S82 The British Thoracic Society multi drug resistant TB clinical advice service activity: 2018–2022 summary

<h3>Background</h3> The UK BTS MDRTB CAS provides an on-line forum and a monthly virtual multi-disciplinary meeting of TB experts to provide advice for drug-resistant or complex cases of TB but also encompassing detailed WGS information and public health advice. This service also ratifies use of high cost MDR therapies. We report on activity from January 2018 to June 2022. <h3>Methods</h3> Data was extracted from a template capturing information on patients and disease. Cases submitted are categorised into: A) XDR-TB, MDR-TB, suspected MDR-TB, B) drug resistant non-MDR TB, complex sensitive TB, other complex TB and C) Non-Tuberculous Mycobacteria (reported elsewhere). <h3>Results</h3> There have been 441 patients discussed in this period. Pulmonary involvement was the commonest site of disease in category A and B (71% and 89%). <b>Category A</b>: 231 cases: 11.3% XDR-TB, 62.8% MDR-TB and 26% suspected MDR-TB. Most individuals are non-UK born (84%) The Indian subcontinent is the most frequent area of origin (26.4%). 13% had documented social risk factors including alcohol misuse 50%, drug use 23.1%, prison history 30.8% and homelessness 15.4%. The most frequently reported symptoms are cough (63%), weight loss (33%) and fever (51%). Prior to referral symptom durations ranged from one week to &gt; 1 year with 65% having symptoms for ≤ three months. In the last year 13.7% have had previous active TB and 18.8% had known contact with an MDR case. Rapid PCR/GeneXpert confirmed rifampicin resistance in 128/141 (90.8%) of cases. <b>Category B:</b> 125 individuals were referred. 36.8% had non-MDR drug resistance, 44.0% complex sensitive TB and 19.2% other complex TB. Within this cohort most are UK born 46.4%. The majority (78%) have clinical risk factors including immunosuppressant use, diabetes, smoking, renal disease or liver disease. Feedback from 2020 demonstrated 92.9% of users reported the advice as clinically useful and 96% would use the service in the future. <h3>Conclusions</h3> This data indicate there is an increasing demand for national expert advice for these most complex cases in a low incidence country and that the BTS MDR CAS provides additional support to local MDTs to improve patient management.