P207 Prospective investigation of tuberculosis treatment delays

<h3>Introduction</h3> The World Health Organisation goal is to halve Tuberculosis incidence by 2025.¹ Delays in starting Tuberculosis (TB) treatment leads to an increased risk of cross infection and severity of disease, both in pulmonary (PTB) and extrapulmonary (EPTB) disease. Public Health England data showed that our hospitals were underperforming compared to National performance regarding the time between symptom onset and starting TB treatment. <h3>Aim</h3> To identify where patients diagnosed with tuberculosis were facing delays in their care pathway before starting TB treatment. <h3>Method</h3> This was a prospective study of all patients diagnosed with tuberculosis (PTB and EPTB) in 2018 at the two District General Hospitals in our county. A TB treatment delay questionnaire was completed with the patient at the time of starting anti-tuberculosis medication. <h3>Results</h3> In 2018, 82 patients were diagnosed with TB, of which 56% were male. The median age was 37 years (range13–91) at the time of diagnosis. 82% of TB patients were born aboard. 13 out of the 28 PTB patients (46%) presented to Primary Care, and had a mean number of 2 GP visits before referral onwards. 3/13 were referred directly to the TB service, 3/13 to A&amp;E, 4/13 to the Lung Cancer service and 3/13 to Acute Medicine. The 8 patients not meeting the target of referral within 28 days had a wide range of ages, 3/8 were UK-born (1 white British) and 5/8 had appropriate management in Primary Care on subsequent TB clinician review. <h3>Conclusion</h3> The main delay in the diagnostic pathway was in Primary Care, although on whole the diagnosis was prompt. Once patients were seen in secondary care, the majority were diagnosed and started on TB treatment quickly. Raising awareness of TB, delivering TB teaching for GPs and streamlining the referral pathway directly to the TB team are essential to reduce diagnostic delay and subsequent morbidity and onward transmission of disease. <h3>Reference</h3> World Health Organisation,The End of TB Strategy, 2014.