Terms used in this guideline
Active case‑finding
Systematically identifying people with active or latent TB using tests, examinations or other procedures.
Adherence
The term adherence refers to the person's ability or willingness to keep to a treatment regimen as directed.
Adults
People aged 18 or older.
Case management
Case management involves follow‑up of a person suspected or confirmed to have TB. It needs a collaborative, multidisciplinary approach and should start as soon as possible after a suspected case is discovered.
Case manager
Standard and enhanced case management is overseen by a case manager who will usually be a specialist TB nurse or (in low‑incidence areas) a nurse with responsibilities that include TB. Depending on the person's circumstances and needs, case management can also be provided by appropriately trained and supported non‑clinical members of the TB multidisciplinary team.
Children
People aged 15 or younger.
Children and young people
People aged 17 or younger.
Cohort review
Cohort review is a systematic quarterly audit of the management and treatment of all TB patients and their contacts. The 'cohort' is a group of cases counted over a specific time, usually 3 months. Brief details of the management and outcomes of each case are reviewed in a group setting. The case manager presents the cases they are responsible for, giving the opportunity to discuss problems and difficulties in case management, service strengths and weaknesses, and staff training needs.
Congregate setting
A place where people congregate or an institutional setting such as a workplace, prison, hostel, or childcare or educational setting, where social contacts might have had significant exposure to TB.
Disseminated TB
Blood‑borne spread of TB that may or may not be accompanied by chest X‑ray or high resolution CT changes.
Enablers
Methods of helping someone to overcome barriers to completing diagnostic investigations and TB treatment. Examples of barriers include: transport, housing, nutrition and immigration status.
Enhanced case management
Management of TB for someone with clinically or socially complex needs. It starts as soon as TB is suspected. As part of enhanced case management, the need for directly observed treatment is considered, along with a package of supportive care tailored to the person's needs.
Equity proofed
Tools such as health equity audit and health impact assessment have been used systematically to assess the potential effect of all policies, programmes and activities (including those without an explicit health focus) on health inequalities. Equity proofing helps ensure all policies and programmes address the social determinants of health and health inequalities. Including a health equity audit as part of the joint strategic needs assessment can help local authorities and their partners to:
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develop strategy and plans according to need
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identify and work with community and health partners
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commission activities based on the best available evidence
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implement interventions to tackle inequity.
End‑to‑end pathway
The pathway from awareness raising and primary prevention, through diagnosis to treatment completion, incorporating all aspects such as contact tracing and other infection control mechanisms, for example, access to isolation facilities. This includes governance and commissioning considerations so that a comprehensive clinical and public health service is developed and delivered across any agreed geographical footprint.
Extensively drug‑resistant TB
Resistance to at least isoniazid and rifampicin, 1 injectable agent (capreomycin, kanamycin or amikacin) and 1 fluoroquinolone.
High incidence
A high‑incidence country or area has more than 40 cases of TB per 100,000 people per year. Public Health England lists high‑incidence countries and areas of the UK on its website.
High‑risk groups
The term 'high‑risk groups' is used in this guideline to mean adults, young people and children from any ethnic background, regardless of migration status, who are at increased risk of having or contracting TB. This includes people classified as under‑served, people identified as contacts according to the case finding recommendations, new entrants from high‑incidence countries and people who are immunocompromised.
Homelessness
For the purposes of TB control, a broad and inclusive definition of homelessness has been adopted that incorporates overcrowded and substandard accommodation. It includes people:
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who share an enclosed air space with people at high risk of undetected active pulmonary TB (that is, people with a history of rough sleeping, hostel residence or substance misuse)
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without the means to securely store prescribed medication
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without private space in which to self‑administer TB treatment
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without secure accommodation in which to rest and recuperate in safety and dignity for the full duration of planned treatment.
Immigration removal centres
Immigration removal centres are private or prison‑run holding centres for migrants waiting to be accepted by, or deported from, the UK. Immigration removal centres are also known as immigration detention centres and pre‑departure accommodation.
Immunocompromised
In this guideline, immunocompromised refers to a person who has a significantly impaired immune system. For instance, this may be because of prolonged corticosteroid use, tumour necrosis factor‑alpha antagonists, antirejection therapy, immunosuppression‑causing medication or comorbid states that affect the immune system, for example, HIV, chronic renal disease, many haematological and solid cancers, and diabetes.
Incident risk assessment
Assessment of risk of exposure to TB in a congregate setting to decide on the need for and extent of contact investigation. The risk assessment would take into consideration factors such as infectiousness of the index case, vulnerability of contacts to TB infection, length of contact with or exposure to an infectious case and the built environment (for example, size of the rooms, ventilation and overcrowding).
Index case
The initial person found to have TB, whose contacts are screened. The source of their infection may be found to be 1 of the contacts, but the person who presents first is regarded as the index case.
Induration
The firm skin reaction occurring after a tuberculin skin test to diagnose latent TB infection. It is measured, and the result used to determine whether the test result is classified as positive or negative. This guideline recommends a threshold of 5 mm for tuberculin skin test positivity.
Infectious TB
Active smear‑positive pulmonary TB, that is with acid fast bacilli visible on microscopy. Active TB affecting other parts of the respiratory tract or oral cavity, though rare, is also considered infectious.
Isolation
An infection control measure in which people with infectious TB are kept away from others who may be at risk of infection. This guideline deals with 3 levels of isolation for infection control in hospital settings:
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negative pressure rooms, which have air pressure continuously or automatically measured, as defined by NHS Property Services
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single rooms that are not negative pressure but are vented to the outside of the building
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beds on a ward, for which no particular engineering standards are needed.
Lost to follow‑up
People are defined as 'lost to follow‑up' if they cannot be contacted within 10 working days of:
Multidisciplinary TB teams
A team of professionals with a mix of skills to meet the needs of someone with TB who also has complex physical and psychosocial issues (that is, someone who is under‑served). Team members will include a social worker, voluntary sector and local housing representatives, TB lead physician and nurse, a case manager, a pharmacist, an infectious disease doctor or consultant in communicable disease control or health protection, a peer supporter or advocate and a psychiatrist.
Multidrug‑resistant TB
TB resistant to isoniazid and rifampicin, with or without any other resistance.
Negative pressure room
Used to isolate some patients known or suspected to have infectious TB. A negative pressure room is one where the air from the room is sucked out into dedicated ducting through a filter and into the outside air, at a distance from all other air intakes. The pressure should be 10 pascals below the ambient air pressure.
Neonates
Children aged 4 weeks or younger.
New entrant
Anyone coming to work or settle in the UK. This includes immigrants, refugees, asylum seekers, students and people on work permits. It also includes UK‑born people, or UK citizens, re‑entering the country after a prolonged stay in a high‑incidence country.
Opportunistic case‑finding
Opportunistic identification of people with active or latent TB using tests, examinations or other procedures in the course of existing appointments or interactions, rather than identification through formal screening programmes.
Outbreak
There is no robust, widely accepted threshold for an outbreak of a disease, but in practical terms an outbreak is the occurrence of an unusually high number of cases in associated people, in a small geographical area, or in a relatively short period of time.
Peers
Peers are people who may have experienced TB. They are often in a good position to help convey, with empathy, the need for testing or treatment. They may be recruited from specific populations. With support they can communicate health messages, assist with contact investigations or testing and offer people support while they are being tested or treated.
Prisons
Any state prison establishments, including young offender institutions.
Rapid access
In the context of TB services, rapid access refers to timely support from a specialist team.
Smear grade
The number of bacilli found in a sputum sample, believed to relate to the degree of infectivity of the person. There are several systems but in general recording goes from no mycobacteria in 100 fields (0 or negative) to more than 10 acid‑fast bacilli per field in at least 20 fields (grade 3).
Substance misuse
Substance misuse is defined as intoxication by, or regular excessive consumption of or dependence on, psychoactive substances, leading to social, psychological, physical or legal problems. It includes problematic use of both legal and illegal drugs.
TB control board
A partnership of mixed professionals and lay people who have experience of leading, commissioning, managing or supporting people with TB. Board members are likely to include the voluntary sector, housing representatives, TB specialists and other clinicians, consultants in communicable disease control or health protection, peer supporter and advocate groups, clinical commissioning groups, executive officers, local government commissioners and an independent chair. This list is not intended to be exhaustive; membership should be determined based on an area's needs, agreements and commissioning arrangements.
Treatment interruption
A break in the prescribed anti‑TB regimen for 2 weeks or more in the initial phase, or more than 20% of prescribed doses missed intermittently.
Under‑served groups
This term is used in this guideline to mean groups of adults, young people and children from any ethnic background, regardless of migration status. They are 'under‑served' if their social circumstances, language, culture or lifestyle (or those of their parents or carers) make it difficult to:
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recognise the clinical onset of TB
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access diagnostic and treatment services
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self‑administer treatment (or, in the case of children and young people, have treatment administered by a parent or carer)
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attend regular appointments for clinical follow‑up.
The groups classified as under‑served in this guideline are:
Under‑served children
Groups of children identified as potentially under served include:
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unaccompanied minors
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children whose parents are under served, including vulnerable migrants
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children whose parents are in prison or who abuse substances
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children from Gypsy and Traveller communities
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looked‑after children.
Vulnerable migrants
Vulnerable migrants may include undocumented migrants and those with no recourse to public funds. Some refugees, asylum seekers and new entrants to the country may also fall into this category.
Young people
People aged 16 or 17.