Variation in contact tracing outcomes across TB clinics in London
PHE ePoster Library. Lewer D. Apr 9, 2019; 257470; 15276
Dan Lewer
Dan Lewer
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Abstract Background:
Contact tracing around people with tuberculosis (TB) allows early identification and prevention of further disease. Practices are thought to vary between TB clinics, but there is limited evidence of this variation and therefore limited opportunities to identify and learn from good practice.
: We analysed patients in London aged 12+ with active pulmonary TB notified from 2012 to 2017. We excluded those with >15 contacts or treated at clinics with < 50 patients. We used regression to identify associations with two primary outcomes: the number of contacts screened and identification of ≥1 active or latent case. Independent variables were sputum smear results, age, sex, country of birth, deprivation and presence of a 'risk factor' (homelessness, mental health problems or illicit drug use). We stratified outcomes by clinic and tested whether case mix explained variation by calculating standardised ratios using the independent variables.
: 7400 eligible patients were identified from 29 clinics. Both outcomes were associated with positive sputum smear, younger age, female sex, being UK-born and an absence of 'risk factors'. The mean number of contacts assessed was 2.84 (95% CI 2.77-2.90), ranging from 1.87 (95% CI 1.41-2.34) to 3.79 (95% CI 3.21-4.37) across clinics. 22.7% (95% CI 21.8%-23.7%) of patients had at least one case of active or latent TB among their contacts, ranging from 10.7% (95% CI 6.0%-17.9%) to 39.5% (95% CI 31.0%-38.7%) across clinics. Several clinics were found to have significantly different contact tracing outcomes to the London average (p<0.01). Although clinics had substantially different patient profiles, wide variations persisted after adjustment for all variables.Conclusion: Contact tracing outcomes vary between TB clinics, and this is not explained by case mix. The results of this study will inform an independent qualitative assessment of local practice in clinics to inform and share good practice across London. Funding None.
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