Socio-economic factors affecting delay in

Mycobacterium Tuberculosis (MTB) diagnosis in Central Lancashire

CLAHRC NWC Intern - Linda JohnsonSupervisors: Prof Mark Gabbay and Dr Philippa Olive - Liverpool University, UCLAN and LTHTR

Background

Methods

Tuberculosis (TB) worldwide and within the UK continues

to be a serious public health problem. 6,520 cases of TB

were reported in England in 2014. 646 of these cases were

in the North West.

Highest TB rates are often associated with people living in

socio-economically deprived communities.

(PHE, 2016, MacPherson. P et al, 2016)

Effective diagnosis and treatment is crucial

for improving patient outcomes by

reducing the severity of the disease and

to reduce public health risks of onward

transmission. (Alavi. S et al, 2014)

The study aims to identify factors involved with delays in

MTB diagnosis and treatment for patients at Lancashire

Teaching Hospitals (LTHTR) during 2014 and 2015.

The primary objective is to identify if delays are apparent

and classify them by number of days.

Once identified, are the delays attributable to

patient care-seeking behaviour,

or an National Health Service (NHS)

systems delay.

Also recognition of links associated with

socio–economic deprivation and TB risk

factors such as, alcoholism, imprisonment,

drug use, homelessness and migration.

(MacPherson. P et al, 2016)

ReferencesAlavi SM, Bakhtiyariniya P, Albagi A. Factors Associated With Delay in Diagnosis and Treatment of Pulmonary Tuberculosis. Jundishapur J Microbiol. 2015 Mar; 8(3): e19238. Published online 2015 Mar 21.

MacPherson P, Squires SB, Cleary P, Davies S, Wake C, Dee K, Walker J, Farrow S, McMaster P, Woodhead M, Sloan DJ. Equitable tuberculosis care in the North West of England: analysis of tuberculosis cohort review data. Int J Tuberc Lung Dis. 2016

Jun;20(6):778-85

Public Health England. (November 2015) Tuberculosis in North West England: Annual review (2014 data), 2015. Public Health England: North West. https://www.gov.uk/government/publications/tuberculosis-tb-regional-reports.

World Health Organization 2006. Diagnostic and treatment delay in tuberculosis. WHO-EM/TDR/009/E http://apps.who.int/iris/bitstream/10665/116501/1/dsa710.pdf

A retrospective data analysis is planned, looking at MTB cases (both Pulmonary and Non-pulmonary) treated at LTHTR and

entered into the Enhanced Tuberculosis Surveillance system (ETS) from 1st Jan 2014 – 31st Dec 2015.

In this study ‘Delay’ is defined as the period between two events - The patient delay is the time interval between symptom

onset to first presentation to a health professional. Treatment delay is the period (in days) between symptom onset and the

start of drug treatment. Diagnostic delay interval between symptom onset and diagnosis. Total delay measured from

symptom onset to start of drug treatment.

Aims and Objectives

Results and Discussion

Diagnostic delay Treatment delay

Patient delay Health Service delay

Onset of

symptoms

1st health

seeking

behaviourDate of

diagnosis

Date of

treatment

Total delay

This is a summary of independent research funded by the National Institute for Health Research (NIHR)’s CLAHRC NWC Programme. The views expressed are

those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health

Different delay durations - (WHO, 2006)

This project is still in progress therefore results are not available at present.

The data collection will include:

• Dates of symptom onset, first seen by health professional, diagnosis and treatment commencement.

• Smoking history, age, gender, ethnicity and country of birth.

• History of ability to administer treatment due to: Alcohol misuse, homelessness, imprisonment.

The results will provide information on where targeted education or improved service provision may be needed to reduce TB

burden within Central Lancashire.