LIVE EVENT RECORDING: Introducing the All Wales Guideline for the Management of Refugees at Risk of Drug Resistant TB

On Wednesday 8th June 2022 we held the launch event for All Wales Guideline for the Identification and Management of Refugees at Risk of Drug Resistant Tuberculosis

Watch the recording of the event here.

An interactive, 45-minute event to ensure that healthcare professional teams across Wales are aware of the important screening work that is being carried out by TB Teams in each Health Board, and how this will affect the refugees that you might see in practice.

Chaired by: Dr Simon Barry – Respiratory Consultant, National Respiratory Clinical Lead

The expert panel includes:

Dr Simon Barry – Respiratory Consultant, National Respiratory Clinical Lead
Yvonne Hester – Lead TB Clinical Nurse Specialist
Dr Jennifer Evans – Consultant Paediatrician and Paediatric Infectious Disease and Immunology Specialist
Dr Ayla Cosh – GP & Clinical Director – Health Inclusion Service

Thank you to everybody who submitted a question for the Q&A section of the event. Unfortunately a number of these questions were not answered during the event due to time limitations, but written responses have been submitted by the expert panel:

What blood tests to monitor patients on antitubercular treatment?

This is very much decided on an individual basis and dependent on clinical response and whether they are experiencing and side effects from treatment. We would also take into account co morbidities and contra indications. Many of the drug regimens we use for MDR treatment will require drug level monitoring to ensure therapeutic doses and to ensure no toxicity.

The monitoring will be dependent on the drugs used. Bedaquiline for example, requires close monitoring of LFTs, U&E, calcium and magnesium so these would be done at baseline and the monthly. With this particular drug we would also need to do regular ECGs due to QT prolongation.

Who leads the treatment initiation and monitoring in children with latent TB?

This will vary between local TB services. All children are seen by a Paediatrican for full assessment first and then treatment may be prescribed by either the Paediatrician or a TB CNS with a prescribing qualification. All follow up is generally done by the TB CNS team with medical support if needed.

Are there any hand outs we can give prior to our inital reviews as part of LES? Ukranian leaflet about TB screening? I've found one on gov website re imms. I have felt the resistance re: screening and feel that it might be better if it wasn't raised as a 'surprise' in the review appt.

Some information leaflets produced by TB services have already had translated and these may be a helpful resource in informing and educating families (attached below the video).

At new patient checks we have been referring to local TB team and also requesting CXR and bloods (though not IGRA) should we be doing CXR or waiting for TB team to do? Our labs have been declining to do the Vit D level in the guidelines, whats the indication for Vit D request?

Many patients with TB have low vitamin D levels. It’s not very important in screening, and if we identify patients with TB, then we can check the levels then.