Clinical trial NCT02512484: Improving the Detection of Active Tuberculosis in Accident and Emergency Departments
Official title: Improving the Detection of Active Tuberculosis in Accident and Emergency (A&E) Departments
Study type: OBSERVATIONAL
Overall status: UNKNOWN
Conditions: Latent Tuberculosis
Active Tuberculosis
Keywords: tuberculosis
accident and emergency
Lead sponsor: Public Health England
Sponsor class: OTHER_GOV
First posted: 2015-07-31
Enrollment: 1000
Sex: ALL
Minimum age (years): 16
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Individuals at high risk of TB

Brief summary: Tuberculosis (TB) control remains a public health challenge. Many people in the UK do not have a general practitioner (GP) registration and their only interaction with the NHS is via Accident and Emergency (A\&E) Departments of hospitals. This is often the case for those in hard to reach groups, who are also those often at highest risk of TB. This study seeks to assess whether A\&E Departments are effective sites for the identification and onward management of TB, both in its latent and active forms.

Detailed description: This proposal is focused upon early diagnosis, referral and treatment of active tuberculosis, which has two key components: 1) ensuring optimal outcome for individuals; 2) contributing to disease control in public health terms by preventing further spread.

A\&E Departments are an important point of testing and referral for the client group that constitute those at greatest risk, as for many this will be their only interaction with the health service. Currently, A\&E Departments contribute about 20% of those diagnosed with TB. The majority of these individuals are most likely to have presented with symptoms indicative of disease, compared to those attending for other reasons who would have been unlikely to have been tested or referred.

This study will seek to evaluate specific measures currently being undertaken by Public Health England and the NHS to control TB as well as investigate whether case finding for active TB in A\&E departments would improve TB control. The economic impact of these interventions will be evaluated, providing a measure of its value for money.

Eligibility criteria: Inclusion Criteria:

1. Individuals 16 years or older, who are new entrants from high incidence countries who have arrived in the UK within the past 2 years or those born in high incidence countries who entered the UK more than five years ago, but have spent more than one year (cumulative) in the past five years in a high incidence country.
2. Those with social risk factors who have signs and/or symptoms of TB.

Exclusion Criteria:

1. Individuals who are under 16 years
2. Individuals who were born in the UK or a low incidence countries and do not have risk factors

Primary outcomes:
measure: xray diagnosis of active TB
timeFrame: 1 year
Secondary outcomes:
measure: diagnosis of latent TB
timeFrame: 1 year
Other outcomes:
Locations:
city: London
country: United Kingdom
facility: Barts NHS Trust
city: London
country: United Kingdom
facility: Ealing Hospital
city: London
country: United Kingdom
facility: West Middlesex Hospital NHS Trust
Study officials:
References:
citation: Gupta RK, Lule SA, Krutikov M, Gosce L, Green N, Southern J, Imran A, Aldridge RW, Kunst H, Lipman M, Lynn W, Burgess H, Rahman A, Menezes D, Rahman A, Tiberi S, White PJ, Abubakar I. Screening for tuberculosis among high-risk groups attending London emergency departments: a prospective observational study. Eur Respir J. 2021 Jun 24;57(6):2003831. doi: 10.1183/13993003.03831-2020. Print 2021 Jun.