S151 Does movement between treatment centres affect whether asylum seekers with latent tuberculosis (TB) infection complete treatment?

Abstract

Cardiff is a pre-dispersal, arrival centre for asylum seekers (AS) to the UK. Following NICE guidelines, the Cardiff TB team screens and treats AS for latent TB infection (LTBI). However, many of these AS do not remain in Cardiff as they are subsequently dispersed by UK Visa and Immigration (UKVI), often at short notice. We aimed to investigate whether treatment completion is affected by dispersal away from Cardiff and whether treatment initiation should be delayed until it is known whether an AS will be dispersed. We completed a retrospective case note analysis of all AS offered treatment for LTBI in Cardiff, between 1/1/2014 and 31/12/2016. We collected data on patient demographics, dispersal destination, whether treatment completion was confirmed and any reasons for non-completion of treatment. We then contacted 17 other TB teams in the areas to which records showed AS had been dispersed, by mail and telephone, in order to obtain details of treatment outcomes. We identified 264 AS diagnosed with LTBI in Cardiff over 3 years: 122 (46%) remained in Cardiff for the duration of treatment, with 92% of these completing treatment. Confirmation of treatment completion was significantly lower in AS dispersed both prior to starting treatment (69%) and during treatment (71%). We further analysed results after excluding 9 AS for whom follow up information was missing,having been dispersed to the care of 3 TB teams whom we were unable to contact: The difference in completion between AS remaining in Cardiff and those dispersed elsewhere remained statistically significant. Our data highlight the difficulties that TB teams face in following-up AS who are frequently dispersed abruptly around England and Wales. The results of this analysis provide insufficient evidence that treatment should be delayed in case an AS is subsequently dispersed, however this finding may depend on accurate and timely knowledge of AS dispersal destinations and adequate communication between TB teams. A more cohesive relationship between the UKVI service and TB teams and a centralised database of AS receiving treatment for LTBI are two recommendations to improve follow-up and treatment completion.