New approaches in the fight against tuberculosis: Challenges and solutions in the healthcare landscape - No1Lost

The number of tuberculosis (TB) cases in Western Europe has fallen steadily in recent decades [1, 2]. However, challenges remain in TB prevention and care [3]. In the UK, for example, people without access to the healthcare system or people with low socioeconomic status and other social risk factors, such as homelessness, imprisonment and alcohol dependency, are particularly affected by a lack of care [4].

In order to successfully identify and combat TB in these risk groups, care models and measures in the healthcare system are required that are precisely tailored to the needs of those affected [5-7]. This is because the effectiveness of TB control measures can vary depending on the population group and living environment [6].

To contribute to the development of tailored care, Berrocal-Almanza and colleagues (2023; [8]) investigated barriers and success factors for TB care. As previous research on this topic was limited to TB care in London [9], the study aimed to fill knowledge gaps for the affected population in Birmingham and Leicester, where TB prevalence is among the highest in the UK [2]. In a mixed-methods study, quantitative data from local TB registers and the national TB surveillance system (2013-2018) as well as qualitative data from interviews with TB patients and healthcare providers were analyzed [8].

Based on the local TB registers and the surveillance system, it was initially determined that unsuccessful TB treatment outcomes (e.g. treatment discontinuation or death) occurred primarily in patients aged 55 or older, who were not born in the UK and who suffered from multidrug-resistant (MDR) TB. According to the participants, poor living and working conditions, inadequate or non-existent social security systems, care structures that do not meet the expectations and needs of those affected and side effects of TB treatment also hindered TB treatment [8].

According to the authors of the study, a prerequisite for overcoming these barriers is increased cooperation between health and social services, medical staff in the GP and specialist sector and low-threshold community-based services. Effective TB prevention and care therefore requires not only measures in the healthcare system, but also the integration of social security measures and the provision of locally anchored TB care without access barriers. Furthermore, from a health policy perspective, it is crucial to facilitate integration and access to healthcare for foreign-born and older people.

Measures to improve TB care and treatment adherence are also currently being developed in Germany. As part of the "No1Lost" project funded by the Federal Ministry of Health (BMG) and run by Justus Liebig University Giessen, the CAPNETZ Foundation and the German Central Committee for Combating Tuberculosis (DZK), the care structures for TB in Germany are to be systematically recorded and brought together in a socio-medically oriented competence network for treatment adherence. In order to avoid treatment discontinuation, particularly in vulnerable groups, the planned network will provide individual advice, systematize and disseminate useful approaches to socio-medical support [10].

Literature used:

1. Robert Koch Institute, RKI Guide to Tuberculosis. Epidemiological Bulletin, 2024. 11: p. 7-23.
2. UK Health Security Agency, Tuberculosis in England: Report 2021. 2021, UK Health Security Agency: London.
3. Trauer, J.M., et al, The Importance of Heterogeneity to the Epidemiology of Tuberculosis. Clinical Infectious Diseases, 2018. 69(1): p. 159-166.
4. UK Health Security Agency. Tackling tuberculosis in under-served populations. 2019; Available from: https://www.gov.uk/government/publications/tackling-tuberculosis-in-under-served-populations.
5. National Institute for Health and Care Excellence (NICE), Tuberculosis: NICE Guideline. 2024.
6. Galea, S., J. Ahern, and A. Karpati, A model of underlying socioeconomic vulnerability in human populations: evidence from variability in population health and implications for public health. Social Science & Medicine, 2005. 60(11): p. 2417-2430.
7. Public Health England (PHE), Collaborative Tuberculosis Strategy for England 2015 to 2020. 2015.
8. Berrocal-Almanza, L.C., et al, Vulnerability and tuberculosis treatment outcomes in urban settings in England: A mixed-methods study. PLoS One, 2023. 18(8): p. e0281918.
9. Anderson, C., et al, Tuberculosis in London: the convergence of clinical and social complexity. European Respiratory Journal, 2016. 48(4): p. 1233-1236.
10. German Central Committee against Tuberculosis e.V. (DZK). No1Lost. 2024; Available from: https://www.dzk-tuberkulose.de/no1lost/.