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Ace study- Improving The Detection Active and Latent Tb in Accident and Emergency Departments and Evaluation of Health Protection Service Interventions against Tuberculosis

Background

Accident and Emergency (A&E) Departments are an important point of testing and referral for those groups at greatest risk of Tuberculosis (TB) infection.  Currently, A&E Departments contribute about 20% of those diagnosed with TB. The majority of these individuals are most likely to present with symptoms indicative of tuberculosis disease, compared to those attending for other reasons that 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 latent and 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.     

Study aims and objectives

Aim

To understand the prevalence and cost effectiveness of screening for latent tuberculosis infection and active TB disease in high risk groups attending Accident and Emergency Departments; and evaluate health protection services aimed at improving the diagnosis and management of tuberculosis in high risk groups.

Primary objectives


Work programme 1:

1. To determine the prevalence of latent and active tuberculosis among migrants attending A&E Departments.

2. To investigate the cost effectiveness of screening for latent and active TB in migrants attending A&E Departments.

Work Programme 2:

1. To evaluate the effectiveness and cost effectiveness of the following health protection service developments aimed at improving the diagnosis and management of tuberculosis in high risk groups.

a. Contact tracing around large incidents

b. Screening for latent tuberculosis in primary care in North West London

c. Pre-entry screening for active tuberculosis

2. To evaluate the structure, process and impact of the following health protection service developments aimed at improving the control of tuberculosis

a. Improving the coordination of tuberculosis control in Birmingham

b. Whole system service reviews in Yorkshire and North West London

c. Supporting cohort reviews 

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