How to recognise latent TB: Online education for GPs

Associate Professor Justin Denholm is aware that active tuberculosis (TB) is not exactly front-of-mind for many Australian GPs.
 
‘It’s easy to look at tuberculosis in Australia and say, we have something like 12–1300 cases per year, which is pretty small numbers when you think about the global burden,’ he told newsGP.
 
‘Almost all of those are managed by specialist physicians in different places around Australia. So, for many GPs working in Australia, you may not see a case of TB in your career.’
 
But Associate Professor Denholm wants to highlight that cases of latent TB, the precursor to active TB, are more common in Australia than many may realise.
 
‘Latent tuberculosis – that is, people who have been infected with TB who don’t currently have signs or symptoms of being unwell, but have a risk for getting sick in the future – that’s something like 5% of all people in Australia,’ he said.
 
‘So actually a large number of people that GPs are seeing are at risk of TB, and that’s something many GPs can engage with as part of their overall package of preventive healthcare.’
 
One fact that is helpful to GPs when monitoring for latent TB is that it tends to be found in a very particular patient population.
 
‘Around 90% of people who get TB here have been born overseas in countries that have more TB than Australia,’ Associate Professor Denholm explained.
 
‘It’s worthwhile thinking about it even in people who have been living in Australia for many years, but the first couple of years after arrival are a particularly important time.’
 
Associate Professor Denholm is keen to spread education about latent TB infection in Australia as widely as possible. This motivation led to a project in which he and his team at the Peter Doherty Institute for Infection and Immunity produced a series of educational YouTube videos for GPs.
 
‘As well as doing individual events and one-on-one training, we recognise that there’s a need for a much larger group, and not just of GPs, but also community-based nurses and a number of other people working in community settings where latent TB might be relevant, to gain some familiarity with the disease and to engage with some of the tools for managing it,’ he said.
 
‘So these videos were made as a way to start that conversation and provide some of the information people need to know what latent TB is and how they can approach it in a community setting.’
 
For Associate Professor Denholm, identifying and treating latent TB fits perfectly with the general practice mission of preventive care, while also presenting an opportunity to make a significant difference in the management of a pernicious disease.
 
‘There were 10 million people who got TB [around the world in 2017], and more than one and a half million of them died,’ he said. ‘For all of those people, if they had been managed in a place that had access to appropriate diagnosis and care, they could have been treated and cured.
 
‘We now have access to ways to identify people at risk of getting TB in the future, and give them treatment to stop them becoming sick in the first place. It is an enormous public health issue that we can engage with individuals about to keep them well.
 
‘As a physician that’s really exciting, that you can engage with a disease that has such a long history and affects so many people around the world.’
 
While the official launch of the video education project will take place later this year, the videos are already freely available to view on YouTube, and Associate Professor Denholm wants them to gain as wide an audience as possible.
 
‘Historically, it has been mainly tertiary care settings where people have been thinking about latent TB in Australia, but there are a very large number of people in Australia who would benefit from diagnosis and treatment of this condition,’ he said.
 
‘I am hoping that a much larger group of people get the benefit of knowing about latent TB and having it treated, and GPs have a critical role to play in this.’
 
Associate Professor Denholm and his team have been grateful with the reception their TB education efforts have gained from GPs, and hope this will continue into the future.
 
‘My sense is that lots of GPs already recognise that latent TB is a big issue, and it’s great to see people take such active steps to make sure they’re engaging with this in a way which is as effective as possible,’ he said.

education infectious diseases latent TB tuberculosis