P226 The impact of COVID-19 on tuberculosis case presentation – the BHRUT experience. A comparative analysis of pre-and post-pandemic trends

<h3>Introduction</h3> The COVID-19 pandemic has significantly influenced the incidence and presentation of tuberculosis (TB) globally and in the UK. To understand these changes and potential reasons, we conducted a retrospective analysis of TB cases managed within our trust before and after the pandemic. <h3>Methods</h3> This retrospective cohort study analyzed patient data from 2018 to 2023, categorizing cases into pre-COVID (2018–2019) and post-COVID (2020–2023) periods. Data were stratified by TB site, risk factors, and initial presentation location. <h3>Results</h3> Among 665 patients, the distribution of TB sites remained relatively stable between pulmonary (50.2%) and extrapulmonary TB (49.8%) pre-pandemic. Post-pandemic, pulmonary TB cases increased to 54.88%, marking a 4.68% rise (χ² = 1.09, p = 0.297). However, there was a significant shift in primary presentation settings: pre-pandemic, 48.37% of patients sought initial care at A&amp;E, whereas this increased to 66.22% post-pandemic. This represents a substantial 17.85% rise, over GP consultations post-pandemic (χ² = 23.75, p &lt; 0.001). Post-pandemic, certain TB risk factors changed notably. Alcohol misuse significantly increased from 5.83% pre-pandemic to 15.16% post-pandemic (χ² = 5.90, p = 0.015). Smoking trends changed from 39.16% to 28.8% (χ² = 3.61, p = 0.057). Other risk factors showed no significant differences: any risk factor (25% to 27.07%, χ² = 0.094, p = 0.759), asylum seeker (2.5% to 4.33%, p = 0.553), drug misuse (4.16% to 5.05%, p = 0.901), homelessness (7.5% to 6.13%, p = 0.777), mental health issues (8.33% to 7.22%, p = 0.858), and prison history (7.5% to 6.13%, p = 0.777). <h3>Conclusion</h3> The COVID-19 pandemic has profoundly impacted TB presentation locally, with an increased severity of pulmonary TB cases and a shift towards acute care settings for initial presentation. Social risk factors have worsened, reflecting broader health and social challenges that have an impact on acute and post-TB care. Our findings further highlight the need for more targeted interventions to address the TB resurgence, and improve health equity. Findings have supported work to improve A&amp;E in-reach and education and collaborative efforts between organisations to address local health inequality and determinants of health.