Open Access Highly Accessed Research article

Tuberculosis in UK cities: workload and effectiveness of tuberculosis control programmes

Graham H Bothamley1*, Michelle E Kruijshaar2, Heinke Kunst3, Gerrit Woltmann4, Mark Cotton5, Dinesh Saralaya6, Mark A Woodhead7, John P Watson8 and Ann LN Chapman9

Author Affiliations

1 Homerton University Hospital, London, UK

2 Health Protection Agency - Health Protection Services Colindale, London, UK

3 Birmingham Heartlands Hospital, Birmingham, UK

4 Glenfield Hospital, Leicester, UK

5 Glasgow Royal Infirmary, Glasgow, UK

6 Bradford Royal Infirmary, Bradford BD9 6RJ, UK

7 Manchester Royal Infirmary, Manchester, UK

8 St James's University Hospital, Leeds, UK

9 Royal Hallamshire Hospital, Sheffield, UK

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BMC Public Health 2011, 11:896  doi:10.1186/1471-2458-11-896

Published: 28 November 2011



Tuberculosis (TB) has increased within the UK and, in response, targets for TB control have been set and interventions recommended. The question was whether these had been implemented and, if so, had they been effective in reducing TB cases.


Epidemiological data were obtained from enhanced surveillance and clinics. Primary care trusts or TB clinics with an average of > 100 TB cases per year were identified and provided reflections on the reasons for any change in their local incidence, which was compared to an audit against the national TB plan.


Access to data for planning varied (0-22 months). Sputum smear status was usually well recorded within the clinics. All cities had TB networks, a key worker for each case, free treatment and arrangements to treat HIV co-infection. Achievement of targets in the national plan correlated well with change in workload figures for the commissioning organizations (Spearman's rank correlation R = 0.8, P < 0.01) but not with clinic numbers. Four cities had not achieved the target of one nurse per 40 notifications (Birmingham, Bradford, Manchester and Sheffield). Compared to other cities, their loss to follow-up during treatment was usually > 6% (χ2 = 4.2, P < 0.05), there was less TB detected by screening and less outreach. Manchester was most poorly resourced and showed the highest rate of increase of TB. Direct referral from radiology, sputum from primary care and outreach workers were cited as important in TB control.


TB control programmes depend on adequate numbers of specialist TB nurses for early detection and case-holding.

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