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Driving down cases of TB

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Sarah Murphy and her team are taking a new approach to treating TB - by reaching out to people before they infect others

It is estimated that one-third of the world is infected with tuberculosis bacteria - and most people don’t even know it.

Sarah Murphy works as a TB nurse specialist on the London TB Extended Contact Tracing project. The team tracks the two forms of TB: active and latent. One goal is to make identification and treatment of infectious TB an active initiative rather than the traditional passive method, waiting for the patient to come to healthcare with symptoms. They are also working to identify more cases of latent TB, where the symptoms aren’t visible, and treat them before developing into active TB disease.

Ms Murphy says that TB diagnosis can be delayed for several reasons: an individual may not acknowledge they are unwell; they may wait to seek medical advice; or doctors may not immediately recognise the symptoms of TB.

Londoners account for 40% of the UK’s TB cases. The pilot programme, LTBEx, efforts of identification, led by Ms Murphy could be a method of driving down that number.

“It is a new initiative of approaching TB control in the UK,” she says. “We are very good at treating people once we know they have TB, but sometimes we haven’t been able to get to them before they infect others. I am excited that if this model works it could be rolled out to other countries that have high levels of TB.”

Someone with infectious TB could be spreading the disease to 10-15 people per year without knowing through continuous contact. While it is not highly infectious, when someone is diagnosed with TB those who have had significant contact with the person infected are contacted to be screened. The LTBEx team’s goal is to standardise how TB contacts are screened during an incident or outbreak.

“With the help of the TB nurses, we pull together information about the patient’s lifestyle, such as social movements, to identify if people outside of their household, such as at work, school or religious buildings, might have been exposed. Then I would arrange to conduct a thorough risk assessment of the location to identify if people have had significant exposure. We always take a systematic approach of the ‘stone in the pond’ to screen those with the most contact first,” she says.

While it may seem like a time-consuming process, Ms Murphy says that with this model, identifying, performing tests and chasing results streamlines the process, hopefully creating impact on TB rates.

The information collected is compiled in the hope it can be used as an evidence base for standardisation of contact tracing.

“It will help us look at what interventions have been most effective and refine the process of TB incident and outbreak management,” she says.

Ms Murphy was drawn to the specialty of TB because of its impact on lives in more ways than just health.

“It is a historical disease that has modern problems that are on the increase. It is not just a healthcare issue. It is a complex disease that touches on political and social issues. It is connected to the HIV epidemic. It is essentially closely associated with poverty - it impacts vulnerable people who have complex problems,” she says.

With more public awareness of the symptoms of TB, Ms Murphy believes that the public can help in driving down the number of cases in London and the UK. A prolonged cough for more than three weeks, night sweats, fevers, feeling lethargic, and unintentional weight loss are just some of the symptoms the public should be aware of, although Ms Murphy notes these symptoms “can be quite vague”.

Ms Murphy brings eight years of serving as a TB clinical nurse specialist to the LTBEx team and manages the team of nurses to develop their skills and competencies of TB screening. Her role in LTBEx allows her to combine her love of TB nursing and public health.

“All clinical nurses need to be aware of public health,” she says. “For me this is a really exciting fusion of both practice and application.”

Abigail Holman

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