TUBERCULOSIS POLICY INTERVENTIONS

How effective are Tuberculosis policy interventions in the London Borough of Newham

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CHAPTER 02: LITERATURE REIVEW (REMAINING PART)1

Tuberculosis in London Borough of Newham1

Tuberculosis Problem among Black Africans in Newham2

CHAPTER 03: INTRODUCING THE POLICIES5

TB control in London Borough of Newham5

Buprenorphine Treatment Policy for Tuberculosis Screening in Newham7

Tuberculosis Policy Intervention for Black Africans10

CHAPTER 04: CONCLUSION AND RECOMMENDATIONS12

REFERENCES15

CHAPTER 02: LITERATURE REIVEW (REMAINING PART)

Tuberculosis in London Borough of Newham

In 1993, aggressive TB control measures widely adopted across London Borough of Newham led to a decline in TB incidence. These efforts included directly observed therapy (DOT) as a standard of care for the treatment of active TB, improvement in infection control practices in hospitals, and improvement in laboratory methods to obtain timely test results leading to more effectively tailored treatment regimens (Trenholm & Ferlie, 2012). These efforts were directly linked to the reduction of overall incidence rates of TB. In 2009, the region had the lowest number of TB cases in recorded history. Despite this success, the decline in cases was predominantly seen among the UK-born population.

From 1993 to 2009, the number of UK-born cases declined by 74% compared to 7% among foreign-born cases, and in 2009 the rate of TB in the foreign born population was 11 times higher than in the UK-born population (18.7 per 100,000 populations versus 1.7 per 100,000 populations). In 2001, the proportion of foreign-born TB cases first exceeded that of UK-born cases and this disparity has continued to increase. Studies have surmised that the decline in TB among the UK-born population in London Borough of Newham was largely due to TB control efforts geared to stopping TB transmission, but these efforts were not as successful among the foreign-born population (Maguire et al. 2011).

This was because TB in the foreign-born population was thought to be due to infection acquired prior to arrival to the region. In 2011, 80% of TB cases in London Borough of Newham were among foreign-born individuals coming from over 100 countries. In 2011, the rate of TB among foreign-born individuals was 18.5 per 100,000 populations versus 2.6 per 100,000 populations among UK-born individuals (Trenholm & Ferlie, 2012). The nationwide shift in TB burden to the foreign-born population suggests that current TB control efforts are not as effective in this population and that enhanced efforts are needed for the continued success towards eliminating TB as a public health threat.

Tuberculosis Problem among Black Africans in Newham

Black Africans with tuberculosis were first seen in London Borough of Newham in the mid-1990s. This coincided with a humanitarian effort which allowed Black Africans from the continent of Africa to settle in the UK (Keal & Davies, 2011). Reports indicate that some Black African populations have migrated to a number of cities in the United Kingdom; however, Newham was a common point of entry and a location where Black Africans settled. The exact size of the Black African population in Newham is unknown and Black Africans are difficult to identify through existing TB surveillance ...