Tuberculosis-specific T-cell response after recent treatment and remote cure.

TB is a rare disease in many high-income countries, which leads to pressures for the pooling of expertise to larger centres [2]. This results in patients being treated in TB centres with higher case loads but greater distances for patients to travel. This study demonstrates that such merging has positive health benefits, as larger centres (load .26 cases?yr) had significantly higher completion rates for TB treatment for young individuals born outside the UK (,50% of TB patients). However, if centralisation leads to patients having to travel greater distances to receive treatment, then this has negative consequences, as this study shows that all patients born outside the UK (,65% of TB patients) were less likely to complete treatment if they had to travel .7.3 km to the TB treatment centre. Other studies have indicated the importance of provider experience to treatment outcome [3] but the present study is the first to demonstrate that such experience has a differing impact on subgroups of the population. Previous studies investigating delay in the diagnosis and treatment of TB have identified the importance of healthcare accessibility [5], but this is the first to be conducted in a high-income country. Additionally, it focuses upon treatment outcome as opposed to diagnosis delay, and examines differential effects amongst population subgroups.