South East: tuberculosis in 2023
Published 4 September 2025
© Crown copyright 2025
This publication is licensed under the terms of the Open Government Licence v3.0 except where otherwise stated. To view this licence, visit nationalarchives.gov.uk/doc/open-government-licence/version/3 or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: psi@nationalarchives.gov.uk.
Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned.
This publication is available at https://www.gov.uk/government/publications/tuberculosis-tb-regional-reports-2023/south-east-tuberculosis-in-2023
Incidence, treatment and prevention of tuberculosis (TB) in the South East using data up until the end of 2023
Executive summary
After years of declining rates from 2011, case numbers of tuberculosis (TB) in the South East have increased since 2020. In 2023, 539 people with TB were notified, a rate of 5.9 per 100,000 population. This was below the England average (8.5 per 100,000) and accounted for 11% of the 4,855 notifications in England.
Most of the South East has very low rates of TB. However, high rates were still observed in Slough (34 per 100,000) and Reading (23 per 100,000). In all other upper-tier local or unitary authorities, rates were the same or below the national average.
Since 2020, the number of people with TB born outside the UK has increased; cases among this group accounted for 80% of all reports. The median time since entry for people born abroad was 5 years, and there was an increasing trend in the proportion of people with TB who had recently arrived into the UK (being diagnosed within 2 years of entering).
India was the most common country of birth, accounting for almost 1 in 4 cases. Case numbers in those born in India increased by 22% in 2023 compared to 2022, and the median time from entry to diagnosis was 4 years. The next most common country of birth outside the UK was Pakistan. People with TB from here had the longest median time since entry, 14 years, and total numbers decreased in 2023 compared to 2022.
In 2023 there was a slight increase in TB among people born in the UK, the first time this has increased since 2018. White was the most common ethnic group for those born in the UK.
Just under half of people notified in 2023 had pulmonary disease, and 74% of those had their diagnosis confirmed by culture (against a target of 80%). People with pulmonary TB in the South East had a median delay from symptoms to starting treatment of 104 days, with 2 out of 3 experiencing a delay of more than 2 months.
The proportion of all cases resistant to one or more first line drug remained stable since 2022 at 12%. Among all people with culture-confirmed results, 31% were clustered (less than 12 SNPs) from another person with TB in England.
1 in 5 people had one of the key co-morbidities (diabetes, hepatitis B, hepatitis C, chronic renal disease, chronic liver disease and immunosuppression). Diabetes and immunosuppression were the most common.
Experience of social risk factors, including alcohol misuse, asylum seeker, drug misuse, homelessness, mental health needs and contact with the criminal justice system, was reported by 16% of people with TB aged over 15 years. Social risk factors were more common in people born in the UK and men.
Of the people notified in 2022 who would be expected to receive 6 months standard treatment, (excluding those with rifampicin-resistant, CNS, spinal, miliary or cryptic disseminated disease) 89% had completed at 12 months, close to the target of 90%. This was only slightly lower, 82%, for those with a social risk factor.
People with CNS, spinal, military, or cryptic disseminated TB who were notified in 2022, were likely to have required longer treatment regimens, with a high proportion still on treatment at 12 months. Deaths were more common in this group, with 16% reported as died at 12 months.
Complexity of support required by people with TB was shown through 38% of people requiring enhanced case management and highlights why even small increases in case numbers can require considerable resource from health and allied services.
In conclusion, TB rates in the South East have continued to rise and are now higher than pre-pandemic levels. In addition, almost a third of people with TB in the South East have either a social risk factor or key co-morbidity. This medical and social complexity provides significant challenges to TB control and the achievement of TB elimination in England by 2035.
Data for all the graphs in this report can be found in the South East TB supplementary data 2023 spreadsheet.
TB incidence and epidemiology
In 2023, there were 539 cases of tuberculosis (TB) notified in South East residents, a rate of 5.9 per 100,000 of the population (Figure 1 and Figure 2). This was the highest rate of TB in the South East since 2017, and represents a 20% increase in rate from 2020, where the rate was at its lowest (4.9 per 100,000). However, the rate in 2023 was still 39% lower than the peak in 2011, when rates in the South East were 9.7 per 100,000.
Figure 1. Number of TB notifications per year, South East, 2001 to 2023
An increase in the number of people with TB was also observed nationally from 2022 to 2023. The rate of TB in the South East in 2023 was 30% lower than the rate for England and accounts for 11% of the 4,855 cases in England in 2023.
Since 2021, the observed TB notification rates for the South East were above the required TB notification rates to meet the World Health Organization (WHO) End TB 2035 goal of a 90% reduction in the incidence of TB (Figure 3). In 2023, the observed TB notification rate in the South East of 5.9 was greater than the required rate to meet this goal (Figure 3).
Figure 2. TB notification rates per 100,000 population per year, South East, 2001 to 2023 [note 1]
Note 1: error bars represent upper and lower 95% confidence intervals.
Figure 3. Observed TB notification rate compared with required TB notification rates to meet the WHO End TB 2035 goal of 90% reduction in incidence by 2035, South East, 2015 to 2023 [note 2] [note 3]
Note 2: error bars represent upper and lower 95% confidence intervals.
Note 3: dashed line represents required TB notification rates to meet the WHO End TB 2035 goal of 90% reduction in incidence by 2035.
Slough remained the local authority with the highest rate of TB (34.2 per 100,000, 55 cases), and was the only local authority with rates over 30 per 100,000 (Figure 4). This was followed by Reading (23.0 per 100,000, 41 cases).
Rates increased in all but 3 South East local authorities in 2023 compared to 2022, but this often involved very small numbers, as most areas have very low rates of TB.
Figure 4. TB notification rate by upper tier local authority of residence, South East, 2023
In 2023, 54% (291) of people with TB in the South East were male, and the rate was higher among males than for females (Figure 5 and Figure 6). Rates and absolute numbers were highest for the 30 to 39 age group for both males (66 cases, 11.4 per 100,000) and females (76 cases, 12.2 per 100,000).
Among men, rates in all age groups were below 10 per 100,000, other than in the 30 to 49 age groups. In women, rates in all groups other than those in the 30 to 39 age group were under 10 per 100,000. There were a total of 9 cases under the age of 10 years old. The 30 to 39 and 70 to 79 age groups were the only age groupings where there were a greater number of females compared to males (Figure 5 and Figure 6).
Figure 5. Number of TB notifications by age and sex, South East, 2023
Figure 6. TB notification rate by age and sex, South East, 2023
In 2023, the country of birth was missing for 2 people with TB in the South East. Overall, 80% of all people with TB in the South East were born abroad (428 cases), the same as the proportion of cases born abroad nationally (80%).
The number of cases among people born outside the UK in 2023 is the highest it has been since 2014, almost 4 times greater than the number of people with TB born in the UK (Figure 7). Since 2020, there has been an overall increasing trend in the number of people in the South East with TB that were born abroad.
Figure 7. Number of TB notifications in non-UK-born and UK-born by place of birth, South East, 2001 to 2023
In those with TB born outside of the UK, the highest number of cases in 2023 was in the 15 to 44 age group, accounting for 63% of non-UK-born cases (Figure 8). The number of cases in this age group that were born abroad declined from 2011 until 2018, and since then there has been an increasing trend in case numbers.
The numbers have also increased from 2022 to 2023 in the other age groups. Children aged 0 to 14 years were the only age group that was more often UK-born.
Figure 8. Number of TB notifications in non-UK-born and UK-born by place of birth and age group, South East, 2001 to 2023
In 2023, information on the time since entry to the UK and notification date of TB was available for 94% of people born abroad (404 out of 428). The median time since entry to the UK was 5 years (inter-quartile range (IQR): 1 to 17). Just over a third of people born outside the UK had entered the UK over 10 years ago (37%, 151 out of 404). The proportion of people that had entered the UK over 10 years ago has decreased since 2018, and there was a decrease of 4% between 2022 and 2023.
Notably, there has been an increasing proportion of people with TB born abroad who had entered the UK within the last 2 years since 2020, with the highest proportion (27%) in 2023 since 2005 (Figure 9).
Figure 9. Proportions of TB notifications by time since entry, for people born outside the UK, South East, 2001 to 2023
In 2023, country of birth was unknown for 2 people with TB in the South East. As in previous years, the most common country of birth for people with TB was India (24%, 129 out of 537), and the median time since entry was 4 years (IQR 1 to 17 years) (Table 1).
The UK was the next most frequently reported country of birth, accounting for 20% of people with TB. For those born in Pakistan, the second most common country of birth outside of the UK (8%), the median time since entry was 14 years (IQR 2.5 to 30.5); this was the longest median time since entry. Following Pakistan, the countries of birth with the longest median time since entry was the Philippines (8 years), Nepal (6.5 years) and Romania (6 years). People with TB from Afghanistan, Nigeria, Sudan and Zimbabwe were more likely to be recent entrants, with a median time from entry to diagnosis of 1 to 1.5 years for each country.
Table 1. Most common countries of birth for people with TB and time between entry to the UK and TB notification, South East, 2023 [note 4]
| Country of birth | Number of people notified with TB | Proportion of people notified with TB (%) | Median time since entry to UK in years | IQR of time since entry to UK in years |
|---|---|---|---|---|
| India | 129 | 24.0 | 4.0 | 1.0 to 17.0 |
| United Kingdom | 109 | 20.3 | Not applicable | Not applicable |
| Pakistan | 42 | 7.8 | 14.0 | 2.5 to 30.5 |
| Nepal | 36 | 6.7 | 6.5 | 2.0 to 13.0 |
| Zimbabwe | 21 | 3.9 | 1.5 | 0.8 to 18.2 |
| Philippines | 20 | 3.7 | 8.0 | 3.2 to 20.8 |
| Romania | 20 | 3.7 | 6.0 | 4.0 to 9.5 |
| Afghanistan | 18 | 3.4 | 1.0 | 0.0 to 2.0 |
| Nigeria | 17 | 3.2 | 1.0 | 0.0 to 1.2 |
| Sudan | 8 | 1.5 | 1.0 | 0.8 to 1.2 |
| Other | 117 | 21.8 | 9.0 | 3.0 to 20.0 |
| Total | 537 | 100.0 | Not applicable | Not applicable |
Note 4: other includes all countries with less than 8 people notified.
In the 6 most common countries of birth (outside the UK), the greatest proportional increase in 2023 was for those born in Zimbabwe (320%), although this is reflected by very small numbers. This was followed by a 54% increase for the Philippines, 38% increase for Nepal and 22% increase for India. There was a decrease in the number of people with TB from Romania (17% decrease) and Pakistan (5% decrease). The number of people with TB born in Pakistan in the South East has remained relatively stable since 2018 (Figure 10).
Figure 10. Numbers of TB notifications for the most common countries of birth for people with TB born outside the UK, South East, 2013 to 2023 [note 5]
Note 5: figure shows the top 6 countries in 2023.
For the most common countries of birth, people with TB born in Pakistan had the highest median age at 50 years and highest proportion of males (55%) (Table 2).
People born in Zimbabwe had the lowest median age of 37 years and the highest proportion of recent entrants diagnosed within 2 years since entry (50%). People born in India with TB had the lowest proportion with pulmonary TB. People born in Romania had the highest proportion of cases with pulmonary TB (65%) but had no UK entrants in the 2 years before diagnosis.
Overall, the most common ethnic group of people with TB in the South East was Indian in 2023. This was also the most common ethnic group for non-UK-born people with TB, followed by Black African and Asian-Other. For UK-born people with TB, White was the most common ethnic group (Figure 11).
Table 2. Characteristics of people with TB from the most common (non-UK) countries of birth, South East, 2023
| Country of birth | Number of people notified with TB | Mean age (years) | Proportion male (%) | Proportion pulmonary (includes laryngeal and miliary) (%) | Proportion with UK entry less than 2 years (%) | Proportion pulmonary of those in the UK less than 2 years (%) |
|---|---|---|---|---|---|---|
| India | 129 | 41.3 | 48.1 | 30.2 | 26.0 | 39.4 |
| Pakistan | 42 | 50.0 | 54.8 | 38.1 | 17.9 | 28.6 |
| Nepal | 36 | 47.8 | 27.8 | 38.9 | 23.5 | 50.0 |
| Zimbabwe | 21 | 37.1 | 47.6 | 61.9 | 50.0 | 40.0 |
| Philippines | 20 | 42.5 | 45.0 | 45.0 | 16.7 | 66.7 |
| Romania | 20 | 40.2 | 50.0 | 65.0 | 0.0 | 0.0 |
Figure 11. Number of TB notifications in ethnic groups by place of birth (UK and non-UK-born), South East, 2023 [note 6]
Note 6: figure ordered by total number of notifications within each ethnicity irrespective of place of birth.
Just under half (49%, 262 out of 539) of those notified with TB in 2023 had pulmonary disease (Table 3). The most common site for extra-pulmonary TB (353 cases) was extra-thoracic lymph nodes (139, 26%) and intra-thoracic lymph nodes (100, 19%).
Table 3. Number of pulmonary TB notifications by site of disease, South East, 2023 [note 7] [note 8]
| Site of disease | Number of people notified with TB | Proportion of people |
|---|---|---|
| notified with TB (%) | ||
| All pulmonary | 262 | 48.6 |
| Pulmonary only | 186 | 34.5 |
| Miliary only | 9 | 1.7 |
| Laryngeal only | 2 | 0.4 |
Note 7: percentages may not add up to 100 as people with TB may have more than one site of disease.
Note 8: ‘pulmonary only’ includes people notified with only pulmonary TB and therefore have not also been notified with miliary, laryngeal and/or extra-pulmonary TB.
Table 4. Number of extra-pulmonary TB notifications by site of disease, South East, 2023 [note 9]
| Site of disease | Number of people notified with TB | Proportion of people notified with TB (%) |
|---|---|---|
| All extra-pulmonary | 353 | 65.5 |
| Extra-thoracic lymph nodes | 139 | 25.8 |
| Other extra-pulmonary | 100 | 18.6 |
| Intra-thoracic lymph nodes | 55 | 10.2 |
| Pleural | 43 | 8.0 |
| Bone - spine | 33 | 6.1 |
| Gastrointestinal | 32 | 5.9 |
| Genitourinary | 13 | 2.4 |
| Bone - not spine | 12 | 2.2 |
| Central nervous system - meningitis | 10 | 1.9 |
| Central nervous system - other | 5 | 0.9 |
| Cryptic disseminated | 5 | 0.9 |
The proportion of people with pulmonary site of disease was similar to recent years, although lower than 2022 (52%) (Figure 12). People with pulmonary disease were more often male (61%), born abroad (72%) and aged 25 to 34 years (24%).
Figure 12. Proportion of people notified with pulmonary TB, South East, 2013 to 2023 [note 10]
Note 10: error bars represent upper and lower 95% confidence intervals.
Data for several comorbidities (diabetes, hepatitis B and C, chronic liver disease, chronic renal disease, and immunosuppression) is routinely collected as part of TB surveillance.
Over 1 in 5 (21%, 112 out of 539) of people with TB had at least one of these comorbidities. The most common were diabetes (9%) and immunosuppression (9%) (Table 4).
HIV testing information was recorded for 98% (530 out of 539) of cases. HIV tests were offered or result already known for 98% (517 out of 530) of these (Figure 13). Of those offered, 24 did not receive the test. The proportion not offered testing was 2.5% (13 out of 530). Of those not offered, 10 (77%) were male, 8 (62%) were non-UK-born and 4 (31%) were children under the age of 15 years.
Table 5. Number and proportion of people with TB with comorbidities, South East, 2023 [note 11]
| Comorbidity | Total with data reported | Number of people notified with TB with comorbidities | Proportion of people notified with TB with comorbidities (%) | Number of people notified with TB missing comorbidity data | Proportion of people notified with TB missing comorbidity data (%) |
|---|---|---|---|---|---|
| At least one of the named comorbidities | 539 | 112 | 20.8 | Not applicable | Not applicable |
| Chronic liver disease | 511 | 2 | 0.4 | 28 | 5.2 |
| Chronic renal disease | 515 | 16 | 3.1 | 24 | 4.5 |
| Diabetes | 517 | 48 | 9.3 | 22 | 4.1 |
| Hepatitis B | 483 | 12 | 2.5 | 56 | 10.4 |
| Hepatitis C | 482 | 5 | 1.0 | 57 | 10.6 |
| Immunosuppression | 511 | 46 | 9.0 | 28 | 5.2 |
Note 11: people with TB are reported as having at least one of the named comorbidities if any of the 6 comorbidities (chronic liver disease, chronic renal disease, diabetes, hepatitis B, hepatitis C or immunosuppression) had ‘yes’ recorded. As a result, the denominator is all notifications. This assumes that people for whom no data was recorded for individual comorbidities were a ‘no’ and may result in under-estimation.
Figure 13. Proportion of people with TB offered an HIV test by year, South East, 2018 to 2023 [note 12] [note 13]
Note 12: dashed line indicates target of 100% of people offered HIV test.
Note 13: error bars represent upper and lower 95% confidence intervals.
Data for several social risk factors (alcohol misuse, asylum seeker, drug misuse, homelessness, mental health needs and prison) is routinely collected as part of TB surveillance.
Where known, the proportion of people with TB, aged over 15 years, with at least one social risk factor was 16% in 2023 (Table 5). More than one social risk factor was recorded for 35 (7%) individuals with TB. The prevalence of social risk factors decreased in 2023 compared to 2022 but was still higher than previous years (Table 6).
The most common social risk factor was experience of current or previous homelessness (6.2%, 31 out of 497 individuals with information). This was followed by current or previous drug misuse (6.0%) and current asylum seeker status (5.3%).
Table 6. Number and proportion of people with TB aged 15 years or over with individual social risk factors, South East, 2023 [note 14]
| Social risk factor | Total with data reported | Number of people notified with TB with social risk factors | Proportion of people notified with TB with social risk factors (%) | Number of people notified with TB and missing social risk factor data | Proportion of people notified with TB and missing social risk factor data (%) |
|---|---|---|---|---|---|
| At least one named social risk factor | 525 | 83 | 15.8 | Not applicable | Not applicable |
| More than one social risk factor | 509 | 35 | 6.9 | 16 | 3 |
| Alcohol misuse (current) | 497 | 19 | 3.8 | 28 | 5.3 |
| Asylum seeker (current) | 508 | 27 | 5.3 | 10 | 1.9 |
| Drug misuse (current or previous) | 498 | 30 | 6.0 | 27 | 5.1 |
| Homelessness (current or previous) | 497 | 31 | 6.2 | 28 | 5.3 |
| Mental health needs (current) | 495 | 16 | 3.2 | 30 | 5.7 |
| Prison (current or previous) | 493 | 16 | 3.2 | 32 | 6.1 |
Note 14: people with TB are reported as having at least one of the named social risk factors if any of the 6 social risk factors (current alcohol misuse, current or a history of homelessness, drug misuse, imprisonment, current asylum seeker status and current mental health needs) had ‘yes’ recorded. As a result, the denominator is all notifications. This assumes that people for whom no data was recorded for individual social risk factors were a ‘no’ and may result in under-estimation.
Table 7. Number and proportion of people with TB aged 15 years or over reporting at least one social risk factor, South East, 2013 to 2023 [note 15]
| Year | Number of people notified with TB with any social risk factor | Proportion of people notified with TB with any social risk factor (%) | Total notifications |
|---|---|---|---|
| 2013 | 48 | 7.2 | 664 |
| 2014 | 46 | 7.2 | 641 |
| 2015 | 62 | 10.7 | 578 |
| 2016 | 49 | 9.0 | 545 |
| 2017 | 49 | 9.4 | 519 |
| 2018 | 48 | 10.0 | 480 |
| 2019 | 54 | 11.0 | 491 |
| 2020 | 45 | 10.5 | 429 |
| 2021 | 52 | 10.4 | 498 |
| 2022 | 88 | 19.0 | 464 |
| 2023 | 83 | 15.8 | 525 |
Note 15: not all social risk factors were captured before 2021 and that this table includes people with no information recorded in the denominator.
In 2023, males with TB were more likely to report experience of each social risk factor than females (Table 7). Drug misuse was the most common in males (11%) and mental health needs was the most common in females (3%). Reports of having a social risk factor varied by age group. A social risk factor was more likely to be reported by those aged 15 to 44 years (19%), compared to those aged 45 to 64 years (13%) and over 65s (5%). UK-born people with TB were also more likely to report having a social risk factor compared to people born outside the UK (26% compared to 13%) (Table 7). For people with TB born outside the UK, asylum seeker status (7%) and experience of homelessness (5%) were the most commonly reported social risk factors. This differed to UK-born people with TB where experience of alcohol misuse (20%), and homelessness (12%) were most commonly reported.
Table 8. Number and proportion of people with TB aged 15 years or over with a social risk factor (SRF) by demographic characteristics, South East, 2023
| Demographic characteristics | Any social risk factor (number) | Any social risk factor (proportion) |
|---|---|---|
| Female | 16 | 6.5 |
| Male | 67 | 23.0 |
| Aged 15 to 44 | 61 | 19.3 |
| Aged 45 to 64 | 19 | 12.6 |
| Aged 65 or older | 3 | 5.2 |
| Non-UK-born | 56 | 13.1 |
| UK-born | 27 | 26.2 |
Deprivation was assessed using the 2019 Index of Multiple Deprivation. In 2023, 40% of all people with TB were resident in the 4 most deprived deciles of the South East (212 out of 539) (Figure 14). Rates were the highest in decile 2 (12 per 100,000) and 4 (10 per 100,000). Although the trend is not linear, the rate generally decreased along with decreasing deprivation, reaching 3 per 100,000 in the least deprived quintile.
Figure 14. TB notification rate by deprivation decile, South East, 2023 [note 16]
Note 16: error bars represent upper and lower 95% confidence intervals.
TB diagnosis, microbiology and drug resistance
In 2023 in the South East, 299 out of 539 people with TB had their diagnosis culture-confirmed, 55%. The proportion of people notified with pulmonary TB that had their diagnosis culture-confirmed was 74% (193 out of 262) (Figure 15). This is lower than the target of 80% which has not been reached in the South East since 2017.
Figure 15. Proportion of people notified with pulmonary TB who were culture-confirmed, South East, 2017 to 2023 [note 17] [note 18]
Note 17: dashed line indicates target of 80% culture confirmation.
Note 18: error bars represent upper and lower 95% confidence.
Of the 299 people with culture-confirmed TB in 2023, 98.7% had first line drug results. 37 people (12%) with culture-confirmed TB had initial resistance to at least one first line drug. Twenty-one of these had resistance to Pyrazinamide, 20 people had resistance to Isoniazid, 9 people had resistance to Rifampicin and 6 people had resistance to Ethambutol. There were 7 cases treated for multi-drug resistant (MDR) TB in 2023. This is a similar proportion of initial resistance to first line drugs to 2022 but is higher that the proportion of resistance prior to this (Figure 16).
Figure 16. Proportion of people notified with culture-confirmed TB with initial resistance to any first line drug, South East, 2017 to 2023 [note 19]
Note 19: error bars represent upper and lower 95% confidence intervals.
Individuals are assigned to a Whole Genome Sequencing (WGS) cluster if their isolate is found to be within 12 single nucleotide polymorphisms (SNPs) of an isolate from another person in the database.
Out of the 299 people with culture-confirmed TB in the South East in 2023, 94 (31%) were less than 12 SNPs from another person with TB in England (Table 9). The number of people with TB identified as being in a cluster has stayed between 27 and 32% since 2020.
Table 9. Number of people notified, proportion with culture confirmation and proportion of notifications identified in a WGS cluster, South East, 2020 to 2023 [note 20] [note 21]
| Year | Total TB notifications | Number of notifications cultured | Proportion of notifications cultured | Number of culture-confirmed notifications identified in a cluster with more than one person | Proportion of culture-confirmed notifications identified in a cluster with more than one person (%) | 95% confidence interval |
|---|---|---|---|---|---|---|
| 2020 | 441 | 241 | 54.6 | 77 | 32.0 | 26.4 to 38.1 |
| 2021 | 506 | 303 | 59.9 | 81 | 26.7 | 22.1 to 32 |
| 2022 | 478 | 279 | 58.4 | 82 | 29.4 | 24.4 to 35 |
| 2023 | 539 | 299 | 55.5 | 94 | 31.4 | 26.4 to 36.9 |
| Total | 1,964 | 1,122 | 57.1 | 334 | 29.8 | 27.2 to 32.5 |
Note 20: a WGS cluster is defined as 2 or more individuals that have isolates with a less than 12 SNP difference.
Note 21: WGS cluster reporting has changed over time. These changes are likely to have affected the most recent year’s data.
TB in children: incidence, epidemiology and microbiology
In 2023, there were 14 cases of TB notified in children under the age of 15 years old, resident in the South East (Figure 17). TB rates in children remain very low in the South East (0.9 per 100,000 of the population, Figure 18).
Of the 14 children aged under 15 years notified in 2023, 8 were born in the UK and 7 were BCG vaccinated. 7 had pulmonary TB and 2 children aged less than 10 years old had severe TB, defined as cases with CNS, spinal, cryptic or miliary TB.
Figure 17. Number of TB notifications in children aged under 15 years, South East, 2001 to 2023
Figure 18. TB notification rate in children aged under 15 years, South East, 2001 to 2023 [note 22]
Note 22: error bars represent upper and lower 95% confidence intervals.
TB treatment
The Royal College of Nursing TB case management tool provides standardised recommendations for enhanced case management (ECM) in individuals receiving anti-TB treatment with clinical or social complexities.
The ECM levels are:
- ECM level 1: people with clinical or social issues which impact on treatment, for example, children with TB, or those taking antiretrovirals
- ECM level 2: people with complex clinical and/or social issues which impact on treatment, for example, complex side effects or single drug resistance, which may necessitate weekly visits
- ECM level 3: people with very complex clinical and or social issues which impact on treatment, for example, social risk factors or MDR RR TB which necessitates directly observed therapy (DOT) or video observed therapy (VOT)
In 2023, 38% of people with TB were recorded as receiving ECM (207 out of 539) (Table 10). Out of the 3 levels, Level 3 ECM was most frequently required (16%, 87 cases), followed by 13% (68 cases) receiving level 1 and 10% (51 cases) receiving level 2.
Table 10. Number of people with TB receiving enhanced case management, South East, 2021 to 2023 [note 23]
| Year | Total TB notifications | Any ECM (number) | Any ECM (proportion) | Level 1 (number) | Level 1 (proportion) | Level 2 (number) | Level 2 (proportion) | Level 3 (number) | Level 3 (proportion) | Unknown level (number) | Unknown level (proportion) |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 2021 | 506 | 152 | 30.0 | 47 | 9.3 | 39 | 7.7 | 63 | 12.5 | 3 | 0.6 |
| 2022 | 478 | 210 | 43.9 | 63 | 13.2 | 54 | 11.3 | 92 | 19.2 | 1 | 0.2 |
| 2023 | 539 | 207 | 38.4 | 68 | 12.6 | 51 | 9.5 | 87 | 16.1 | 1 | 0.2 |
Note 23: total TB notifications includes all people notified with TB regardless of whether they are receiving ECM or not, or if this information is missing.
Treatment delay is defined as the time from symptom onset to treatment start. This includes from symptom onset to first presentation to healthcare and from the first presentation to diagnosis and start of TB treatment. Information on delay was calculated for 95% of people (248 out of 262) with pulmonary TB in 2023 who did not have a postmortem diagnosis.
The proportion of people notified with pulmonary TB with a treatment delay over 2 months in the South East in 2023 was 66%, similar to previous years (Figure 19). People notified with extra-pulmonary TB were slightly more likely to have delays of over 2 months (71% in 2023).
Figure 19. Proportion of people notified with pulmonary TB with a treatment delay over 2 months, South East, 2018 to 2023 [note 24] [note 25]
Note 24: error bars represent upper and lower 95% confidence intervals.
Note 25: delay to treatment is defined by when treatment was started from symptom onset.
In 2023, around a quarter of people with pulmonary TB experienced a delay of 2 to 4 months, less than all previous years between 2018 and 2022. However, a delay of over 4 months was observed for 42% of people with pulmonary TB, this was the highest proportion since 2018 (Table 11). Median time from symptom onset to start of treatment was 103 days (IQR 45 to 187), much higher than the median time observed since 2018 (range: 75 to 92) (Figure 20). The lower proportion with a 2 to 4 month delay is a result of the increasing proportion with a delay of greater than 4 months.
Table 11. Number and proportion of people notified with pulmonary TB with a treatment delay, time between symptom onset and treatment start, South East, 2018 to 2023 [note 26]
| Year | 2 to 4 months delay (number) | 2 to 4 months delay (proportion) | Over 4 months delay (number) | Over 4 months delay (proportion) | Total | Missing (number) | Missing (proportion) | Total eligible |
|---|---|---|---|---|---|---|---|---|
| 2018 | 82 | 32.7 | 71 | 28.3 | 251 | 12 | 4.6 | 263 |
| 2019 | 73 | 28.1 | 93 | 35.8 | 260 | 13 | 4.8 | 273 |
| 2020 | 64 | 33.7 | 66 | 34.7 | 190 | 11 | 5.5 | 201 |
| 2021 | 73 | 32.7 | 75 | 33.6 | 223 | 26 | 10.4 | 249 |
| 2022 | 60 | 29.4 | 72 | 35.3 | 204 | 40 | 16.4 | 244 |
| 2023 | 52 | 24.3 | 90 | 42.1 | 214 | 34 | 13.7 | 248 |
Note 26: all people included in this table are people with pulmonary TB who did not have a postmortem diagnosis and it was known that they had started treatment. People included within the ‘Total’ includes these individuals and where the time from symptom onset to treatment start was also known. ‘Total eligible’ includes people in ‘Total’ plus those people where the time from symptom onset to treatment start was unknown/missing. Percentages for ‘2 to 4 month delay’ and ‘over 4 months’ delay were calculated using the ‘Total’ figure. The percentage for ‘Missing’ uses ‘Total eligible’. ‘2 to 4 month delay’ includes people with a delay of 61 to 121 days inclusive. An ‘over 4 month delay’ includes people with a delay between 122 and 730 days inclusive.
Figure 20. Median treatment delays among people notified with pulmonary TB, South East, 2018 to 2023 ]note 27] [note 28] [note 29] [note 30]
Note 27: dashed line represents the target treatment delay of 56 days by 2027.
Note 28: ends of the whiskers represent the theoretical lower and upper limits for detecting outliers (lower or upper quartile negative or positive 1.5 times the interquartile range). Outliers falling outside of these limits have been removed.
Note 29: delay to treatment is defined by when treatment was started from symptom onset.
Note 30: all people included in this figure are people with pulmonary TB who did not have a postmortem diagnosis and it was known that they had started treatment. It excludes individuals with a delay over 730 days.
TB treatment outcomes
In 2022, 89% (380 out of 429) of those with expected treatment durations of less than 12 months, had completed treatment by 12 months. This excluded people who had MDR and rifampicin-resistant TB, as well as those with CNS, spinal, miliary or cryptic disseminated disease where expected treatment durations are longer.
Reasons for not completing included still being on treatment (4%, 18 out of 429), loss to follow up (3%, 13 out of 429) and death (3%, 11 out of 429). At the last recorded treatment outcome, a further 16 people completed treatment bringing completion to 92%. There were no further deaths or people lost to follow up and a further 1 person had treatment stopped (Table 12).
Compared to 2022, the completion at 12 months decreased slightly by 2% from 91%, but has remained close to the target of 90% in recent years (Figure 21).
For people with one or more social risk factor recorded, the completion rate at 12 months remained relatively stable between 2021 and 2022 at around 82%. This was higher than it was in 2018 (78%) and 2020 (76%) (Figure 22).
Table 12. Treatment outcome at 12 months and last recorded outcome for people notified in 2022 with non-MDR or non-RR TB with expected treatment duration less than 12 months, South East, 2022 [note 31] [note 32]
| Outcome | TB treatment outcome at 12 months (number) | TB treatment outcome at 12 months (proportion) | Last recorded treatment outcome (number) | Last recorded treatment outcome (proportion) |
|---|---|---|---|---|
| Treatment completed | 380 | 88.6 | 396 | 92.3 |
| Died | 11 | 2.6 | 11 | 2.6 |
| Lost to follow up | 13 | 3.0 | 13 | 3.0 |
| Still on treatment | 18 | 4.2 | 2 | 0.5 |
| Treatment stopped | 3 | 0.7 | 4 | 0.9 |
| Not evaluated | 4 | 0.9 | 3 | 0.7 |
| Total | 429 | 100.0 | 429 | 100.0 |
Note 31: not evaluated indicates that the treatment outcome was not evaluated, not recorded or is unknown and the final outcome is not still on treatment nor died.
Note 32: table does not include people notified with CNS, spinal, cryptic or miliary TB or people notified with a postmortem diagnosis of TB.
Figure 21. Proportion of people with non-severe TB treated for non-MDR or non-RR TB who completed treatment within 12 months compared with the target of 90%, South East, 2018 to 2022 [note 33] [note 34]
Note 33: dashed line indicates treatment target of 90%.
Note 34: error bars represent upper and lower 95% confidence intervals.
Figure 22. Proportion of people treated for non-MDR or non-RR TB without central nervous system (CNS) disease and with one or more social risk factors who completed treatment within 12 months, South East, 2018 to 2022 [note 35]
Note 35: error bars represent upper and lower 95% confidence intervals.
The proportion of people who died before completing treatment at 12 months was the lowest (2.6%, 11 cases) since 2013 (Figure 23). Loss to follow up was higher for people notified in 2022 compared to 2020 and 2021. The proportion of people still on TB treatment at 12 months (4.2%, 18 cases) was the highest since 2018, having decreased between 2018 and 2020. The proportion with treatment stopped was very low accounting for just 3 cases (0.7%).
Figure 23. Outcomes of people evaluated who did not complete treatment by 12 months for people with non-MDR or non-RR TB and expected treatment duration, South East, 2013 to 2022
There were 25 people notified in 2022 with CNS, miliary or cryptic disseminated TB, that was rifampicin-sensitive. At 12 months, only around half (52%, 13) had completed treatment. Of the 12 that had not completed treatment, 7 were still on treatment, 4 had died and 1 was lost to follow up.
For MDR and RR TB, the treatment outcome is measured at 24 months, so outcomes are presented for people notified up to 2021. In 2021, 66.7% (6 out of 9) of those with MDR and rifampicin-resistant TB completed treatment at 24 months. Of the 3 that had not completed treatment, 1 had died, 1 was still on treatment, and 1 unknown. This is down from 100% treatment completion between 2018 and 2020, although numbers are very small so year-on-year fluctuations should be interpreted with caution.
Table 13. TB outcome at 12 months for people with non-RR or MDR-TB with expected treatment duration of within 12 months, South East, 2013 to 2022 [note 36]
| Year | Treatment completed (number) | Treatment completed with any social risk factor (number) | Died (number) | Lost to follow up (number) | Still on treatment (number) | Treatment stopped (number) | Not evaluated (number) | Total (number) |
|---|---|---|---|---|---|---|---|---|
| 2013 | 548 | 37 | 21 | 19 | 10 | 1 | 4 | 603 |
| 2014 | 525 | 33 | 24 | 22 | 12 | 3 | 8 | 594 |
| 2015 | 440 | 43 | 36 | 15 | 18 | 2 | 2 | 513 |
| 2016 | 431 | 39 | 27 | 14 | 24 | 1 | 3 | 500 |
| 2017 | 407 | 33 | 20 | 23 | 13 | 2 | 4 | 469 |
| 2018 | 384 | 35 | 23 | 16 | 19 | 3 | 1 | 446 |
| 2019 | 396 | 38 | 17 | 15 | 14 | 4 | 3 | 449 |
| 2020 | 334 | 28 | 20 | 4 | 7 | 6 | 1 | 372 |
| 2021 | 393 | 35 | 12 | 4 | 18 | 4 | 2 | 433 |
| 2022 | 380 | 65 | 11 | 13 | 18 | 3 | 4 | 429 |
Note 36: not evaluated indicates that the treatment outcome was not evaluated, not recorded or is unknown and the final outcome is not ‘still on treatment’ or ‘died’ within the timeframe of 12 months. Data includes all sites except cases with CNS, spinal, cryptic or miliary TB.
Table 14. Proportions of TB outcomes at 12 months for people with non-RR or MDR-TB with expected treatment duration of less than 12 months, South East, 2013 to 2022 [note 37]
| Year | Treatment completed (proportion) | Treatment completed with any social risk factor (proportion) | Died (proportion) | Lost to follow up (proportion) | Still on treatment (proportion) | Treatment stopped (proportion) | Not evaluated (proportion) |
|---|---|---|---|---|---|---|---|
| 2013 | 90.9 | 6.1 | 3.5 | 3.2 | 1.7 | 0.2 | 0.7 |
| 2014 | 88.4 | 5.6 | 4.0 | 3.7 | 2.0 | 0.5 | 1.3 |
| 2015 | 85.8 | 8.4 | 7.0 | 2.9 | 3.5 | 0.4 | 0.4 |
| 2016 | 86.2 | 7.8 | 5.4 | 2.8 | 4.8 | 0.2 | 0.6 |
| 2017 | 86.8 | 7.0 | 4.3 | 4.9 | 2.8 | 0.4 | 0.9 |
| 2018 | 86.1 | 7.8 | 5.2 | 3.6 | 4.3 | 0.7 | 0.2 |
| 2019 | 88.2 | 8.5 | 3.8 | 3.3 | 3.1 | 0.9 | 0.7 |
| 2020 | 89.8 | 7.5 | 5.4 | 1.1 | 1.9 | 1.6 | 0.3 |
| 2021 | 90.8 | 8.1 | 2.8 | 0.9 | 4.2 | 0.9 | 0.5 |
| 2022 | 88.6 | 15.2 | 2.6 | 3.0 | 4.2 | 0.7 | 0.9 |
Note 37: not evaluated indicates that the treatment outcome was not evaluated, not recorded or is unknown and the final outcome is not ‘still on treatment’ or ‘died’ within the timeframe of 12 months. Data includes all sites except cases with CNS, spinal, cryptic or miliary TB.
TB prevention
Contact information is presented for people with pulmonary TB. The proportion of people with pulmonary TB with at least 5 contacts has been increasing since 2018 (15%) to 2023 (21%) (Figure 24).
Figure 24. Proportion of people notified with pulmonary TB with at least 5 contacts identified and screened for active and latent TB by year, South East, 2018 to 2023 [note 38]
Note 38: error bars represent upper and lower 95% confidence intervals.
The median number of contacts identified for all pulmonary TB cases was just 3 (IQR 1 to 5). Females were more likely to have 5 or more contacts identified and screened (26% for females versus 18% for males).
UK-born people with TB were slightly more likely to have 5 or more contacts identified (26%) than those born abroad (19%).
The median number of contacts identified was higher than the median for all people with pulmonary TB for those with MDR or RR TB and children (median of 5 for both) (Table 15).
Table 15. Contact tracing information for people with pulmonary TB by demographic and disease characteristics, South East, 2023 [note 39] [note 40] [note 41]
| Category | Total | Contact information entered (number) | Contact information entered (proportion) | 5 or more contacts identified and screened (number) | 5 or more contacts identified and screened (proportion) | Median contacts identified and screened (median) | IQR of contacts identified and screened |
|---|---|---|---|---|---|---|---|
| All people with pulmonary TB | 260 | 222 | 85.4 | 54 | 20.8 | 3.0 | 1.0 to 5.0 |
| Female | 100 | 86 | 86.0 | 26 | 26.0 | 3.0 | 2.0 to 5.5 |
| Male | 160 | 136 | 85.0 | 28 | 17.5 | 2.0 | 1.0 to 4.8 |
| Adults | 253 | 218 | 86.2 | 52 | 20.6 | 3.0 | 1.0 to 5.0 |
| Children (15 years or less) | 7 | 4 | 57.1 | 2 | 28.6 | 5.0 | 2.5 to 20.5 |
| Non-UK-born | 187 | 160 | 85.6 | 35 | 18.7 | 3.0 | 1.0 to 5.0 |
| UK-born | 72 | 61 | 84.7 | 19 | 26.4 | 2.5 | 1.0 to 6.0 |
| No social risk factor | 203 | 172 | 84.7 | 41 | 20.2 | 3.0 | 1.0 to 5.0 |
| At least 1 social risk factor | 57 | 50 | 87.7 | 13 | 22.8 | 3.0 | 1.0 to 5.0 |
| Non-MDR or RR TB | 256 | 218 | 85.2 | 52 | 20.3 | 3.0 | 1.0 to 5.0 |
| MDR or RR TB | 4 | 4 | 100.0 | 2 | 50.0 | 5.0 | 2.5 to 5.5 |
Note 39: routine contact tracing information is collected from close contacts only. Individuals identified as part of an incident are collected separately and not included in this table.
Note 40: individuals with more than 65 contacts were excluded as indicative of a large outbreak investigation and therefore not representative of the routine contact tracing.
Note 41: individuals with more than 65 contacts were excluded as indicative of a large outbreak investigation and therefore not representative of the routine contact tracing.
A total of 1,054 contacts were identified from 222 people with pulmonary TB: 812 (77%) were adults and 242 (33%) were child contacts. Of these, 767 (73%) were screened, which yielded 2.5% with active disease and 24% with latent infection. Higher yields were identified in child contacts (4% active disease and 33% latent infection).
Among those with latent TB infection, just 68% started treatment (81% for children), and just 56% completed treatment (71% for children verses 48% for adults) (Table 16).
Table 16. Number of contacts identified, screened, screening results and treatment for contacts of people notified with pulmonary TB (index individuals), South East, 2023 [note 42]
| Treatment and screening categories | All adult contacts (number) | All adult contacts (proportion) | All child contacts (number) | All child contacts (proportion) | Total contacts (number) | Total contacts (proportion) |
|---|---|---|---|---|---|---|
| Number of contacts identified | 812 | Not applicable | 242 | Not applicable | 1,054 | Not applicable |
| Number of contacts screened for active TB and latent TB | 578 | 71.2 | 189 | 78.1 | 767 | 72.8 |
| Number of contacts with active TB | 12 | 2.1 | 7 | 3.7 | 19 | 2.5 |
| Number of contacts with latent TB | 124 | 21.5 | 62 | 32.8 | 186 | 24.3 |
| Number of contacts who started treatment for latent TB | 77 | 62.1 | 50 | 80.6 | 127 | 68.3 |
| Number of contacts who completed treatment for latent tuberculosis | 60 | 48.4 | 44 | 71 | 104 | 55.9 |
Note 42: individuals with more than 65 contacts were excluded as indicative of a large outbreak investigation and therefore not representative of the routine contact tracing.
BCG immunisation is recommended for people at higher risk of exposure to TB, particularly to protect against serious forms of disease in infants. Those eligible are:
- all infants (up to 12 months) with a parent or grandparent born in a country where incidence of TB is over 40 cases per 100,000 population per year
- all infants living in an area of the UK with an incidence above 40 per 100,000 population
The timing of the neonatal BCG immunisation was changed to a 28-day immunisation programme in September 2021. This change was prompted by the addition of screening for severe combined immunodeficiency (SCID) to the routine newborn screening test at 5 days of age.
Coverage data for BCG is available from the Cover of vaccination evaluated rapidly (COVER) programme Coverage Statistics 2022 and 2023 - NHS England Digital. Coverage is assessed at 3 months, with overall coverage for the South East 64.8% of the eligible population in 2022 to 2023. Coverage varied by local authority, from 5% in Surrey to 87% in Portsmouth.
Of all South East residents notified in 2023, 47% (251 cases) had received BCG. Consistent with previous years, a higher proportion of non-UK-born cases had received BCG. Of the 6 children aged less than 5 years old with TB, all were born in the UK, and half had received BCG. Similarly, 50% of children under 15 years old were vaccinated (7 out of 14) (Table 17).
Table 17. BCG vaccination coverage among people with TB, South East, 2023
| Place of birth | Number of vaccinated people with TB under 5 years old | Total number of people with TB under 5 years old | Proportion of vaccinated people with TB under 5 years old | Number of vaccinated people with TB under 15 years old | Total number of people with TB under 15 years old | Proportion of vaccinated people with TB under 15 years old | Number of vaccinated people with TB (all ages) | Total number of people with TB (all ages) | Proportion of vaccinated people with TB (all ages) |
|---|---|---|---|---|---|---|---|---|---|
| Non-UK-born | 0 | 0 | 0 | 3 | 6 | 50 | 206 | 428 | 48 |
| UK-born | 3 | 6 | 50 | 4 | 8 | 50 | 44 | 109 | 40 |
| All cases | 3 | 6 | 50 | 7 | 14 | 50 | 251 | 539 | 47 |
Discussion
The South East of England remains a mostly very low incidence area for TB, below the average for England. Case numbers have, however, been increasing since 2020, the reversal of a downward trend that had been observed since 2011. Even allowing for some impact of the COVID-19 pandemic, case numbers have continued to rise in the South East and are now higher than the numbers before the pandemic. This means the South East is no longer on track to meet the WHO End TB 2035 goal of a 90% reduction in incidence.
A small number of local authorities have significant rates of disease, such as Slough and Reading, while most local authorities see very low numbers of people with TB. The increase in case numbers since 2020 has been mostly among people who were born outside of the UK, and particularly in those aged 15 to 44 years old. Of those born outside the UK, the increase has also been in those entering the UK more recently: more than a quarter of those who were born abroad had entered the UK less than 2 years before their diagnosis. However a considerable proportion of cases still occur in people who are in the UK for many years (just over a third of non-UK-born people had been in the UK for over 10 years).
The most common country of birth was India, where 24% of all people with TB in the South East had been born. TB case numbers among people born in India have increased by 22% in 2023, with an increasing trend since 2020. People from India were more often recent migrants (the median time since entry was 4 years, and 26% were diagnosed within 2 years of entering the UK).
People with TB in the South East frequently had other medical concerns: over 1 in 5 reported one of the key co-morbidities collected in surveillance, with diabetes and immunosuppression the most common. Increased risk of disease in those receiving immune-suppressing treatments, and the potential complications to management of TB in the context of multi-morbidity are areas for careful monitoring by TB and other healthcare services.
In addition, 17% of people with TB had one or more of the key social risk factors collected within surveillance. These therefore remain a group of particular public health priority, requiring efforts to reduce the inequity in risk of, and successful treatment of TB. Almost half of the TB cases had pulmonary disease, a slight decrease from the previous 2 years and 74% of these were culture-confirmed, which remains below the 80% target for culture confirmation. Culture confirmation has important implications for the ability to carry out WGS, and provide information on drug resistance and relatedness. The proportion of people experiencing long delays between symptom onset and starting treatment has been increasing, with 42% of people with pulmonary TB in the South East in 2023 having a delay of more than 4 months from first experiencing symptoms to starting treatment.
Treatment completion remains high among people with TB in the South East. For people notified with TB in 2022, where their expected treatment duration was less than 12 months, 89% had completed treatment by 12 months. This is higher than seen for all people with TB in England, and remains close to the 90% target. It was, however, lower among people with one or more social risk factors, where additional work is needed to reduce this inequity.
Contact tracing is a key intervention for early identification of cases and preventing disease. Only around a fifth of people with pulmonary disease had at least 5 contacts identified and screened for TB, and the median number of contacts identified and screened per pulmonary index case was just 3. As this varied by person characteristics (for example females reported a higher median number of contacts), this suggests more could be done to identify and screen around some individuals.
While TB rates remain low across most of the South East, there has been a rise in case numbers in recent years, and TB services in low incidence areas can be particularly affected by large fluctuations in numbers. Complexity of support required by people with TB was demonstrated by 38% of people requiring enhanced case management; therefore even small increases in case numbers can require considerable resource from health and allied services.
TB rates in the South East have continued to rise and are now higher than pre-pandemic levels. Most of the rise in cases reflects an increase in people with TB who were born outside the UK and particularly recent migrants. However many cases still arise among those born in the UK, or who have lived here for many years. Issues remain with above average delays from symptom onset to treatment, and almost a third of people with TB in the South East have either a social risk factor or important co-morbidity. TB remains associated with inequalities, and the burden and impact is felt hardest by those groups. This medical and social complexity provides significant challenges to TB control and the achievement of TB elimination in England by 2035. Continued focus is needed by TB services and partners working with risk groups, to diagnose, treat and prevent cases of TB in the South East.
Recommendations
The recommendations below link to the 5 priority areas in TB action plan Tuberculosis (TB): action plan for England, 2021 to 2026:
1. Recovery from COVID-19
UKHSA South East teams should continue to monitor TB notifications: reports will be shared with partners quarterly (for timely information) and more in-depth analysis annually, to be reviewed at the South East Control Board and network meetings across the South East.
2. Prevent TB
The increase in TB among recently arrived migrants suggests there may need to be improvements in this area. Missed opportunities or concerns over pre-entry migrant screening should be identified at local cohort reviews and raised directly to the national UKHSA TB team.
Local latent tuberculosis infection (LTBI) programmes should review local epidemiology, alongside their uptake and testing results, to evaluate their efforts.
Local integrated care boards (ICBs) should ensure they have identified and commissioned appropriate screening for high risk groups (including people experiencing homelessness, those in contact with the criminal justice system, people seeking asylum, but also those starting biological therapies). They should work with TB service providers, local authorities and others to deliver these.
Contact tracing efforts should continue to be monitored through local cohort reviews, as well as in routine TB surveillance reporting (such as the South East quarterly report).
3. Detect TB
Improve early detection of TB by identifying, investigating and acting on the evidence and components that contribute to delays in diagnosis. Oversight of, and understanding of reasons for, delays should remain a core part of TB cohort review. Surveillance reports should continue to include indicators on delays, to monitor trends over time.
TB services should try to improve culture confirmation rates for all people with TB (to above 80% for pulmonary), and ensure PCR use for all people with potentially pulmonary or infectious TB.
4. Control TB disease
Work to improve current TB completion rates, aiming for target of 90% treatment completion rates for TB drug-sensitive cases by 2026.
Ensure effective management of cases of multi-drug resistant (MDR-TB) in association with the British Thoracic Society (BTS) MDR-TB Clinical Advice Service (CAS). The joint South East and London MDR TB cohort review should continue to maintain oversight of management of MDR cases, and provide learning and educational opportunities to TB services.
5. Workforce
Workforce review by ICBs should review the numbers and complexity of cases in their areas to ensure a sufficient TB workforce to manage the rising numbers of cases and complex cases. This should also consider the workforce needed to implement any LTBI screening programmes and support people through treatment in a timely manner.
All TB services should review the data provided by the NHSE Getting it right first time (GIRFT) review, and over the coming year work with ICBs and wider stakeholders to help ensure that services are equipped to meet needs of local communities. This will be a priority area of work for TBCB and TB services as it is an opportunity to look at capacity and other recommendations also address the priority areas above.
Appendix
Figure 25. TB notification rate by upper tier local authority of residence, South East, 2001 to 2023 [note 43]
Note 43: grey lines represent the other upper tier local authorities in the region.
Methods
Full details of the data sources, methodologies and a glossary of the terms used in this reports are available in the Tuberculosis in England 2024 report.