P164 Improved treatment completion for tuberculosis patients: a case for a dedicated social care team

The increasing social needs of people with Tuberculosis (TB), and the poor adherence to anti-TB therapy (ATT) associated with homelessness, drug or alcohol abuse, and prison history, led the North Central London TB Network (NCLTBN) to introduce a social care team (SCT) in 2008 to support patient engagement with care. We report our experience of a specialist SCT and the impact on treatment outcomes within this large UK network. Using the Royal College of Nursing-endorsed case management risk assessment, patients with social risk factors (SRF) for non-adherence to ATT are identified and a referral made to the SCT. The SCT provides intensive casework support for areas including homelessness, housing, benefits, debt and immigration, and makes referrals to drug and alcohol and mental health services. Retrospective data analysis of the NCLTBN social care database from 2017 to 2019 was conducted. Patients who were (n = 170) and were not referred to the SCT (n=734) were compared. The majority (84.7%) of patients referred had more than 1 SRF. Referrals were most often for benefits (49.4%), and housing (47.1%). Following SCT input, 83.4% of benefits referrals were supported with new and existing benefits applications. For housing referrals, almost two-thirds of issues could be resolved with specialist advice (66.1%). Additionally, 19.4% of patients were referred for homelessness, of which 66.1% were rehoused. Patients referred to the SCT were significantly more likely to complete their planned ATT than those without reason to be referred (88.2% versus 77.7% respectively, p=0.0025). This remained the case when stratifying by receipt of Directly Observed Therapy and adjusting for possible confounders in a logistic regression model (table 1). The dedicated SCT helped to improve TB patients’ living environments and financial security - factors conducive to good treatment adherence. Furthermore, input from the SCT was associated with significantly improved treatment outcome. Given that across England the proportion of TB patients with SRF and complex needs is increasing, our data provide a strong argument for the development of similar SCTs, in addition to planned or existing DOT, within other UK TB services.