contacts had a positive yield 33% of respiratory contacts defaulted 19% of non-respiratory contacts defaulted NOTE Data are number of contacts. An outcome of other was given for contacts who transferred out of the area or declined invitation for contact tracing. Outcomes of contact tracing for contacts aged over 35

Conclusion The mode first assessment for each contact type was in accordance to the national guidelines Contacts to respiratory cases have lower adherence to protocols compared to non-respiratory contacts Contacts require up to five appointments for protocol completion to approach 90%. Approximately 20-30% fail to attend the first 2 scheduled appointments 34% of contacts did not complete protocol or defaulted