Area for action 8: national latent TB infection testing and treatment programme

The national latent TB infection (LTBI) testing and treatment programme (the LTBI programme) has been in place since 2015 as a key action of the collaborative strategy.

The LTBI programme tests new entrants to the UK based on eligibility criteria set out in the Strategy. These are:

  • born or spent more than 6 months in a high TB incidence country (≥150/100,000 or Sub Saharan Africa)
  • entered the UK within the last 5 years (including entry via other countries)
  • aged between 16 – 35 years.
  • no previous history of TB or LTBI
  • not previously screened for LTBI in the UK

In 2015 59 CCGs with high numbers of TB notifications and rates were identified as high priority for the LTBI programme. The LTBI programme is funded by NHS England and implemented locally by CCGs. CCGs LTBI programmes are delivered through the following models:

  • primary care-based testing/primary care-based treatment
  • primary care-based testing with treatment in secondary care or community care-based TB services
  • secondary or community care-based TB services for LTBI testing and treatment
  • combination of the above

The LTBI testing and treatment programme is delivered by CCGs in primary care and/or community and/or secondary care teams.

The programme is monitored and evaluated by NHS England based on data submitted to and reported on by Public Health England to NHS England and LTBI programme partners.

Key messages since the launch of LTBI programme in 2015:

  • A total of 45,121 LTBI tests have been reported from programme commencement to 31 March 2019
  • 17% of all LTBI tests were positive for LTBI
  • 64% of people with a positive LTBI test commenced treatment
  • 69% of people with a positive LTBI test who commenced treatment completed treatment

LTBI programme outcomes such as number of LTBI tests achieved against planned, LTBI test positivity, LTBI treatment uptake and completion varies across CCGs.

NHS England’s programme indicators to monitor LTBI programme progress are:

  1. LTBI testing and treatment programme coverage
  2. LTBI testing acceptance
  3. IGRA test performance and LTBI positivity
  4. LTBI treatment uptake
  5. LTBI treatment completion
  6. Adverse events from LTBI treatment

Guidance has been developed and provided to support the LTBI programme for CCGs and their LTBI programme partners by NHS England and PHE. Some of this guidance is historical but may still be useful.

Information and advice on the LTBI programme can be accessed by emailing NHS England and PHE at england.tbprogramme@nhs.net and tbscreening@phe.gov.uk respectively.

To support CCGs, LTBI treatment programme providers and patients NHS England has supported the development of resources including:

Additional advice and support has included:

This guidance supported CCGs and NHS England in the implementation of the Strategy by recommending actions to take including the identification of lead CCGs, developing local incentives or other models for GPs in identifying and testing patients at risk of latent TB, and the development of secondary care treatment services where latent TB is detected.

Details of the plans to be developed in order to access additional funding are given. The guidance also gives clarity on the mutual responsibilities of TB control boards, CCGs and NHS England team and how accountabilities will operate between them in the delivery of the strategy.

This was the original LTBI programme plan template used by CCGs to submit their LTBI programme costs and activity to NHS England for funding support.

To help with local implementation a guide was developed for CCGs, GPs, PHE Health Protection teams and TB services. This offered practical advice and outlined the implications of setting up a LTBI testing programme. It brought together relevant information from NICE guidance, research and learning from areas that have set up or piloted LTBI programmes – case findings.

TB case notifications and rates

Provisional data for 2018 was released on World TB Day, March 2019 and show a continued decline in the number of TB case notifications and rates in England. A total of 4,672 people with TB were notified in 2018, a rate of 8.4 per 100,000. This represents an 8.4% and 8.7% annual decline in the number and rate of TB, respectively. These are now the lowest figures ever recorded for TB incidence in England and since the peak of 2011.

This continuous decline since 2011 brings the rate of TB in 2018 below the 10 per 100,000 population threshold which defines the UK as a WHO low incidence.

The decrease in TB notifications has been greater than originally estimated in 2014 for the Strategy. From 2015 to 2018 TB notifications decreased by 27.8% and by 43.6% between 2011 and 2018.

The 2018 annual TB report, published September 2018, presented data to end 2017. This report outlined in detail information on TB across England and commented on the information such as how the decline in TB numbers and rates have not been experienced equally by all population groups with the largest falls occurring mainly in people born outside the UK. The proportion of people who experience a delay between symptom onset to diagnosis remains stubbornly high and the proportion of people who have multi-drug resistant TB, although relatively low, has not declined recently.

There are also significant inequalities in the rate of TB; the most deprived 10% of the population have a rate more than 7 times higher than the least deprived 10%, and people born outside the UK have a rate 13 times higher than people born in the UK. Nearly 13% of people notified with TB have a social risk factor.

In 2018, the number of UK born TB patients declined by approximately 10% compared to 2017. In contrast, the number of cases and the rate in the non-UK born population declined at a slower rate of 7.5% in the same period.

If you have any other general questions about the programme, please email england.tbprogramme@nhs.net