title: Tuberculosis in UK cities: workload and effectiveness of tuberculosis control programmes.
abstract: BACKGROUND
  Tuberculosis (TB) has increased within the UK and, in response, targets for TB control have been set and interventions recommended. The question was whether these had been implemented and, if so, had they been effective in reducing TB cases.
  
  
  METHODS
  Epidemiological data were obtained from enhanced surveillance and clinics. Primary care trusts or TB clinics with an average of > 100 TB cases per year were identified and provided reflections on the reasons for any change in their local incidence, which was compared to an audit against the national TB plan.
  
  
  RESULTS
  Access to data for planning varied (0-22 months). Sputum smear status was usually well recorded within the clinics. All cities had TB networks, a key worker for each case, free treatment and arrangements to treat HIV co-infection. Achievement of targets in the national plan correlated well with change in workload figures for the commissioning organizations (Spearman's rank correlation R = 0.8, P < 0.01) but not with clinic numbers. Four cities had not achieved the target of one nurse per 40 notifications (Birmingham, Bradford, Manchester and Sheffield). Compared to other cities, their loss to follow-up during treatment was usually > 6% (χ2 = 4.2, P < 0.05), there was less TB detected by screening and less outreach. Manchester was most poorly resourced and showed the highest rate of increase of TB. Direct referral from radiology, sputum from primary care and outreach workers were cited as important in TB control.
  
  
  CONCLUSIONS
  TB control programmes depend on adequate numbers of specialist TB nurses for early detection and case-holding.Please see related article: http://www.biomedcentral.com/1741-7015/9/127.
authors: Homerton University Hospital, London, UK. graham.bothamley@homerton.nhs.uk
authors: Graham H
authors: GH
authors: Bothamley
authors: Michelle E
authors: ME
authors: Kruijshaar
authors: Heinke
authors: H
authors: Kunst
authors: Gerrit
authors: G
authors: Woltmann
authors: Mark
authors: M
authors: Cotton
authors: Dinesh
authors: D
authors: Saralaya
authors: Mark A
authors: MA
authors: Woodhead
authors: John P
authors: JP
authors: Watson
authors: Ann L N
authors: AL
authors: Chapman
mesh_terms: D002947:Cities / Q000453:epidemiology*; D006801:Humans; D008503:Medical Staff / Q000600:supply & distribution; D011159:Population Surveillance; D015397:Program Evaluation; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology* / Q000517:prevention & control; D006113:United Kingdom / Q000453:epidemiology; D016526:Workload / Q000706:statistics & numerical data