ECM level | Clinical factors | TB specific | Social factors |
---|---|---|---|
0 | Physically able to self-medicate No central nervous system impairment Positive IsoScreen at reviews Correct tablet count at reviews | Contact tracing requirements limited to adults in the same household No stigma related issues | No language barriers No housing or finance issues impacting on treatment |
1 | Elderly to monitor for side effects Children to ensure compliance of child and parent/carer Requires GP or community pharmacy input for blister packs to check correct doses Taking complex medications e.g. HIV medications Disease site e.g. smear positive pulmonary or central nervous system disease | Contact tracing requirements in various areas and/or settings e.g. patient out of area, workplace, community group settings Stigma that can be dealt with through one-to-one education | Requires interpreter for first visit but has some understanding of English Requires signposting for benefits and/or financial issues Patient difficult to reach e.g. no front door bell, more than 1 address, problems getting time off work/college, refusal of home visits |
2 | Having complex side effects requiring LFT monitoring Needs more regular prompting with medications e.g. blister packs, regular IsoScreen, tablet counts HIV and TB co-infection and starting both anti-retroviral and TB medications at the same time Single drug resistance | Transmission within contacts or children who are contacts Stigma that requires more formal education e.g. through community centres or workplaces | Financial difficulties that may affect treatment compliance e.g. attending clinic, poor nutrition, poor heating Language barriers throughout treatment requiring easily accessible interpreter at each visit either face to face or by phone Alcohol and/or drug dependency without LFT derangement Patient difficult to reach e.g. DNA at clinics, not home for reviews |
3 | More than one drug resistance Needs reintroduction of medications e.g. due to deranged LFT’s | Complex contact tracing e.g. transmission to children, vulnerable groups, extensive transmission Involvement of PHE for workplace or community screening | Difficult language barriers throughout treatment Homelessness or housing issues due to finance Illegal immigrants, difficulty accessing benefits Potentially dangerous patients where more than one person is required to visit Children who DNA and where social service involvement is required Patient difficult to reach e.g. consistent DNA at clinics, consistently not home for reviews |