World TB Day 2023

World TB Day 2023 is the 24th March 2023. This year the theme is 'Yes! We can end TB!', and ‘aims to inspire hope and encourage high-level leadership, increased investments, faster uptake of new WHO recommendations, adoption of innovations, accelerated action, and multisectoral collaboration to combat the TB epidemic’ ( The prevalence of TB in imprisoned populations has been consistently shown to be higher than in community. Therefore, efforts to tackle TB in prison are essential to the effort to meet the End TB targets (

In the blog below, Dr Ahimza Nagasivam outlines innovative collaborative work being conducted by the UKHSA National Health Equity & Inclusion Health Division and National TB Unit to further develop a toolkit, ‘Tackling TB in Under-Served Populations’. This will provide up-to-date support for partners wanting to develop or improve services for underserved populations.


Tackling TB in inclusion health groups in England: updating the national UKHSA toolkit

A recent global systematic review found that people in prison are at higher risk of contracting TB infection and developing TB disease than the general population, across all regions. This does not come as a surprise. We are accustomed to TB being referred to as a ‘social disease’ or a ‘disease of the poor’, and a core component of the WHO End TB Strategy is the “provision of universal access to TB care and prevention, with greater attention on vulnerable and hard-to-reach populations”. Targeted work for vulnerable and hard-to-reach (also called under-served or inclusion health populations) has always been recognised as critical within TB control efforts - but practically achieving what is needed to better prevent, identify, diagnose, and treat is a complex challenge.

At the UK Health Security Agency, we are conscious of this challenge and the need for pragmatic solutions that acknowledge the very real problems faced by services on the ground. For example, we know that prison reception symptom screening for TB can still lead to people with active TB disease being missed, because symptoms such as a cough are easily attributed to other common ailments in this population. Stigma, low awareness of signs and symptoms, and complex concurrent health needs often lead to late presentation of TB in prison. Even once care is accessed, the frequent, often unpredictable movement of people across the prison estate or from prison into the community makes it more difficult to ensure that test results are acted upon in a timely way, and when needed, the full treatment course for TB is completed.

To help tackle these problems for people in prison and other inclusion health populations, the UKHSA National Health Equity & Inclusion Health Division and National TB Unit are working together with a range of external stakeholders to refresh a toolkit that was last published in 2019 - Tackling TB in Under-Served Populations - A Resource for TBCBs and partners. The aim of this refresh is to provide up-to-date support for partners wanting to develop or improve services for these populations, by bringing together the most relevant resources, and showcasing examples of good practice that can inspire and guide others wishing to develop similar programmes within their localities.

In this refresh, we are bringing together the needs of a range of inclusion health groups – such as people experiencing homelessness, sex workers, under-served migrants, and people misusing substances. In doing so, we are recognising that the needs of these groups are not distinct; many of the key challenges to tackling TB are common across these populations, and people often move between groups or experience multiple social vulnerabilities over their lifetime.

To ensure that we make this toolkit as useful as possible, we have reached out to TB nurses and regional TB leads working across England to ask them about their most pressing current needs and what they would most want from such a resource. We have also spoken with inclusion health experts, TB outreach services and national health partners to ensure that we bring in their knowledge of the tools and resources that already exist or are in development. We hope that the process of developing and publishing this toolkit also raises the needs of inclusion health groups with TB up the agenda of commissioners and service delivery partners, and supports better partnerships and collaborative working. The toolkit is due to be launched in September and will be made publicly available on the website.


   Dr Ahimza Nagasivam is a Public Health Specialty Registrar in London, working with the UKHSA National Health Equity & Inclusion Division. She has experience working in public health at the local, national and international levels, and is passionate about improving access to quality healthcare for excluded populations.


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