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Blizard Institute - Faculty of Medicine and Dentistry
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  4. Centre for Immunobiology
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  7. Detection and treatment of tuberculosis infection in primary care

Detection and treatment of tuberculosis infection in primary care

Primary care – often the first point of presentation to health care - plays a critical role in detection of both active TB disease and latent TB infection. In a large cluster randomised trial across 50 east London practices (Lancet 2007) we showed that GPs and practice nurses screening new patients at risk of TB for TB symptoms increased the proportion of people with active TB diagnosed in primary care. This was the first randomised evidence that screening for TB was effective in any setting, and paved the way for the UK’s national latent TB screening programme. Patients found this targeted approach acceptable rather than stigmatising (J Public Health 2006). Further work using an interrupted time series design in Leicester practices shows that TB screening for migrants is effective as part of city-wide multiple infectious disease and long-term condition health check for migrants. Primary care can also play a key role in TB management: in a randomised trial of 34 east London practices we showed that managing latent TB infection in migrants is also effective in primary care, and a cheaper alternative to hospital management (Eur Resp J 2024). Ultimately, primary care needs to be a core component of co-ordinated international policy and action, not just for TB, but for wider infectious disease screening and control (Lancet Public Health 2022). 

Outputs

  1. Griffiths C, Sturdy P, Brewin P, Bothamley G, Eldridge S, Martineau A, MacDonald M, Ramsay J, Tibrewal S, Levi S, Zumla A, Feder G. Educational outreach to promote screening for tuberculosis in primary care: a cluster randomised controlled trial. Lancet. 2007;369(9572):1528-34.
  2. Brewin P, Jones A, Kelly M, McDonald M, Beasley E, Sturdy P, Bothamley G, Griffiths C. Is screening for tuberculosis acceptable to immigrants? A qualitative study. Journal of public health (Oxford, England). 2006;28(3):253-60.
  3. Pareek M, Eborall HC, Wobi F, Ellis KS, Kontopantelis E, Zhang F, Baggaley R, Hollingsworth TD, Baines D, Patel H, Haldar P, Patel M, Stephenson I, Browne I, Gill P, Kapur R, Farooqi A, Abubakar I, Griffiths C. Community-based testing of migrants for infectious diseases (COMBAT-ID): impact, acceptability and cost-effectiveness of identifying infectious diseases among migrants in primary care: protocol for an interrupted time-series, qualitative and health economic analysis. BMJ Open. 2019;9(3):e029188.
  4. Burman M, Zenner D, Copas AJ, Gosce L, Haghparast-Bidgoli H, White PJ, Hickson V, Greyson O, Trathen D, Ashcroft R, Martineau AR, Abubakar I, Griffiths CJ, Kunst H. Treatment of latent tuberculosis infection in migrants in primary care versus secondary care. Eur Respir J. 2024;64(5).
  5. Eborall H, Wobi F, Ellis K, Willars J, Abubakar I, Griffiths C, Pareek M. Integrated screening of migrants for multiple infectious diseases: Qualitative study of a city-wide programme. EClinicalMedicine. 2020;21:100315.
  6. Baggaley RF, Zenner D, Bird P, Hargreaves S, Griffiths C, Noori T, Friedland JS, Nellums LB, Pareek M. Prevention and treatment of infectious diseases in migrants in Europe in the era of universal health coverage. Lancet Public Health. 2022;7(10):e876-e84.

Projects

COMBAT-ID

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