This year, the theme of World TB on the 24th March 2024, is ‘Yes! We can end TB! It is designed to convey the idea that is still possible to address the global TB epidemic effectively. There are 5 key areas where action must be taken:

  1. High-level leadership and action to end TB
  2. Sustainable investment of resources, support, care and information are vital to ensure universal access to TB care and for research
  3. Scaling up of access to TB preventive treatment (TPT) and screening services
  4. Ending TB requires concerted action by all sectors, communities and the civil society
  5. Tackling health inequities to ensure health for all

WHO state, ‘People with TB are among the most marginalized and vulnerable, and face barriers in accessing care.’ This is certainly the case for many people in detention with TB.

Below, Dr Anjana Roy who is the TB lead for the national Health and Justice Team at the UK Health Security Agency, describes the development of a TB Toolkit to support the development of effective services for marginalised groups, including imprisoned people.


Tackling TB in inclusion health groups: a toolkit for a multi-agency approach

A comprehensive TB Toolkit to support professionals involved in leading and the development, improvement, and delivery of services to tackle TB in Inclusion Health groups in England has been recently published by the UK Health Security Agency(UKHSA). This is timely as the TB Toolkit supports UK’s commitment to the WHO TB elimination targets, to contribute to TB control in the wider population and align with the TB Action Plan for England, 2021 to 2026. In England, there has been a decline in TB notification rates over the last 10 years, but the rate of decline has slowed, with rates remaining highest in large urban areas with high levels of deprivation and in underserved groups now more widely referred to as “Inclusion Health Groups” (IHG).

The IHG populations considered for this toolkit include but are not limited to:  People experiencing homelessness; Vulnerable migrants (including asylum seekers, refugees, and undocumented migrants); People in contact with the Criminal Justice System; Sex workers; Gypsy, Roma, Traveller groups; Victims of modern slavery and People with drug and alcohol dependence. The groups are diverse but share experiences of stigma, poor access to services, very high levels of disease and social exclusion.

The toolkit was informed by experts working in specialist areas, surveys conducted with national TB leads and nurses and literature reviews. The toolkit includes discussion of the shared and distinct challenges experienced by IHGs which act as barriers to care, the latest evidence on treatment of TB in IHGs, and new analysis of tuberculosis rates and outcomes in IHGs in England. The toolkit also links to resources, recommendations to address barriers, and directory of tools and resources for services to draw upon and adapt locally. The toolkit is derived from strong partnership working and demonstrates the innovation and commitment of local services to meet the needs of IHG with exemplars of good practice.

Recommendations in the toolkit are based on the following principles to the service providers, acknowledging that commission of services is determined locally subject to resourcing and prioritisation.

  • Enhance engagement in screening and prevention programmes. Example using outreach models
  • Enhance communication, health literacy and awareness. Example addressing stigma and misinformation concerning TB to IHGs
  • Enhance early diagnosis and treatment completion in IHGs. Example using Video Observed Therapy (VOT) and Directly Observed Therapy (DOT) where possible
  • Build inclusive partnerships. Example building TB and IHGs into local strategic and business plans with clearly defined roles and responsibilities
  • Enhance use of inclusion health data. Example involving people with lived experience in service design and commissioning

Dr Anjana Roy, Consultant in Public Health, National Health and Justice Team, UK Health Security Agency


Emerging findings from a recent Delphi study to define global priorities for prison health research and aligned training suggest that many professionals in the area of prison health consider TB to be a priority, particularly those working in low income countries. If you have research or examples of good practice you would like to share relating to TB, please email and these will be posted up.