15.0 Prevention and control of transmission of HIV related tuberculosis
The guidelines for these are in the Interdepartmental Working Group on Tuberculosis published in 1998 by the Department of Health116 and is available on the Department of Health and Health Protection Agency websites:

http://www.dh.gov.uk/PublicationsAndStatistics/fs/en

http://www.hpa.org.uk/infections/topics_az/tb/links/guidelines.htm

In summary, for good control of tuberculosis there should be:

  1. A recognition that tuberculosis is a potential diagnosis
  2. That the diagnosis should be confirmed as soon as possible
  3. That drug resistance should be considered early in non-responding patients or when patients have a history compatible with drug resistance
  4. There should be no delay in starting treatment
  5. Treatment should be started with appropriate drugs
  6. Patients should have supervised therapy. 

There should be appropriate accommodation for isolation of patients with potential tuberculosis and those with known tuberculosis.  A risk assessment should always be made.  There should be adequate isolation rooms and negative pressure facilities should be properly monitored.  Aerosol generating procedures should not take place except in negative pressure rooms in patients with suspected or confirmed with tuberculosis.  All patients with suspected or confirmed pulmonary tuberculosis should be considered potentially infectious until proven otherwise.  There should be no intermingling of HIV infected or other immunosuppressed patients with patients who have potentially or infectious tuberculosis. 116

All hospitals should have a TB control plan based on risk assessment.  There should be adequate protection of health care workers and other contacts.

15.1 Notification

TB is a notifiable disease in the UK as it is in many other countries.

Concerns over deductive disclosure of HIV status if the HIV treating physician notifies a patient can be overcome as any physician involved in the patients care can notify the patient.

Contact tracing should follow the BTS guidelines but requires considerable sensitivity.