P218 Pulmonary tuberculosis treatment delays: has the Covid-19 pandemic caused delays in patients presenting to health care professionals?

<h3>Aim</h3> Following the Covid-19 pandemic there has been concern about delays in healthcare, which is particularly concerning in tuberculosis (TB) infection. We aimed to assess whether there were increased delays post-pandemic for pulmonary TB (PTB) patients, and to identify at which stage in their pathway these occurred if so. <h3>Method</h3> We retrospectively analysed the patient pathway for PTB cases diagnosed at our Trust in 2022 and 2023. We recorded the time from symptom onset to presentation to a healthcare professional (HCP), time from first presentation to referral to secondary care, secondary care review to TB team referral, TB referral to TB team review, and TB treatment start date. These results were compared to a historic dataset from patients diagnosed with PTB by 2 Trusts in our region in 2018. <h3>Results</h3> 31 PTB patients in 2022/23 were compared to 28 patients in 2018. The median time from symptom onset to starting TB treatment in 2022/23 was 93 days (range 14–949 days) compared with 73 days (range 0–720 days) in 2018. 9 out of the 31 (29%) patients in 2022/23 were &gt; 120 days. The median time from symptom onset to presentation to a HCP was 28 days in 2022/23 (range 0–195 days) compared to 11 days (range 0–102 days) in 2018. 14/31 (45%) of patients presented to a GP in the 2022/23 cohort, and 8/10 of those presenting with &gt;28 days of symptoms presented to a GP. The median time from presentation to a GP to hospital referral was 14 days (range 0–824 days) compared to 31 days (range 0–240 days) in 2018. The median time from ED review to TB team referral was 6 days and from other hospital teams was 7 days. The median time from TB team referral to review was 1 day. <h3>Conclusion</h3> The time taken to diagnose and start treatment for PTB has increased post-pandemic, notably due to delays in patients presenting to healthcare, particularly to GPs. Improving accessibility and presentation to healthcare is crucial to reduce the risk of TB transmission.