The impact of the COVID-19 pandemic on the latent tuberculosis service in Southampton

The COVID-19 pandemic caused disruption to all elements of TB services, including screening and chemoprophylaxis for latent TB. This disruption risked TB reactivation, increasing the risk of morbidity and transmission. Services have struggled to restart following the pandemic. <bold>Aim:</bold> To evaluate the impact of the COVID-19 pandemic on the latent tuberculosis service in Southampton. A retrospective analysis of 625 records from 2018-2022; including new entrants to the UK, healthcare workers, international students, and refugees. <bold>Results:</bold> The time between referral and clinic appointment increased from 79 days to 112 days between 2018 and 2022 and the chemoprophylaxis completion rate dropped from 89.5% to 75.7%. Some patients unwilling to take treatment chose radiological surveillance. The pandemic forced a change in consultations. Pre-pandemic all consultations were face to face, but in 2021 all were telephone, whereas in 2022 the majority were telephone. In 2018, 19% of patients were healthcare workers. By 2022 this had risen to 56%, reflecting increased recruitment from abroad. The country of origin of patients seen in the service changed from mainly India in 2018 to Nigeria in 2022, with a spike in refugees from Afghanistan in 2021. <bold>Conclusion:</bold> The pandemic reduced the number of clinic spaces, increasing the time between referral and appointment, not fully mitigated by telephone consultations. There was a corresponding fall in patients completing treatment. Recruitment from abroad has resulted in increased numbers of healthcare workers presenting for chemoprophylaxis, with differing views on its value, impacting completion rates. Services should be cognisant of these issues in their service design.