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A national tuberculosis strategy
The ‘Collaborative Tuberculosis Strategy for England 2015–2020’1 was recently published on the 19 January 2015 and represents a joint approach by Public Health England (PHE) and the National Health Service of England (NHSE) to tackle the ongoing issue of tuberculosis (TB) in the UK.
Although we saw an encouraging small decrease in the numbers of TB cases in 2013,2 this is in the setting of this disease continuing to be a problem in the UK where we still have one of the highest rates of TB in Western Europe3 and where rates of TB in some high-burden boroughs are comparable to some areas of the Indian subcontinent and South East Asia. Our rates of disease are still almost double that of the preceding two decades. Despite the epidemiological data indicating that the majority of TB cases are in foreign-born individuals, the UK has not yet implemented a systematic programme of latent TB infection (LTBI) detection and prophylactic treatment.4 In addition, there is evidence that ongoing transmission rates are also extremely high in vulnerable groups such as the homeless, those with substance abuse problems and those with a past history of imprisonment.5 The Find & Treat service based in London has been able to provide a targeted approach in this setting, but similar projects are lacking in other high-incidence UK cities.
While the majority of cases and highest rates of disease are centred around the well-recognised ‘hot-spots’ of TB (in conurbations like London, Leicester, Birmingham, Luton, Manchester and Coventry), there is an emerging issue of complex and multi-drug resistant TB (MDR-TB) in areas of low incidence where the local clinical infrastructure may be less well resourced and coordinated. …